Sensory or Behavior?

He squeals loudly and lets all of his body weight collapse to the floor (“flopping”), as he covers his face with his hands and hums to himself. He is still for several seconds, making quiet humming sounds. Then he suddenly stands up, looks around the room and darts toward the front door. A parent quickly runs over to keep him from trying to leave the home, and steers him back to the living room by his shoulders telling him “We’re staying in here”. Once back in the living room, within a span of several minutes he repeatedly tries to jump on the couch, eat lint from the carpet, and stand on the coffee table. All of these attempts are interrupted or blocked by a parent. Throughout the entire observation, he makes continuous vocal sounds, some sound like “eeeeee-eeee” and others are short, high - pitched squeals or shouts (“Ahh!”).

This is a brief scenario describing a client I observed recently during an intake, but really these descriptors could describe multiple children I work with…bounces, climbs, puts items in mouth, quick and sudden movements, crawling or laying on the floor, vocal sterotypy, etc. These are often referred to as “sensory issues”, “unmet sensory needs”, “sensory seeking/avoiding”, or “stims”.

If you're new to these terms like “sensory issues” or “stims”, maybe you have no idea what I’m talking about. If so, check out this visual aid:  

I think what people mean when they say “Is it sensory or behavior” is really “Does this individual have something in their body that feels too high or low right now, OR are they just acting up”. There is an assumption that “sensory issues” mean the child needs to do something active or calming, but “behavior” is just about pushing buttons. The misuse of both of these terms must be quite confusing for a layperson to understand.

There are a few things that are important to understand about sensory issues from an ABA perspective …..which if you are here, you must want an ABA perspective:

  • We focus on behavior. Saying the word “sensory” can mean many different things to different people, so to keep it clear and simple we focus on what we can see and/or measure.
  • So if we label something a “behavior” and not a “sensory issue”, then what does that mean? It means we view behaviors as gaining or avoiding something. If I pull out my phone to play Candy Crush anytime I have to wait in a line (which I do, by the way), I’m bored, and me going for a video game is a way to alleviate that boredom. What if I didn’t have my phone? Well, I might twirl my hair, bite at my nails, or tap my foot. Depending on my options, my behavior may look very different. However the reason, or the WHY, of  my behavior is the same.
  • Speaking of the WHY, or function, if we don’t consider sensory issues to be separate from behaviors then what are they? We ABA people would call them Automatic Reinforcement maintained behaviors. 
  • The intervention needs to be clinically sound. Blanket, or general, interventions like "Just put on her weighted vest when she gets hyper" aren't going to cut it. I know blanket strategies are easier, faster, and more accepted by direct staff/teachers, but they also are a toss up. Will they work? Maybe. ....and maybe not. True behavior intervention needs to be valid and tied to the function of the behavior, as well as empirically supported.
  • Vague or poorly defined words like “sensory issues”, “overly stimmy”, “sensory diet”, “sensory protocol”, etc., are pretty hard to implement. If I tell you “Everytime Dominic starts acting stimmy, let him do sensory exercises”, would you know what that meant? Most likely not, which is why ABA people use clear and objective language to define our interventions.

Are you now wondering then what in the world CAN you  do about these self-stimulatory, automatic reinforcement maintained behaviors? Well, wonder no more:

Select and define the behavior you want to target---be specific (“climbing furniture” not “hyperactivity”)
Conduct a FBA  to determine the function(s)
Now that you know the function, select a replacement behavior (what the child will do instead of climbing furniture, mouthing items, standing on the kitchen counter, etc.). The replacement behavior needs to provide the same function payoff, and if possible should be topographically similar
Decide how to teach the replacement behavior, and block/redirect the target behavior
Make sure all relevant caregivers and staff know how to implement your intervention, and what to do both before and after the target behavior occurs
Evaluate your plan, review the data, and if necessary make changes

Lastly, there are 2 super-duper important things to understand as it relates to automatic reinforcement maintained behaviors:
  1. Never deliver the specified treatment/stimuli contingent upon problem behavior. You want to teach your clients to request or initiate appropriate ways to meet their automatic reinforcement needs, not teach them that “bored in the classroom” + ”start mouthing all my pencils”= “now I am in the hallway sucking on a lollipop”.
  2. I don’t advise targeting behaviors for reduction just because they are repetitive in nature. First ask yourself, is the behavior harmful? Is it causing impairments at school? Is it interfering with the child's ability to interact with others?  I also suggest reading about how a teen with Autism describes her need to engage in “stims”.

References/Recommended Reading:

Morrison, Heather; Roscoe, Eileen M; Atwell, Amy. (2001). An Evaluation of Antecedent Exercise on Behavior Maintained by Automatic Reinforcement using a Three Component Multiple Schedule. Journal of Applied Behavior Analysis. 42. 523-41.

Roberts-Gwinn, Michelle M; Luiten, LeAnn; Derby, K Mark; Johnson, Tania A; Weber, Kimberly. (2001) Identification of competing reinforcers for behavior maintained by automatic reinforcement. Journal of Positive Behavior Interventions.3.2. 83.

Piazza, Cathleen C.; Fisher, Wayne W.; Hanley, Gregory P.; LeBlanc, Linda A.; Worsdell, April S.(1998) Treatment of Pica through Multiple Analyses of its Reinforcing Functions. Journal of Applied Behavior Analysis.31.2. 165-189

Goh. H., Iwata. B.A., Shore, B.A., DeLeon, I.G.. Lerman. D.C., Ulrich. S.M., &
Smith. R.G. (1995). An analysis of the reinforcing properties of hand mouthing. Journal
of Applied Behavior Analysis. 28. 269-283

Lang, R., O’Reilly, M., Healy, O., Rispoli, M., Lydon, H., Streusand, W., Davis, T., Kang, S., Sigafoos, J., Lancioni, G., Didden, R., & Giesbers (2012). Sensory integration therapy for autism spectrum disorders: A Systematic review. Research in Autism Spectrum Disorders, 6, 1004-1018

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