Vol. 24 Issue 4 Page 18
Vision Watch: OT in 2017
Some researchers inside and outside OT-some of them in medicine-are ready to make the case for including sensory processing disorder (SPD) as a primary diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the diagnostic bible of psychiatric medicine. Such a classification would legitimize the condition, opening the way for more research dollars and for treatment reimbursement.
But it's not going to be easy; there are many who think it won't be possible to meet the criteria in time to make the next edition, the DSM-V, due out around 2011.
Last November, Darrel Regier, MD, director of research for the American Psychiatric Association (APA) and vice chair of its DSM-V task force, told Time magazine that advocates would have to provide hard evidence that "[SPD] is not just a part of autism or ADHD, that it's a better definition of what these kids are experiencing."
A few years ago, that might have been next to impossible. But new research is beginning to show how sensory responses "show up" in the brain and elsewhere, and what is normal and what's not. Today the heart of SPD research is in Colorado, where Lucy Jane Miller, PhD, OTR, a prominent author in the study of sensory processing disorder, directs the Sensory Therapies and Research (STAR) Center near Denver.
Studies there and at the University of Colorado have found pieces of the kind of evidence Regier is looking for.
For example, Miller and her associates have compared electrodermal response to sensory stimuli in children with sensory processing disorders and in typical kids. The researchers attached electrodes to the children's hands and then used the scent of strong wintergreen, a siren and the light touch of a feather across the cheek as stimuli. They repeated these stressors eight times.
They found that even typical children respond with measurable sweating or other stress indicators the first time the stimuli occur. But after that, the children with normal sensory processing adjust, as though they expect or are prepared for the next round. The children who are sensory challenged in a particular way do not adjust. Every time the stimulus is applied, they go into fight-or-flight response.
At the University of Colorado, researchers have found that some children with sensory problems cannot process sound and touch together. There is also some evidence that sensory processing disorders can be inherited.
In some respects, such evidence is ahead of the game in psychiatry. Most disorders in the DSM are classified by symptom in order to avoid the need to list causes for them. There is still no etiology or identifiable genetic marker for any of the major mental illnesses.
However, there is plenty of evidence pointing toward these, and in recent years the psychobiological model has become the most prominent model in today's psychiatric clinics. That fact is changing the way people in the mental health arena look at the DSM. The hope is to make the manual more etiologically based through thorough research, although that is expected to take decades.
So What's Holding SPD Up?
Right now most mental health researchers are inclined to look at sensory problems as a subgroup of symptoms that appear mostly in children with ADHD or autism, two diagnoses that already appear in the DSM. They believe that SPD is still "too vaguely defined." Children can have sensory processing "symptoms," and yet when tested not be classified as having SPD.
Researchers are close to agreeing that perhaps SPD should be granted provisional status as a possible diagnosis that requires further study. That would open the door for research monies, but it would not be likely to bring the disorder legitimacy on the medical stage until close to 2025.
Where Does the Project Stand?
Currently the DSM-V Task Force is finishing its review of six white papers constructed through a collaboration of APA and the National Institute of Mental Health (NIMH) that cover: basic nomenclature issues, neuroscience, developmental science, personality disorders and relational disorders, mental disorders and disability, and culture and psychiatric diagnosis.
You can keep track of the process yourself by going to www.dsm5.org.
People whose names are important in the process include:
Michael B. First, MD, associate professor of clinical psychiatry at Columbia University, director of the APA's Prelude Web-based Project and consultant on DSM activities.
Darrel A. Regier, MD, MPH, vice-chair of the DSM-V Task Force and director of APA's division of research. He is also executive director of the American Psychiatric Institute for Research and Education (APIRE).
William Narrow, MD, MPH, research director of the DSM-V Task Force and associate director of diagnosis and classification in APA's division of research.
Regier and Narrow can be reached at the APA at 703-907-7300.
ADVANCE will be updating Vision Watch every month on our Web site at www.advanceweb.com/OT, where you will be able to add information you've found on research or developments.
E.J. Brown is editor at ADVANCE. <% footer %>