Thursday, November 12, 2015

The Lure of "Sensory Protocols"




Photo source: www.forbes.com, www.rompa.com



If you have spent any time with ABA people you may have picked up on the fact that we're all about data. We collect data, analyze data to make decisions, and look for the evidence, or data, behind strategies or techniques before we implement them.
 
So where do we stand on the issue of “sensory diets/sensory protocols/sensory interventions”? Well, many items or activities often included in a “sensory intervention” (I keep placing that in quotation marks because one of the problems is there is no set definition of this term. It means many things, to many different people), such as koosh balls, massage, tickles, dark lighting, aromatherapy, scented oils, pillows, etc., are quite enjoyable and can be very reinforcing to individuals with Autism.

Did you catch that?

Okay, I’ll say it again: Many items or activities often included in a “sensory intervention” such as koosh balls, massage, tickles, dark lighting, aromatherapy, scented oils, pillows, etc., are quite enjoyable and can be very reinforcing to individuals with Autism.

And there is the problem. “Sensory protocols” are often implemented as a response to problem behavior, in order to quickly remove the agitated child, let them de-stress, and to give them a quiet and relaxing space to gradually de-escalate. So what happens if you apply an enjoyable and possibly reinforcing activity after problem behavior has occurred? You inadvertently reinforce, or strengthen, problem behavior.


Many center programs or schools are now setting up separate cool down areas where some type of “sensory protocol” is applied, such as the child sits on a beanbag and listens to soft music while a teacher or aide gives them deep pressure and joint compressions.
These professionals often are unaware that the very protocol designed to reduce or prevent problem behavior is actually causing problem behavior to increase. Here’s a sample scenario to show you what I mean:

Child in math class--->hates math class--->bored--->throws book across room, yells, and stands on desk---->immediately removed from math class (yay!)---->taken to the cool down room---->now laying on a fur blanket, sipping on water, and holding a koosh ball---->awesome!


For all the parents and educators: there is NOTHING wrong with using preferred items to bring about behavior change. Just pay attention to WHEN you present these items/activities. Preferred, enjoyable items and activities should be presented when desired behaviors occur and not when problem behaviors occur. When problem behaviors repeatedly occur, your best plan of action is to conduct a FBA, and create a Behavior Plan.  


So why do “sensory protocols” or other interventions without empirical support persist, or even gain traction among professionals and educators? What is the lure? Well, Lilienfield et al (2015) provide a few answers to that question:
  • Parents are often desperate for Autism treatment options
  • Behaviors often wax and wane naturally as children age and mature, so it can seem that sudden short term improvements are due to a particular treatment or intervention
  • The internet and technology brings a mass of information to people quickly, and most people would rather read something online than in a research article
  • At a psychological level, once someone believes in something it can be quite difficult to convince them otherwise


Over the years working with parents, educators, and related (non ABA) professionals, I absolutely agree that fad treatments can seem very alluring. It’s like that fast food place that you know you shouldn’t eat at, but the food is cheap and convenient. You probably wouldn’t listen to me telling you about the dangers of a McNugget right as you are about to eat one. 30 minutes later…maybe. :-)

Based on my experiences with this issue, here are the main captivating lures I see when it comes to “sensory protocols”:

The Lure
The Truth
Typically easy or quick to come up with, can be implemented or created by anyone
Most quality, evidence based interventions require the use of credentialed or licensed professionals who have specific expertise
Materials/objects are often cheap and readily available, some can even be made
Gather together all of these cheap and readily accessible items and use them as reinforcers, not as a “treat” that only comes out after the child has aggressed at someone. If the only time the child can access all these amazing items is after they have become severely disruptive, then Houston, we have a problem
Can appear to have an immediate effect, or in the short term can appear to be working
Especially for an escape maintained child, yes….these types of interventions will appear to work like magic. Unfortunately, that is only until the child gets sent back to class or a high demand situation. What I typically see is a high cycle of: behavior, calm down room, behavior, calm down room, etc. Another important point to consider is do you plan to create a sensory room in all environments? No? Then what happens when problem behaviors occur at the beach, the post office, or at Grandmas house?
A “sensory room”, particularly in a school, can serve as negative reinforcement for the teacher (escalated and disruptive student is quickly removed from the classroom)
If at all possible, it’s best not to remove the child from the location where problem behavior began, or for another educator/professional to come to the “rescue” and remove the student. This sends a message to the child you don't want to send: that you cannot handle the child’s behaviors, and if they want to quickly leave a certain setting all they have to do is exhibit problem behavior
If the child enjoys it, what’s the harm?
Lemon treatments waste money, time, efforts, and energy that could be directed at effective interventions based on data. They can also shape up problem behaviors and make them far worse, or more entrenched over time


Reference: 
The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example
Lilienfeld SO, Marshalla J, Todd JT, Shane HC (2015) Evidence-Based Communication Assessment and Intervention





2 comments:

  1. A good sensory diet is a scheduled set of sensory activities based on the individual needs/FBA of the child. The goal is to put those sensory tools in place before they are needed, so that the child won't have to interrupt normal activities to get help calming down. eg: Johnny often gets over stimulated in PE class, use heavy work before PE, wear noise reducing headphones during PE, and give Johnny the option of visiting the calm down area after PE.

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  2. Thank you for your comment!

    Over the past few decades, multiple rigorous studies have been conducted to review the research on sensory integration/diets and related therapies/interventions. No scientific support for the theory underlying those interventions or their effectiveness has been found, either with people with Autism or any other diagnosis. I included a research link at the end of the post above, if you would like to conduct some lit review.

    Behavior Analysts are ethically obligated to use and recommend interventions that have proved most effective in scientific studies, so as a field we do not support or recommend the use of sensory protocols/diets. What we DO support are a variety of evidence based interventions and strategies that are function based, and dependent upon analysis of data.

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