Use of the term “sensory diet” or “sensory needs” has grown tremendously among professionals providing services to individuals diagnosed with autism. These days, it would be more surprising for a parent not to contact this idea than to contact it, both within and outside of the school setting. Families and schools spend crazy amounts of time and resources to ensure their children contact this type of therapy. In my experience, “sensory diet” and related phrases are one of the top 5 phrases used in IEP meetings, hands down. So, what do these terms even mean? Let’s first take a look behind the curtain of this infamous phrase to see how it got here. Although many people may not be aware of this, what we are really talking about when we say “sensory diets” or “sensory needs” is what’s called “sensory integration therapy” (SIT). Here is one source’s definition of SIT:
“Sensory integration involves providing a ‘diet’ of sensory stimulation to a child, in an attempt to improve the way in which the child’s brain processes and organizes sensory information. This can include vestibular and tactile stimulation, purposeful movements, use of weighted vests, and brushing, among other techniques.”
Sounds familiar (and experimental), right? Although most professionals using these strategies do not typically refer to them as sensory integration, the techniques and underlying theories would likely be described similarly as in the definition above. Put more simply, all of these terms imply that children with autism need some amount of various sensory experiences in order to function more normally from day-to-day. Now, at first glance, this seems to make a lot of sense. After all, many people with autism certainly love sensory activities – so it would be easy to assume that these are things they need from a biological standpoint. But are the acts of loving and needing synonymous? What if they aren’t? What if these sensory experiences are truly just preferences that are out of control because of a lack of social skills that help all of us keep our weird sensory habits (mine would be forcefully moving my feet under the table) in check? If we play devil’s advocate, this would mean that we are spending a TON of time, money, and energy on something that has nothing to do with progress or a better quality of life!
Now, take a deep breath. This next paragraph will likely blow you away and possibly even offend you. I simply ask that you finish reading with an open mind. I can also promise that you will still walk away with a positive outlook on the “S”-word if you’re able to make it to the end!
The bottom line is that nothing (to date) has proven that love=need when it comes to sensory experiences. I know it is easy to think that the underlying evidence supporting these ideas has been growing as exponentially as has use of the techniques themselves; however, this is completely false. Let me now present you with some factual information. According to the 2009 National Standards Project (NSP), a comprehensive literature review of research on many commonly used treatments for autism, sensory integration neither falls in the “established treatments” or the “emerging treatments” categories; instead, it was categorized as an “unestablished treatment” meaning that, “little or no evidence was found to assume its effectiveness.” More specifically, unestablished treatments may not have any research supporting them or the studies that were conducted have very low scientific merit scores; in the case of sensory integration, only seven total studies were found. These findings are comparable to other older sources such as, “Controversial Therapies for Developmental Disabilities” (2005). Based on an extensive review of the existing research at that time, the book echoes the NSP by noting that, “available studies [on sensory integration] are sparse and tend to be methodologically flawed.”
Despite multiple reviews with the same findings, the use of sensory integration techniques is widespread and typically incorporated into IEPs, treatment plans, and daily/weekly routines at home & school without question. As was my reaction upon learning this information, the common question is, “Why? If this is true, why are so many clinicians doing it?” Well, let’s remember the lesson we are always trying to teach our kids…that just because everyone is doing something, doesn’t mean it is good or right. I think this is one major example of us adults failing to practice what we preach.
Now for the positive note! We can easily see that people with autism seek and avoid certain sensory experiences in many different ways. Just because providing them as part of a “sensory diet” isn’t supported in a therapeutic sense, doesn’t mean that (a) these experiences can’t be used in meaningful ways and (b) people who love them can’t be taught to scale back on them based on social situations, just as we do. If we know these experiences are things that they love, can’t we simply use them for motivational purposes and/or to pair ourselves with fun stuff in the process!? In other words, there are a number of beneficial roles for preferred sensory experiences outside the theory of sensory integration that, therefore, don’t result in the sacrifice of precious time and resources on unproven therapeutic techniques.
I think we would all agree, as passionate clinicians and loving family members, on the importance of using time and resources as wisely as possible to help people live life to the fullest. To continue using any type of therapy with a lack of evidence simply does a major disservice for helping them reach this goal and at no fault of their own. My hope is for this entry to challenge all service providers and families, including myself, to continue seeking information on scientifically validated treatments so that our language, resources, and therapeutic strategies are as passionately driven by evidence-based practices as we say they are.
Precious lives are at stake…let’s know what we’re talking about!
National Standards Project (2009) http://www.nationalautismcenter.org/about/national.php
Jacobson, J.W., Foxx, R. M., & Mulick, J.A. (2005). Controversial Therapies for Developmental Disabilities (pp. 68-70; 218; 252-253).
Liz Van Dorn (and yes, you did notice a trend of Auburn football colors…WAR EAGLE!)