Is it Sensory or Behavior? OT Detectives to the Rescue!

Heather LaCroix, MOTR/L, is an Occupational Therapist at Franciscan Hospital for Children. If you have questions, or to refer your child for an Occupational Therapy session, please call (617) 254-3800, ext. 4820 or email info@fhfc.org.

Do you find yourself asking, why does my child do that? Why does my child not take a bath? Why won’t they eat a banana? How can I stop them from doing that behavior? You’re not alone, and many parents have turned to Occupational Therapy as a way to help answer these seemingly never-ending questions.

According to the CDC, 1 in 68 children has been identified with autism spectrum disorder (ASD).* This alarming rate has parents and providers are looking for the best treatments to help the children in their care.

A common question that arises around the topic of autism is, is it sensory or is it a behavior? Sensory Integration and Applied Behavior Analysis (ABA) are two common therapies available to families of children with autism.

Sensory Integration is the ability to take information through our senses, pair it with prior information, memories, and knowledge stored in the brain, and create a meaningful response. These senses include touch, movement, smell, taste, and vision. Applied Behavior Analysis uses techniques and principles, developed through decades of research in behavior analysis, for increasing useful behaviors and reducing those that may cause harm or interfere with learning. Often these two therapies are seen as two separate treatments, but there is a great opportunity in using them together in Occupational Therapy.

Let’s investigate an example of a sensory processing issue: a child cries and hits their infant sibling. Is the underlying cause of this behavior because the child wants to hurt their sibling, or is it because the baby is crying and the child is unable to process the auditory output of the baby’s crying?

Children with typically developing nervous systems are able to process sensory information, like their sibling crying, without having to think about it or having severe difficulties. They might not like the stimulus, but they’re more likely and able to identify and process it, behaving appropriately by moving away from the sound or asking for it to stop.

On the other hand, a child that is unable to process this sensory information might respond with maladaptive behavioral reactions such as yelling, bolting, flopping, aggressions or self-injurious behavior. Others may see this as child who is misbehaving, when in fact this reaction reflects how they are able to process a sensory stimulus.

Occupational Therapists are trained to look at children differently… we often think of ourselves as detectives! It’s our job to take parent/caregiver input and, with skilled observation, come up with a hypothesis to explain and treatment plans to address these behaviors. Some of the tools that we use include the Sensory Profile, sensory integration observation checklist, the Alert program, parent/caregiver interviews and clinical observations.

Ultimately, the goal of any Occupational Therapy session is to provide children with the tools they need to best function within their daily world. In the case of Sensory vs. Behavior, we work with children of all ages to help them identify sensory information that is difficult to process and work on more socially appropriate ways to address these difficulties.

*Centers for Disease Control and Prevention (CDC) – Facts About ASD