“Sensory is the bridge between physical and mental health.”

– Virginia Spielman, Executive Director STAR Institute (Denver, CO).

In my private practice with clients, in workshops with parents and when I mentor other OT’s, the most frequent question and area of interest is this, “How do we know if it’s sensory or behavior?” I used to answer, “Let’s be a detective and figure it out. “ Then I switched to saying, “It’s both.” My new answer is, “Sensory IS behavior!”  It means we can’t ever expect to reduce negative behaviors without considering the sensory factors at play. We also can’t improve sensory processing without observing or influencing behavior.  AND we need to interpret both, in the context of environment and what we know client’s need and want.  

The Role of Sensation

Allow me to explain.  Our senses are what give us information about our place in the world. They enable us to be in the world, to engage with the world, and to interact with the people and objects in our world. Sensory processing is about how our brain and body interact to help us accomplish daily things.  Without our senses, we would not be able to “feel” and we would not be able to interpret what’s going on around us as we do things. We literally make “sense” of things, through our “senses”.  For all these reasons, our senses are essential to function.  BUT…all function is also behavior.  Behavior is objectively, what we “do”.  Occupational therapists look at what people do and how they do it to maximize function.  By observing people doing, we are observing our senses at work! Our senses are what enable us to “occupy” ourselves and our space in the world!

Negative Behaviors vs. Positive

When people ask “Is it Sensory or Behavior?” they are typically referring to negative behaviors they don’t like such as hitting, yelling, breaking or throwing things.  Sometimes they are referring to more subtle behaviors like ignoring, crying, refusing or avoiding. In cases of children with sensory challenges they may also be referring to things like rocking, spinning in circles, touching or smelling everything, or being “always on the move”. ALL of these behaviors can represent a sensory need OR they might not.  There is no one definitive way to know.  What we do know however, is that there are ways to start narrowing down the possibilities and that if we consider both sensory AND behavior in the context of the person at any given time, we are more likely to have success at shaping positive responses and interactions in the world. We also know that ALL behavior (positive or negative) is an indication of something.  It is a way of communicating both conscious and unconscious needs, desires, or states.

So What do we Do?

How do we respond with sensory strategies and what behavioral technique(s) should we start with?  My answer is a glowing (and likely frustrating), “It depends.” Here are some key questions to ask yourself in deciding where to start:

1. What patterns do you see? Ask the 5 W’s…Who is around? What is happening at the time? Where does the behavior occur? When does it occur most often and how long does it last? Why have they done this or other negative behaviors before? 
2. Does the behavior stop when the child gets what they want?  If a child’s negative behaviors stop as soon as they get their desired outcome, it is more than likely a behavior to serve a personal desire vs. a sensory need.
3. Do you know what the child wants? Sometimes we know exactly what a child wants when we see negative behavior and we don’t provide what they want until we see more positive behaviors.  If you know what they want, then using this as a teachable moment vs correcting the negative behavior may yield more positive results. 
4. What do you do when the behavior occurs? Therapists and parents need to focus on their own responses to negative behaviors sometimes more than the negative behaviors themselves, in order to eliminate or reduce the negative behavior from occurring. I had a young boy who escalated every time we went in the sensory gym.  I was too focused on thinking he needed vestibular input (the swings) in order to self-regulate to notice he was visually overstimulated and thus running around and unable to engage as a result.  Once I changed what I was doing (leading him to the sensory gym) and instead led him to the smaller treatment room to play with blocks, he was able to engage in back and forth play and visual motor activities with me and he stopped escalating. 

The answers to the questions above will help to make the decision about the next right step.  I’d love to think I could answer every scenario in one post, but I know that’s not realistic.  Instead, the following are strategies I use most in sessions when attempting to address sensory and behavior at the same time:

1. Slow Down
2. Breathe Deeply & Observe
3. Wait
4. Connect with the feeling a child may be having; validate, share, & label that feeling
5. Stop expecting or reduce expectations 

I’ll expand upon each of these 5 strategies in upcoming blog posts and in an upcoming FREE training that I’m doing on Zoom (Saturday May 30th), as part of launching my Sensory Collective Membership for Sensory OT’s.  Know these strategies are not a quick fix.  They are not a one size fits all and they don’t work every time.  They typically work in combination with each other and often alongside other interventions.  However, these 5 strategies can support better self-regulation and thus better behavior.  They can increase potential and readiness to learn new ways of behaving, and they might improve a child’s ability to be in and to engage or interact with his or her world.  And who doesn’t want that regardless of the root cause?!

If you are a sensory OT interested in advancing your skills and sensory knowledge base, or looking to connect with other sensory OT’s, consider joining the Sensory Collective, launching June 1st!! It’s an affordable group coaching program where you can join other therapists live and receive support around evidence based practice in sensory processing.  Gain confidence in your skills, learn how to work with hard clients, and maintain and provide best practice in your setting…while also having fun!! Click HERE to join!