|
Sensory or Behavior: Not an Either/Or Debate
BY Tara Delany, MS, OTR/L
Executive Director of School Steps Inc, Rocklin, CA
Executive Director of Baby Steps Therapy, Rocklin, CA
"It‘s sensory; he can‘t help himself!"
"It‘s behavior; he knows exactly what he‘s doing!"
And the debate goes on: Is it sensory or is it behavior? Five years ago, I would have listed off the differences to you. I would have said in this situation and under these conditions, it is behavior. Or I would have said given that situation and those conditions, it is sensory. I would have declared either case emphatically and then advocated for understanding on the part of the teacher or parent based on the behavior/sensory issue at hand.
Today, however, I‘ve come to realize that it is impossible to divorce the two. Instead of trying to separate the sensory issues from behavioral issues, think about them as interwoven layers. The first layer is the basic reactions within the nervous system to incoming stimuli-this is called reflexive behavior. The second layer is the child‘s feelings about responding in this manner, which affects how the child fits within his/her environment and how he or she interacts with people. In essence, it is how the child acts based on knowing how he will react to a given stimuli. This is, for the most part, considered "learned behavior". (Note that "learned behavior" does not equal either "willful" behaviors or behaviors that are "in the control" of the child.) This second layer then is a combination of nervous system adaptation and cognitive problem solving.
"Picky eating" is an excellent example of the sensory/behavior union. The tactile and olfactory stimuli of food cause the nervous system‘s reflexive reaction, which can be gagging or strong aversion to the smell. The learned behavior comes as parents and caregivers adjust the environment around that reflexive behavior. For example, parents might begin to offer only the foods that they know the child will eat, such as chicken fingers, french fries, and crackers. In this way, the child "learns" that only certain foods do not trigger the undesirable reflexive reaction, so they in turn solidify their limits on what they will eat. Many tactually sensitive children are picky eaters. Long after the tactile defensiveness issues are resolved, the picky eating behavior remains because only the reflexive layer of the behavior was addressed and the learned component of "picky eating" was never unlearned.
The corollary to the "Is it sensory or is it behavior?" debate is the question "What is the "best" method for modifying undesirable behaviors?" The sensory-therapeutic community and the Applied Behavioral Analysis (ABA) community both defend their approaches as better or more scientific. Since most behavior cannot be labeled as purely sensory or cleanly learned, but rather is a combination of the two, sensory and behavioral issues must simultaneously be modified. It makes sense to utilize sensory-based therapy and/or sensory strategies paired with cognitive behavioral strategies, even though a rigid ABA approach is rarely indicated. The basic principles of ABA are often unknowingly employed in OT practice without being labeled as such. Once the jargon of the "behaviorist" is put side to side with the jargon of the OT who has a sensory integration approach, planning sensory treatments while incorporating specific behavior techniques can be seen to be advantageous. While true believers on both sides of the fence debate the merits of each position, incorporating both sensory and cognitive strategies in your treatment is usually required.
The idea of ABA, and of Cognitive Behavioral strategies in general, is to improve maladaptive social behaviors using careful analysis and the basic scientific principles that govern learning and behavior. A systematic therapeutic approach that relies on repetition and reward is created. One of the founders of this field of study is B.F. Skinner, who is famous for his animal experiments showing that food rewards (immediate positive consequences of a target behavior) led to behavioral changes. Skinner‘s findings are widely endorsed as applied to pets, but are difficult to transfer directly to the far more complex human brain. For one thing, all people are not motivated by the same rewards. Once we discover what motivates a child, these can be used deliberately to help the child learn new behaviors. When a newly learned, desirable behavior is paired with a positive reinforcement, tied to a child‘s specific motivators, likely the new behavior will be repeated. The opposite is also true: A maladaptive behavior that results in an unpleasant event (negative or aversive reinforcement), that impaired behavior is less likely to be repeated. This then is the basic tenant of behavioral learning theory.
Accepting that basic behaviors can be changed with different reinforcements, a related question surfaces next: How can sensory behaviors be ameliorated? Of course, many types of sensory behaviors exist. Understanding the origin of the specific sensory issues and how they drive automatic behavior is crucial. This understanding establishes the basis for the third layer, learned behavior. Identifying the sensory processing disorder subtype can be done on a first pass after an evaluation, e.g., determining if the child has sensory over-responsivity, under-responsivity or sensory seeking characteristics for each sensory domain. Once the sensory issues are interpreted, both the automatic and the learned components of the issues can be addressed using both OT with a sensory integration approach and a systematic behavioral approach called "shaping".
Shaping posits that behavior should be changed incrementally, with positive reinforcement until the desired behavior is achieved. Shaping is most likely to succeed when the targeted desired behavior is clearly defined. For example, shaping often works when helping a child overcome his/her fears of specific sensory inputs, or when learning independent self-care skills, or when acquiring appropriate social skills.
Let‘s revisit the picky eater. A parent or therapist uses a shaping technique when praising the child for tolerating a new food on his plate, even if he doesn‘t take a bite. The next step is to praise the child for trying one bite, then two bites, and so on. Many other behaviors may also be modified by shaping. For example, a parent could praise her young child for dressing himself even if the shirt is on backwards and the shoes are on the wrong feet. At a later stage, praise might only be offered if shoes are on the correct feet and the shirt is right side out and front is forward (Alberto and Troutman, 2003).
Shaping can be a natural adjunct during treatment with a sensory integration approach. Often when working with special populations rewarding even the slightest improvement is key to encouraging children, including just trying food with a slightly different texture or tolerating just a marginally noisier environment.
Behavior must be systematically and gradually shaped. Aggressive shaping for children with sensory issues is a sure road to failure and often the behavior will worsen. Consider the nervousness that many people have speaking in public. If required to present in front of a few hundred people, a person who has difficulty with public speaking is likely to have the same physiological reactions as a child with sensory over-responsivity issues. The speaker‘s heart will race, sweat will increase, and their stomach will be "in knots." Poor performance, if met by an indifferent or hostile audience, will further reinforce the perception that public speaking is scary. If instead, the presentation is practiced before a friend who offers positive reinforcement, and practice presentations are made to an ever-increasing audience size, could the speaker acclimate to the idea of presenting to a large crowd? The idea is to associate positive external reinforcement to increased exposure to a specific experience, ultimately leading to internal reinforcement and altering the physiological response to that experience.
Our nirvana as therapists or parents happens when a child‘s motivators shift from external to internal. Once motivated by internal reinforcements, e.g., feeling good about mastering a task or participating, a child‘s progress is likely to speed up. This "virtuous circle" is progress that comes from the internal motivation to succeed, which leads to greater success, which garners greater external reinforcement (praise/reward/social connection) creating an upward spiraling series of events.
In conclusion, combining the neurological advances that can occur from OT with a sensory integration approach and the cognitive behavioral strategies used in ABA as well as other cognitive approaches, while allowing fluidity between and among approaches, will likely lead to greater success in the treatment of children with Sensory Processing Disorder or other conditions that have concomitant sensory issues because both layers are addressed. A child‘s nervous system can adapt during appropriate sensory based therapy to set the stage for learning. Cognitive strategies that shape behavior capitalize on the sensory-based treatment, which enhances the neurological changes that the child makes. Patty Schetter from Behavior and Training Associates explains it succinctly when she says: "If behavior is changing, then learning is occurring and the principles of applied behavioral analysis are in play."
|
|
|
