Parents willing to accept alternative explanations for what appears to be misbehavior respond eagerly to my suggestion that these problems are not evidence of personal failure. "I'm hoping you'll tell me I'm not the worst mother in the world," the mother of an uncontrollable 4-year-old boy with significant sensory integration problems recently said to me. Once she and her husband recognized the source of their son's difficult behavior, they were able to appreciate his predicament, alter their expectations and rethink their ideas about how to discipline him. I encouraged them to accept and support him as he was , and to adopt a lifestyle that would accommodate his many needs. In consultation with their son's OT, they learned to control his environment in order to prevent sensory overload as much as possible.

But I'm still learning myself, and I'm not always certain when sensory integration is a reasonable framework for understanding behavior problems. When kids persist in everyday battles, I routinely inquire about their over- and under-sensitivity to sensory experience. I recommend an OT evaluation before a medication consultation for most hyperactive children. I don't want to overidentify sensory integration problems; on the other hand, I don't want to ignore the possibility that some kids cannot follow the rules, earn the points or honor the family contract despite considerable effort on their part.

I've discussed the possible connection between oppositional behavior and sensory integrative dysfunction with physicians, teachers and therapists--many of whom are considered authorities on the topic of disruptive behavior. Not one of them has been well informed about sensory integration theory. Most of them dismiss it out of hand because it has not been empirically validated. I find their closed-mindedness puzzling.

Therapists forced to appease managed care administrators are understandably hesitant to embrace alternative diagnoses. "Unproved" treatments are unlikely to be authorized. However, our track record for treating angry, defiant kids is not impressive. What I am discovering is that many difficult, oppositional kids can be helped. Not all of them have sensory integration problems, certainly, but a large number of them may. If they could be identified and treated early--before they get labeled as "behavior disordered," before peer problems develop, before they alienate their teachers, before their relationships with their parents get tangled up in guilt and rage and shame, before they lose faith in themselves--they might be spared the social, emotional and psychological repercussions of repeatedly failing to meet the expectations of adults.

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