Your OTA Questions, Answered

Take a look at our frequently asked questions.

What does SPD look like in the classroom?

This is referred to as both dysfunction in sensory integration (DSI) and sensory processing disorder (SPD). Sensory processing disorder is currently used more commonly in the context of research, while clinicians often use the term sensory integration dysfunction. See What is SPD? for more information.

Use one of OTA’s “How do I Know?” checklists to determine whether a sensory integration-based evaluation might be useful. Speaking to a therapist certified in sensory integration can also assist you in determining if problems might exist. Go to Getting Started and complete the appropriate intake form to initiate an intake discussion with our clinical intake coordinator.

We do not have verifiable research in this area yet but it appears that there may be a variety of causes, such as genetics, prematurity, birth trauma, exposure to toxins, etc. Our researchers at The Spiral Foundation along with other leading experts in the field are exploring this and many other areas of SI. Can sensory processing disorder be cured? When occupational therapy is provided using a sensory integration framework, the problems can be minimized. The nervous system can be changed, and the ability to process sensation can be improved. Biological research has shown that with therapy, the interference of sensory processing dysfunction with daily life tasks will be greatly minimized.

No, it has not been found that these issues go away with time. However, they can appear to be minimized due to the greater flexibility most adults enjoy in choosing daily activities in comparison to children. Adults can also receive sensory integration intervention, and many report making gains with therapy.

The letters stand for the degree the therapist has earned and whether he or she is registered and licensed. All therapists have to pass an examination in order to become registered. For example, MS, OTR/L means “master of science in occupational therapy, a registered and licensed therapist.” Some therapists have FAOTA after their credentials. This means that they have been asked to be a Fellow of the American Occupational Therapy Association. This distinction is awarded to therapists in recognition of their skill and knowledge, which has resulted in the growth and improvement of occupational therapy.


If a child has another diagnosis, will he or she still benefit from sensory integration intervention? Sensory integration difficulties can occur alone or can occur in conjunction with many other diagnoses. Children with other diagnoses will likely be receiving a variety of services (speech therapy, ABA, tutoring, etc.). They may also be using medications. Sensory integration intervention is an appropriate service for children who, in addition to their other difficulties, have problems with sensory processing that impact their everyday functional performance.

There can be problems with arousal, attention, and excessive movement with each disorder. Sensory integration intervention could help to reduce these problems. Some behaviors usually attributed to ADD or ADHD may in actuality indicate sensory processing disorder. For example, a child who is sensitive to touch or noise might be easily distracted, and poor postural stability or poor processing of vestibular input from the inner ear could result in constant movement when sitting.

No, it is estimated that approximately 70% of children with autism experience sensory integration problems, and yes, the intervention can help to reduce the effects of autism.

How is sensory processing disorder related to anxiety disorder? Research is needed in this area, but it appears that individuals with sensory processing disorder are often prone to anxiety due to the constant frustration in leading one’s life. Anxiety may also result from the tension related to being over-sensitive to touch, taste, smell, noise, and/or movement.

If the basis for the lack of speaking clearly or reading well is rooted in sensory processing problems, then, yes, it can help develop those abilities. Many children with speech and language problems have difficulty with cerebellar functioning. The cerebellum is the center in the brain where vestibular (movement), ocular (visual), and proprioceptive (body position) input is organized. Occupational and speech and language therapy with a sensory integration focus can address these issues, resulting in improved language skills and reading abilities. In addition, skills addressed through this therapy, such as regulation of arousal level, postural control, and motor planning are foundation abilities that are needed to support learning of any kind.


Intervention for a child is playful and follows a child-led, adult-guided approach where the therapist encourages the child to participate in fun but purposeful activities that stimulate sensory systems that may not be working as effectively as they should. Therapy is fun for the child and is skillfully managed by the therapist to ensure it is appropriate for the child and is set to the “just right challenge.” The therapist ensuries that the activity is not too difficult so that the child no longer wants to play but is not too easy so they lose interest quickly. It is this ‘just right challenge’ that ensures the child forms an adaptive response that will develop the functions in which the child is having problems. Frequently the use of an imaginative play theme can enhance the child’s willingness to engage in desired activities for longer periods of time. The rapport that the therapist and child develop is central to the therapy. Intervention for adolescents and adults will involve age appropriate activities and techniques that focus on stimulating sensory systems that may not be working as effectively as they should be. Focus is placed on functional performance and along with direct intervention may involve home programming and consultation.


Occupational and physical therapists have very similar training, however, the OT receives more training in oral and hand skill interventions and the PT receives more training in postural and gross motor development.

Occupational and physical therapists who specialize in sensory integration assessment and intervention must already have a bachelor’s or master’s degree in their field. In order to become certified in SI, the therapist must take four, five-day courses covering sensory integration theory, assessment techniques, interpretation of test results, and intervention/treatment. Some qualified therapists are not SI certified, but have had a direct mentoring relationship with an SI certified therapist. It is ideal to be both assessed and treated by a therapist who has this type of background and who has experience in both evaluation and treatment of sensory integration difficulties.

The length of therapy varies depending on what set of difficulties the individual is experiencing. It is common for children to need 50 to 80 sessions of therapy. In some cases therapy is given two to three times per week, which may shorten the number of months of therapy. Some adults work with us on an intensive model and attend 3-4 times a week for 2-3 weeks.

A sensory diet is a daily or weekly list of activities for an individual to engage in during regular routines to help maintain an optimal state of arousal. Sensory diet activities can also provide greater body awareness prior to performing skilled tasks. Although a sensory diet is developed by a therapist trained in sensory integration and can be an adjunct to treatment, it can also be implemented by parents, teachers, or clients themselves.

In a clinic, the goal is to provide therapy to address all aspects of a child’s life (e.g., sleeping, eating, playing), and includes functioning at home and in the community as well as at school. In the school setting, the intervention must be related to specific difficulties in school functioning only.

Many insurance plans do provide coverage for occupational therapy using a sensory integration approach. Each plan is different, however, making it necessary to talk with an insurance representative for your particular plan prior to initiating services. For OTA-specific insurance information and questions you should ask, click here. Some schools may provide OT with a sensory integration emphasis within in the school setting, and occasionally a school will pay for outside services involving sensory integration. It is most likely for a school to fund outside services if the addition of sensory integration-based intervention can help keep a child in a regular classroom or regular education setting.

OTA The Koomar Center does not require you to have a medical doctor refer you for services, but if you want services reimbursed by an insurance company, it is necessary that you get one. Most clients find it helpful to have a medical referral on record so it is there if needed. Insurance companies differ regarding the need to obtain preauthorization for services, the number of visits they will cover in a given day or other time period, and whether they require periodic re-evaluations. The client/parent is responsible for keeping track of these requirements. OTA will not be responsible for keeping track of this information for insurances where we are not a participating provider. OTA will obtain the prior authorization for treatment for occupational therapy clients covered by HPHC and UHC-HP, and for speech and language clients covered by HPHC, UHC-HP and BCBS. Clients need to provide OTA with a Letter of Medical Necessity from their primary care physician.

A Letter of Medical Necessity (LMN) is a letter from a primary care physician providing OTA-Watertown with a diagnosis for referring a client for service. All clients need a LMN in order to bill the insurance company accurately and to seek proper reimbursement. If you plan to bill your insurance company or access one of our insurance providers you must provide a LMN prior to receiving services.

A referral is usually an approval number with number of visits provided by the primary care physician for HMO members. A Letter of Medical Necessity is a doctor’s letter with a diagnosis or reason for referring a client to a specialist. A blank Letter of Medical Necessity which you may take to your doctor for completion is available on our website under “Getting Started.”

When do I need to pay if you are also billing my insurance? If OTA is a participating (in network) provider of your insurance company you are required to pay your co-payment at the time of service. All other clients receive services through OTA’s Comprehensive Treatment Plan (CTP). Under the terms of this plan, each month of service is prepaid (or the entire course of treatment may be prepaid). You may submit the paid invoices directly to your insurance company My insurance company said that you cannot bill me directly for your services. This is only true if OTA is an in-network provider for your insurance company. Our fee agreements state that you are responsible for payment of your bill for services rendered. If your insurance company does not hold a contract with OTA then you are the only responsible party for payment of your bill.

Unfortunately, OTA can only do this for insurance companies for whom we are an in-network provider. At this time, they are Harvard Pilgrim Health Care (and some United Healthcare plans with a Harvard Pilgrim benefit) for occupational therapy and speech and language therapy, Blue Cross/Blue Shield for speech and language therapy only.
OTA uses the code that best fits the extended, sensory-based evaluation that is most commonly done in our office. Our evaluations include assessment of motor, social, adaptive, language, and/or cognitive functioning. We also include an in-depth report and a report meeting as part of the evaluation process. The codes of 96112 and 96113 are the codes that best-fit our evaluations. The claims representative at my insurance company said you used the incorrect diagnosis code. An occupational therapist cannot diagnose, only evaluate, therefore we use the diagnosis code provided by your physician in the Letter of Medical Necessity. If you do not have this letter, we will be happy to supply you with a form letter for your doctor to fill out. Please request this from the front desk secretary or the client coordinator.

OTA does not have reduced rates for evaluations. If you have a serious financial hardship, you may ask at the front desk for a Personal Financial Statement to complete for consideration for intervention services. The completed form, along with a signed copy of your most recent years’ federal tax return (with all schedules) will be reviewed by the Administrative Director for consideration of a reduction in treatment fees (not evaluation fees). The availability of reduced rate services is not guaranteed.

If you have an evaluation report that outlines your child’s sensory issues, it is important to share it with the school. It can also be helpful to have your child’s teacher fill out a sensory integration teacher checklist (link to school age checklist) highlighting issues related to school performance. When the teacher has made his or her own observations, it is often easier to begin a dialogue. As specialists in sensory integration, we give informational talks and lectures that school personnel can attend. My special education department says SI intervention doesn’t work for kids over eight. Is this true? No, this is absolutely not true. This myth seems to have arisen from an early study by pioneer A. Jean Ayres, in which she compared two groups of children receiving sensory integration based therapy. In one group the children were six to eight years of age; in the other they were eight or older. In this study, the younger group made better gains over a sixth month period. However, both groups made gains, and we now know that intervention is effective for individuals of all ages.

It can be helpful to provide your doctor with short written explanations of sensory integration dysfunction. Click here for a physician fact sheet.

This is a common perception by individuals not familiar with SPD. It can be helpful to have them read books written for laypersons, such as The Out of Sync Child by Carol Kranowitz or Sensory Integration and the Child by A. Jean Ayres. Clinics often hold evening overviews, (link to the spiral overviews sheet) which can also be informative and allow the grandparents to ask questions. Additional resources such as the “When our Senses Don’t Make Sense” DVD is available through the Spiral Foundation website.
It is important to tell people that your child processes sensation differently than others do and that this difference can result in ongoing stress for your child. It can be helpful to compare your child’s reactions to the reactions we all have when undergoing a great deal of stress. It may be helpful to explain that your child has a physiological problem and is not always in control of his or her behavior. See What is SPD? for more information.