Who they are
Lucy Jane Miller is an American occupational therapist and researcher who has been the primary advocate for recognising Sensory Processing Disorder (SPD) as a standalone diagnostic category. She is the founder of the STAR Institute for Sensory Processing (formerly the Sensory Processing Disorder Foundation) in Colorado and a professor emerita at the University of Colorado. She studied under A. Jean Ayres and has positioned herself as the intellectual heir to the sensory integration tradition.
The question of whether sensory processing difficulties constitute an independent diagnosis—or are features of autism, ADHD, anxiety—is one of the field’s most consequential debates. Miller is the loudest voice on one side.
Key contributions
Advocacy for SPD as a diagnosis
Miller’s 2007 RCT argued for “Sensory Processing Disorder” as a distinct category, renamed from Ayres’ “sensory integration dysfunction.” The reasoning: if SPD is a diagnosis, insurance covers occupational therapy. Without diagnosis, there’s no billing code, and families pay out of pocket.
This advocacy has not succeeded. SPD is not recognised in the DSM-5 or ICD-11. The American Academy of Pediatrics recommended in 2012 against using SPD as a diagnosis. But Miller’s campaign has ensured that the question stays on the clinical agenda.
The STAR Institute and clinical research
The STAR Institute is one of the few centres dedicated to sensory processing research and treatment. It provides clinical services, trains occupational therapists, and generates research. Miller’s clinical work has contributed to the evidence base for sensory-based interventions, including studies on the effectiveness of occupational therapy using sensory integration approaches.
Nosological refinement
Miller proposed classifying SPD into sensory modulation disorder, sensory-based motor disorder, and sensory discrimination disorder—more granular than Ayres’ or Dunn’s frameworks. It hasn’t been widely adopted but represents serious differentiation between types of sensory difficulty.
Critical assessment
The push for SPD diagnosis stems from legitimate clinical concern and economic incentive (OT revenue depends on diagnoses that justify referrals). This doesn’t invalidate the work, but the advocacy should be understood in context.
Most researchers agree that serious sensory challenges exist, but there is no consensus on whether they constitute a distinct disorder or are better understood as features of autism, ADHD, anxiety, and other conditions. The DSM-5’s inclusion of sensory reactivity as an autism criterion, rather than as a separate diagnosis, reflects this view.
Miller’s clinical work is well-regarded, but the STAR Institute functions as both research centre and commercial facility, creating potential conflicts. The institute often presents SPD as more established than research supports.
The honest position: sensory processing differences are real, common, and clinically significant. Whether they need a separate diagnostic label, or whether they are better addressed as features of existing conditions, remains unresolved. See The evidence problem in sensory interventions for the broader evidence context.
Selected works
- Miller, L.J. et al. (2007). “A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder.” American Journal of Occupational Therapy, 61(2), 228–238.
- Miller, L.J. (2014). Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. Revised edition. New York: Penguin.
- Miller, L.J. et al. (2007). “Concept evolution in sensory integration: A proposed nosology for diagnosis.” American Journal of Occupational Therapy, 61(2), 135–140.
Last reviewed
2026-04-15