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ALEX COHEN, host:

This is Day to Day from NPR News. I'm Alex Cohen.

MADELEINE BRAND, host:

And I'm Madeleine Brand. We're going to talk now about a condition that more and more children are being tagged with. It's called sensory integration dysfunction or sensory processing disorder. Some people call it a disease, others do not. Our pediatrician Dr. Sydney Speisel is here now, and he has his doubts as to whether this is a disease in the traditional way that you define a disease. Welcome back, Syd.

Dr. SYDNEY SPIESEL (Pediatrician): Thank you. Nice to be here.

BRAND: Well, tell us, please, what is this sensory processing disorder? How - what are the symptoms?

Dr. SPIESEL: It actually is something that began about 40 years ago when an occupational therapist, a clinical psychologist, Jean Ayres, saw a bunch of kids who almost couldn't tolerate certain physical sensations like skin contact, like a rough shirt or a stiff label on a shirt. Some of the kids didn't like loud sounds or tastes and also, some of these kids were clumsy and had balance problems, and she thought that these represented a failure of sensory integration; that is, the brain was not making good sense out of messages coming from skin or from muscles or from the organ that keeps track of motion in our inner ear. And some of these patients had other problems like learning disabilities, mental retardation, social and behavioral problems, and even varying degrees of autism. And she kind of thought that if she could improve or fix the sensory integration problem, it would also improve the behavioral problems.

BRAND: So, what has happened in the intervening 40 years?

Dr. SPIESEL: She devised a bunch of treatments, which have been applied mostly and, in fact, almost exclusively by occupational therapists. They're used, I would say, a lot in the autistic community. In fact, about - almost 40 percent of all kids who are somewhere in the autistic spectrum have been getting treatment with this modality. And a lot of educators are quite tied in it and use it for kids with learning disabilities and things like that.

BRAND: Now, why do you doubt that this is actually a disease?

Dr. SPIESEL: The question is, is it really a symptom - a syndrome of things that are all the result of something common happening in the central nervous system, or is it some behavioral style, maybe the way some kids react to anxiety. We certainly see these kinds of behaviors in kids with ADHD. So, the question is, is it something specific, and if we use her treatment, does it come back and affect the underlying condition that the kid has?

BRAND: And this treatment is what?

Dr. SPIESEL: Occupational therapists use play to give children achievable challenges that push a kid toward improving the areas where there's a perceived weakness in sensory integration. So, for example, they might rub or brush the skin, or use exercises to improve balance, or play soft music, or even put weighted clothes or weighted vests on kids.

BRAND: And you said that there are no scientific studies that back this up as an approved technique - a technique that actually works.

Dr. SPIESEL: The real problem is that traditionally, occupational therapy is a service profession, and there isn't much validated theoretical underpinnings or a tradition of kind of critical scientific evaluation of the results. So most of the studies that have been done have been a little bit naive. The studies are anecdotal - things to be published or too small to be valid. Just one or two kids often without a comparison group. And so it's hard to know whether it's a sensory integration treatment or just the fact of getting treatment that makes the difference.

BRAND: Well, let's bring in Terry Spencer. Her son was diagnosed with sensory processing disorder in kindergarten. And I believe he's 11 now. Terry Spencer, welcome to the program.

Ms. TERRY SPENCER: Thank you very much.

BRAND: Your son has had therapy, has had occupational therapy such as Syd just described?

Ms. SPENCER: Yes, he has.

BRAND: And how has he changed from when he was first diagnosed?

Ms. SPENCER: Well, he's been able to learn how to do things that he wasn't able to do, things like jumping a rope and skipping and catching a ball and not walking into walls so frequently, and those type of things.

BRAND: So, he's become more coordinated?

Ms. SPENCER: Yes, helped his coordination. He also has the sensitivity to sound, so he'll be distracted by sound, doing homework or something and the furnace kicks on, he - it stops him, and he's distracted by things like that.

BRAND: And so, what therapy did you give him specifically, and how has it helped with things like the loud sounds and with the coordination?

Ms. SPENCER: He sees an occupational therapist a couple times a month and they do different things. They swim and they do different play activities. They do a lot of spinning and swinging and motion - heavy work exercises to help him find his place in his body.

BRAND: And as you say, you've noticed the difference.

Ms. SPENCER: Yes, we have. He was unable to skip. He was unable to jump rope. He was unable to do those things and he learned those things. He has motor planning issues, and so this helps him learn how to do a new skill and how to develop abilities to do new skills as they come up.

BRAND: Doctor Sydney Spiesel, when you hear Terry describe the therapy that her son underwent and how it's helped him, what do you say?

Dr. SPIESEL: You know me. I'm very much a pragmatist. Anything that engages a child and gives positive attention is fine with me. Even if I'm skeptical of the theoretical underpinning and I don't - I have a doubt that the treatment really shapes and changes brain development, but certainly, any strong positive interaction between a occupational therapist or some other person is going to be very helpful, and I believe that very profoundly.

BRAND: So, it sounds like what you're saying is that almost any interaction would work, and that goes counter to what the occupational therapists are saying, that you need specific, targeted activities that work specific muscle groups or have specific goals.

Dr. SPIESEL: Well, the answer is, sort of. I am sort of saying that. But two things, one is that anything that particularly engages a child and makes a child happy and it forces their - reinforces their sense of their self, I think, is always going to be positive. That's sort of, to my mind, the basis of good teaching. But I don't want to undermine - you know, if people are having a sense that their child is having a good, useful experience and they're feeling better and happier in the world as a result of sensory integration treatment, I'm in favor of it.

BRAND: Terry Spencer, mom from Topeka, Kansas, thank you very much for joining us and sharing your story.

Ms. SPENCER: Thank you.

Dr. SPIESEL: Thank you, Terry.

BRAND: So Syd, let's change tack a little bit here, and I just want to say goodbye and thank you so much for all of your wisdom that you've shared with me and with our listeners. I have really appreciated getting to know you and learning from you and having you on our show. So thank you very, very much.

Dr. SPIESEL: Well, you know, it's been a great pleasure for me. I mean, this is a very sad moment for me because frankly, I love your show, and I love having had the chance to just chat with you on a regular basis. And I've enjoyed the opportunity to spout off, actually, frankly. And even times when I made people angry, when I talked about the immunology of breastfeeding or my skepticism about infant signing, or when I tout the benefit of coffee, the medical benefits of coffee, or when I announced my third law of pediatrics, that the average age of toilet training around the world - directly proportional to the latitude - the further the equator, the slower the toilet training, which I found - actually, came up on the Internet as elega terza(ph) de Spiesel, which I thought was very funny.

(Soundbite of laughter)

BRAND: Well, Doctor Spiesel, Doctor Sydney Spiesel, you can still - if you want to see what he's writing about and spouting off about - you're still at slate.com?

Dr. SPIESEL: Absolutely, yeah.

BRAND: OK. Doctor Sydney Spiesel, a Yale Medical School professor, and a pediatrician from Woodbridge, Connecticut.

Dr. SPIESEL: Thank you.

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