Treatment of Sensory Issues
There is no FDA-approved medication specifically for treating sensory processing issues, and current evidence does not support pharmacological intervention as first-line therapy. Non-pharmacological approaches, particularly occupational therapy with sensory integration techniques, should be the primary treatment modality 1, 2.
Primary Treatment Approach
Occupational therapy using sensory-based interventions is the recommended treatment for sensory processing difficulties, though the evidence base remains limited and inconclusive 1. This approach involves:
- Activities designed to organize the sensory system through vestibular, proprioceptive, auditory, and tactile inputs using specialized equipment like brushes, swings, and therapeutic balls 1
- Individualized treatment plans based on assessment tools such as the Adolescent/Adult Sensory Profile (AASP) and Canadian Occupational Performance Measure (COPM) 2
- Sensory modulation interventions that can improve functional symptoms and participation in daily activities 2
When to Consider Pharmacological Treatment
Medications should only be considered when sensory issues are part of an underlying diagnosed developmental or behavioral disorder, not for isolated sensory processing difficulties 1. The context matters significantly:
For Behavioral Symptoms in Dementia
- Atypical antipsychotics are first-line pharmacological treatment only when severe behavioral symptoms include psychotic features (hallucinations, delusions causing distress) 3
- Non-pharmacological interventions including sensory therapy should be attempted first when there are no psychotic features and no immediate danger 3
- Risperidone can be used for irritability associated with autistic disorder in children aged 5-16 years, starting at 0.25-0.5 mg/day depending on weight 4
For Neuropathic Sensory Symptoms
If sensory issues involve neuropathic pain or numbness rather than sensory processing difficulties:
- Duloxetine 60-120 mg/day is first-line for painful peripheral neuropathy with proven efficacy (NNT 5.2) 5
- Pregabalin 300-600 mg/day or gabapentin 900-3600 mg/day are alternatives for neuropathic pain 3, 5
- Topical treatments (5% lidocaine patches, 1% menthol cream) provide localized relief without systemic effects 3, 5
Critical Limitations and Caveats
Parents and caregivers must be informed that research on sensory integration therapy effectiveness is limited and inconclusive 1. Key considerations include:
- Sensory processing difficulties are characteristics associated with other disorders (autism spectrum disorders, ADHD, anxiety) rather than a standalone diagnosis 1
- A comprehensive evaluation must rule out other developmental and behavioral disorders before attributing symptoms solely to sensory issues 1
- A large randomized controlled trial (n=138) found no significant benefit of sensory integration therapy over usual care on primary behavioral outcomes at 6 or 12 months 6
- Prevalence of sensory processing alterations in typically developing children ranges from 10-20%, with 15.9% meeting severe alteration criteria 7
Treatment Algorithm
- Complete thorough evaluation to identify any underlying neurodevelopmental, psychiatric, or neurological disorders 1
- Initiate occupational therapy with sensory-based interventions as first-line treatment, with a defined trial period to assess effectiveness 1, 2
- Monitor for improvement in functional goals using standardized measures over 6-12 weeks 2
- Consider pharmacological treatment only if:
- An underlying disorder requiring medication is diagnosed (autism with severe irritability, neuropathic pain conditions) 4, 5
- Severe behavioral symptoms with psychotic features are present in dementia 3
- Sensory issues are causing significant functional impairment despite adequate non-pharmacological intervention 3
Avoid using medications solely for sensory processing difficulties without an identified underlying condition requiring pharmacological management 1.