Is it sensory or is it behavior? I get this question quite a bit in the clinic. Parents want to know if their child is just messing with them, or if they truly have a sensory processing issue.
About 75% of the time, Dad chimes in with, “He’s just trying to get away with something,” while Mom is certain that sensory techniques are the golden ticket.
My response? “It could be both.”
(And no, that answer is not meant to be a cop-out.)
More than once I’ve seen occupational therapists “ping ponging” a child back and forth with a psychologist over a child’s severe behaviors. OTs say, “It’s behavior!” Psychologists reply, “It’s sensory!” And they disagree until the parent’s head spins.
This sort of back and forth usually happens because neither the OT nor the psychologist sees their techniques working in isolation. And hey, when you have the pressure of a parent who wants to know when someone is going to help their child, it can be easy to pass the buck. Let’s just be friends, people, because there are many instances when we really need to work together.
A Sensory/Behavior Link
Yes, sometimes a child’s outburst is purely sensory related; and yes, sometimes it is simply a typical tantrum. But there are many instances when the line greys and one might feed into another. Allow me to give a few examples of how sensory processing difficulties can breed behaviors.
Imagine you are an infant with an oral sensory sensitivity. Every time you eat something you feel awful, want to gag, and can’t stand the textures mushing around in your mouth. At a young age, you have learned that food = pain.
Now, imagine that as you grow, or receive amazing OT intervention, you are able to handle more complex textures without gagging. However, every time a new food is introduced, you remember that whole food = pain thing and toss the food onto the floor in a screaming rage. Victory! You showed that oatmeal who’s boss.
A parent might see that outburst and think, “Oh no, her sensory sensitivities are still impacting her eating habits!” When in actuality it might be a behavior that developed due to previous sensory issues.
For another example, let’s say that you are receiving intervention for your child with sensory processing issues. Every time they have a meltdown, they get a big ol’ dose of attention from Mommy or Daddy as you direct them to calming sensory input.
The child may then learn that crying/screaming = attention from Mom and Dad. Therefore, even when sensory processing issues start to resolve, a child might save a few of those nasty outbursts just for their parents. In this situation a mother might come to me and say, “I think he might be sensitive to clothing, but he really only acts out about it around me.”
How to Tell the Two Apart
Behavior or sensory… isn’t that the million dollar question? Professionals discuss this topic in books, lecture about it in courses, or debate about it amongst each other. Some of the latest issues with the official Sensory Processing Disorder (SPD) diagnosis stem from the fact that many physicians call all of these symptoms “behaviors”, claiming that SPD is not necessarily a stand-alone diagnosis.
Regardless of everyone’s opinions, parents can become paralyzed in a meltdown moment as they fear disciplining their child for something sensory related. They often tell me that they worry that others will look at them as “bad parents” because they don’t know what to discipline and what to write off as sensory.
This is where I tell my parents to be incredibly attentive to the subtle signs from their child. With any behavior analysis, there is an “antecedent,” or something that happens before the behavior. This is where the parent has to look for the clues. What was the root cause of the outburst?
This is one of the reasons why I am a big fan of journaling for parents of children with sensory processing issues. You would be surprised by the trends that a parent notices in their child when it is all written down in front of them.
A parent sees that their child refuses to listen to them in the morning in order to get out the door in time for school.
The child sees sensory overload from a snowball effect of aversive sensory input in the mornings. The little brother flicking the lights on and off to wake him up… his favorite cereal replaced by some generic brand…the tag in his new sweater for picture day that is relentlessly scratchy.
It is in these subtle details that you might be able to better figure out your child’s behaviors.
Another clue to watch out for is when behavioral interventions simply don’t work. Say you start to take away your child’s favorite things because they refuse to sit still in their chair. “No Wii tonight!”… “Your X-box is gone forever!”… “Now you can’t watch TV until you are 35!”
The child with sensory processing issues is going to be sobbing because they’ve lost their privileges, but you know they’ll still be bouncing around in that chair. In this case the child’s nervous system is driving them to move around, and they can’t do much to override that feeling. So no matter how motivating the reward or punishment may be, they just can’t help it.
What is the Best Approach?
I have to say, I don’t enjoy it when a child is beating on me throughout a session and the parent comments, “Oh, he just needs a lot of sensory input today.” Uh, no. The child might crave that heavy proprioceptive input into his muscles and joints, or may very well have acted out because his sensory system was overloaded, but you also have to realize that aggression and behavior play a part as well.
So yes, if an occupational therapist has determined that your child has sensory processing issues, you have to consider that it is going to influence their behaviors. This is why I feel that an approach with both sensory and behavioral techniques is ideal.
In general, sensory strategies recommended by an OT are safe to try along with your behavior plan. Continuing to support the sensory systems is a vital part of your child’s everyday life, and actually a good way to “tease out” behaviors if you observe how the child responds to situations when you know that they are regulated.
One key point with a behavioral strategy: make sure that sensory input is never withheld as a punishment. Even though it looks like fun, those sensory diet activities are actually something the child needs in order to stay organized.
This is just one of the reasons to support a close relationship between behavioral and sensory approaches. I’ve even seen some professionals recommend that the parent not let the child swing, or withhold their fidgets until they calm down. For some children, that is asking the impossible.
Even when parents are meticulously looking for the clues and attempting to determine why their child acts out, it’s not always going to be cut and dry. This is one of those “easier said than done” situations. This is why I feel it is important to support both sides of the issue so that the child has the opportunity for a balanced, regulated life with the appropriate boundaries.