To Tack or Jibe: Problem Solving for Sensory-Based & Other...
Transcript of To Tack or Jibe: Problem Solving for Sensory-Based & Other...
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To Tack or Jibe: Problem Solving for Sensory-Based
& Other Behavioral Difficulties
2014 Early Intervention & Preschool Conference Mobile, Alabama
November 17 – 19, 2014
Laura Schertz MS, OTR/L [email protected]
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Learning Objectives Understand sensory processing disorder nosology to identify &
differentiate among sensory-based behaviors.
Define behavior & the primary reasons for behavior; learn to analyze problematic behaviors.
Describe a multipronged prevention approach & basic intervention principles to manage common sensory-based & other behavior difficulties.
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Presentation Outline Basic Principles
Sensory Integration
ABC’s of Analyzing Behavior
Problem Solving Framework
Obtaining Behaviors
Avoiding Behaviors
Intervention
Sensory Diet
Environmental Techniques
Behavioral Strategies
Temper Tantrums
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Basic Principles
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Behavior Defined What people do & say
Many dimensions can be measured
Behaviors can be observed, described, & recorded
Overt or covert
Environmental influence
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Sensory & Behavior Philosophy Children have fundamental need to function within their environment
Behaviors may result from:
trying to meet specific need
response to an environmental demand or stimuli
learned response or coping strategy
Behaviors almost always maintained by >1 factor
Children can use the same behavior for many reasons
Intervention must address the whole child
Your attitude is important!
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Are you looking at a sensory-based problem? External environment interacting with child’s internal environment
Internal sensory environment is different
React with challenging/unusual behaviors
When sensory is also behavior-based…
Sensory triggered by body’s needs
Becomes learned & established
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When behavior becomes a problem… Behavior is a concern when:
it’s bothersome,
interferes with ability to learn or function,
or is harmful.
The focus needs to be on the FUNCTION OF THE BEHAVIOR rather than the actual behavior.
Behaviors may be LEARNED, not WILLFULL
It may be the only way they know how to behave
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Why is it important to know if sensory is involved? Danger in addressing only behavioral aspects or only sensory aspects
Affected by & reflect their external environment & internal state
Behavior occurs for multiple reasons & must be analyzed on many levels
React according to physical & mental abilities, emotional responses, their sensory needs, & by using learned responses
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Developmental Concerns Impact on Behavior Developmentally-based issues often at root of behavior problems
Try to compensate for or avoid weakness
Struggle to develop effective coping strategies
Not always willful, not always sensory
Areas of developmental concern that may be possible cause of behavior
Communicative disorders
Motor control difficulty
Sensory processing disorders
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Sensory Integration & Sensory Processing Disorders
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sensory stimulus
central processing output
What is Sensory Integration?
3 components
Taking information in
Putting it together with other information
Creating a meaningful response
Requires integration of external & internal information within the brain & the ability to use this information functionally through appropriate adaptive responses.
Sensory systems & integration of senses
Tactile, Proprioception, Vestibular
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Sensory Processing Disorders Occur when brain is not able to organize sensory information
Hallmarks of sensory integrative dysfunction:
Inconsistencies in performance & fluctuations in emotions & behavior
Difficulties in attention, arousal, organization of behaviors, motor planning, & coordination
Difficulties processing
Can occur from breakdown in any of the 3 phases
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Miller, L. J., Anzalone, M. E., Lane, S. J., Cermack, S. A., & Osten, E. T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. The American Journal of Occupational Therapy, (61)2, 135-140.
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Sensory Modulation Disorder Sensory modulation occurs as the CNS regulates neural messages about
sensory stimuli.
Sensory Modulation Disorder
Difficulty responding to sensory input with appropriately graded behavior
Inconsistent responses to the situation’s demands
Difficulty achieving & maintaining developmentally appropriate range of emotional & attentional responses
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Sensory Modulation Disorder: Sensory Overresponsivity More sensitive to sensory stimulation
Overresponsivity may occur in ≥1 sensory systems
Feel sensation too easily, too intensely, or for too long
Behavioral & emotional responses
Hallmark: sympathetic nervous system activation
Response to sensory stimulation
Difficulties are heightened in new situations & during transitions
Intensity of response to unexpected stimulation > self-generated stimulation
Summative effect
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Sensory Modulation Disorder: Sensory Underresponsivity
Disregard, or do not respond to, sensory stimuli in their environments
Appear not to detect incoming sensory information
Inaction due to failure to notice cues for action, not lack of motivation
Behavior often described as withdrawn, difficult to engage, inattentive, lethargic
Classic symptom: hyporesponsivity to touch & deep pressure stimulation
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Sensory Modulation Disorder: Sensory Seeking/ Craving Extreme overarousal with constant movement
Receiving sensory input directly related to degree of disorganization experienced
If unstructured, obtaining additional sensory stimulation may ↑the overall state of arousal & ↑ disorganization
May also occur to receive enhanced input if have ↓’d sensory perception
Characteristics of sensory seeking
Crave unusual amount/ type of sensory input
Constant moving, “crashing & bashing,” “bumping & jumping,” impulsiveness, carelessness, restlessness, & overexpression of affection
Influence on peer social interactions
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Sensory-Based Motor Disorder: Postural Disorder
Postural disorder: difficulty stabilizing the body to meet demands
Poor core strength,↓’d endurance, poor balance, attempt to↑BOS, & poor co-contraction ⇒ move inefficiently & poor body awareness
May avoid movement/ prefer sedentary activities OR physically active but↓control
Avoiding movement due to postural disorder OR vestibular sensory overresponsivity?
Unstable or fearful in challenging positions (PD)
Seems to have an aversive response to the movement (SOR)
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Sensory-Based Motor Disorder: Dyspraxia Dyspraxia: inability/ difficulty with 3 aspects of completing motor action
1. Ideation – ability to generate new ideas
2. Sequencing – planning out the steps needed to conduct the idea
3. Motor execution – implementing the motor plan
Presentation of dyspraxia
Awkward & ↓coordination for GM, FM, & OM & Ideational difficulty
↑difficulty for complex tasks as part of functional activity in a dynamic environment requiring subtle adaptations of timing in movement
Rarely achieve automaticity & subcortical level of performance
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Sensory Discrimination Disorder Sensory discrimination:
Ability to interpret information, comparing details & disregarding irrelevant info
Forms foundation of adequate body scheme (i.e., feed forward mechanism)
Sensory Discrimination Disorder
Difficulty interpreting qualities of sensory stimuli & perceiving similarities/ differences
Somatic senses important
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ABC’s of Analyzing Behaviors Antecedent, Behavior, Causes & Consequence
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B: Behavior Defining Target Behaviors
Concrete, objective terms
Environmental factors?
Linked behaviors
List all behaviors linked to a single problem
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Warning Signs
Cues behavior is about to occur
Window of opportunity to intervene
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A: Antecedent Behaviors don’t occur in isolation
Connected to activities/events
Gives insight to the purpose
What happened immediately before the behavior?
Environmental factors affecting behavior
Special events may impact the child’s behavior
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C: Determining the Primary Cause Behaviors stem either from need to obtain something the child wants or
to avoid something the child doesn’t want.
Those behaviors may reflect sensory-based issues, a motor-control/motor-planning deficit, or serve as a form of communication for social or nonsocial purposes.
This is known as the primary cause of the behavior
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C: Cause for Behavior
OBTAIN
Communicative
Attention/ Social
Object, Activity, Task
Internal
Sensory
Systemic
AVOID/ ESCAPE
Communicative
Attention/ Social
Object, Activity, Task
Internal
Sensory
Systemic
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C: Consequences to a Behavior Why identify the consequence?
Helps define & clarify what the child is trying to obtain or avoid
Establishes what is sustaining the problematic behavior
What happened after the behavior?
Reinforcers encourage or reward behaviors
Behavior followed by positive reinforcing consequence is more likely to happen again
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Reinforcement & Punishment Reinforcement involves strengthening a behavior
Positive & Negative Reinforcement
Punishment involves weakening a behavior
Positive & Negative Punishment
Primary & Secondary reinforcers
Continuous vs. Intermittent reinforcers
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Action Plan
Prioritizing the Behavior to Address
Harmful to self or others
2-pronged approach to eliminate underlying problem
& aggressively intervene to stop the harmful behavior
Destructive
Disruptive or distracting
Interferes with the ability to learn
Socially inappropriate
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High Priority
Low Priority
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Action Plan
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Ways to Address the Behavior
• STOP or ELIMINATE the behavior
• ALTER the behavior; SUBSTITUTE a more acceptable replacement behavior
• LIMIT the behavior
• TREAT the primary cause & wait to see if the behavior goes away
• IGNORE the behavior & do nothing
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Summary of Analyzing Behavior Behaviors serve multiple functions
Identify ABC’s to analyze behavior
Behavior more likely to happen again if followed by + reinforcing consequence
Repeated behaviors become learned
Prioritize behaviors to address according to harm or interference with learning
To be rid of a problematic behavior:
Link desired response to 1° reinforcer & teach appreciation of 2° reinforcer
link 2° reinforcer to 1° reinforcer & fade 1° reinforcer
use 2° reinforcer intermittently & ignore undesirable behavior
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Problem Solving Framework
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Video: Biting at daycare
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BEHAVIOR
OBTAIN
Social/ Communication
Attention Need/ Want:
Object or Activity
Internalized/Systemic
Sensory Input
Productive Nonproductive
AVOID/ ESCAPE
Communication
Attention Task, object,
or activity
Internalized/Systemic
Sensory Systemic/ Visceral
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BEHAVIOR
WANT
Interpersonal/ Interactive
Social Something
Intrapersonal/ Internal
Sensory
“Sensory Diet”
Stimming
DON’T WANT
Interpersonal/ Interactive
Social Something
Intrapersonal/ Internal
Sensory Medical
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Problem Solving Framework:
OBTAINING BEHAVIORS
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OBTAINING BEHAVIORS: COMMUNICATIVE
OBTAIN
Communicative
Attention Need or Want –
object or activity
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BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
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Communicative Obtaining Behaviors Difficulty communicating needs & wants
Without necessary speech & language to communicate wants/needs & resort to nonverbal methods of communication to get their needs met
Gestures, movements, negative strategies that get attention without verbally communicating
Use behavior to get what they want
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BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
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OBTAIN: COMMUNICATIVE: Attention Smiles, hugs, praise
Negative attention seeking behavior
Attention of any type can be very rewarding & reinforcing
Negative attention singles a child out & provides immediate gratification
Negative attention often stronger & more immediate than praise
Shock/ surprise reaction
Full ownership
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BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
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INTERVENTION STRATEGIES for OBTAIN: COMMUNICATIVE: Attention Behaviors
Give structured positive attention to desired “on-task” behaviors
Specify exactly what you liked
Avoid general praise
Use child’s name & associate it with positive experiences
Do not inadvertently reward incorrect or inappropriate behavior
Negative attention-seeking behaviors
Behavioral intervention techniques
Ignore negative behaviors
Control responses of others
Intervene before negative behavior begins; praise on-task behavior
Educate all team members
Be consistent, implement in all environments
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Full ownership behavior
Teach situations & environments where not allowed & consistently enforce
Reinforce desired behavior before undesirable behaviors are displayed
Keep child engaged in task
Use delayed-gratification techniques
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INTERVENTION STRATEGIES for OBTAIN: COMMUNICATIVE: Attention Behaviors
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BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
OBTAIN: COMMUNICATIVE: “Something” Personal need (food, drink, toilet)
Preferred object or activity
Need or want
Behavior often tells us that they want more than just attention
Must always ask, what are they attempting to communicate?
Obsessive & compulsive tendencies often result in the child trying to repetitively obtain an object, use a behavior, or repeat a thought
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INTERVENTION STRATEGIES for OBTAIN: COMMUNICATIVE: Something Behaviors Identify what is being communicated
Is the method of communication is acceptable?
If not, are they able to know what they need or want?
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If Yes If No
Establish communication Implement communication system Be consistent Implement in all environments Teach acceptable methods of communication Teach delayed gratification for need/want
Anticipate needs Control environment Teach coping skills
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INTERVENTION STRATEGIES for OBTAIN: COMMUNICATIVE: Something Behaviors Can you give them the object/ activity if attempt to communicate
correctly?
Resisting transition to new activity, insisting on obtaining/ maintaining preferred activity?
When working with objects of obsession:
Use as primary reinforcer for on-task behaviors with specific criteria to obtain
When the object is interfering with the activity or presents a problem
Set up the environment to make sure the object is NOT available
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OBTAINING BEHAVIORS: SENSORY
BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
OBTAIN
Sensory
Productive Nonproductive
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Sensory Obtaining Behaviors
Provoked by 1+ situations/ needs & often maintained by 2-3 reinforcers
Frequently seen in sensory seeking & occasionally in underresponsivity
Powerful sensory systems
Vestibular, Tactile, Proprioceptive
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BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
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BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
OBTAIN: SENSORY: Productive
Productive Sensory Obtaining Behaviors
Behaviors un/consciously used to obtain sensory experience that serve purpose or meet basic sensorimotor need
Stimulate sensory processing, registration, or organization
Increase arousal, pleasure, or postural tone
Productive sensory-obtaining behaviors = key to self-regulation
Are these productive sensory behaviors acceptable?
What purpose does it serve? Is it effective in meeting the child’s need?
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Nonproductive sensory obtaining behaviors
Self-stimulation behaviors that create a reinforcing sensory experience
Endorphin release
Elimination of nonproductive sensory behavior
Address the underlying sensory need or replacement behaviors will develop
When to change a behavior/ intervene: productive sensory behavior + effectively meets need + acceptable ⇒ don’t need to change
productive sensory behavior + effectively meets need + not acceptable ⇒ CHANGE!
nonproductive sensory behavior + not acceptable ⇒ CHANGE!
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OBTAIN: SENSORY: Nonproductive BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
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INTERVENTION STRATEGIES for OBTAIN: SENSORY: Unacceptable Productive & Nonproductive Behaviors Stopping a sensory behavior that serves a purpose, without meeting
that purpose, often results in other, less desirable behaviors.
Analyze to determine sensory need being met
Identify acceptable alternate sensory activities
Design a sensory diet that address underlying sensory system
Teach, prompt, & reinforce the child to use alternate activities
Develop supportive routines, be consistent, & implement in all environments
Behavioral strategies to extinguish, alter, or limit unacceptable behavior
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Problem Solving Framework:
AVOIDING BEHAVIORS
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AVOIDING BEHAVIORS: COMMUNICATIVE
BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
AVOID
Communicative
Attention Task, Object, or
Activity
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Behaviors intended to communicate they want to Avoid/ Escape: attention, people, & events (i.e., social in nature)
Problematic or challenging behaviors used in place of language
May be conscious or unconscious
New people, new situations
Negative attention
Reprimands
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AVOID: COMMUNICATIVE: Attention
BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
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Primary goal: help child learn to cope in new situations by teaching:
1. What to expect
2. How to respond appropriately
3. Assure have skills needed to function in new environment
Give structured positive attention to desired on-task behaviors
Teach routine greetings & social skills
Prepare child for new situations
Teach skills needed
Familiarize child with all aspects of new situation
Practice related activities & responses
Prompt & reinforce desired behaviors
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INTERVENTION STRATEGIES for AVOID: COMMUNICATIVE: Attention Behaviors
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Child avoids task, object, activity
Primary reason for avoidance
Lack the skills needed to complete a task successfully
AND the ability to communicate this effectively
We may believe they are capable, but the child may not believe they are & will act accordingly
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AVOID: COMMUNICATIVE: “Something”
BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
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INTERVENTION STRATEGIES for AVOID: COMMUNICATIVE: Something Behaviors What aspects of the task are they trying to avoid?
Determine primary cause for the behavior through the following:
Task analysis: break activity into component parts, determine skills needed to accomplish the task
Skills analysis: assess child’s functional skills
Emotional analysis: analyze child’s emotional response to the task
Modify environment, grade the task, & help child succeed while convincing child they are capable.
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Task too difficult
Modify task to make easier, provide emotional support
Don’t change activity; provide assistance & emotional support
Therapeutic intervention to↑skills
Lacks self-confidence
Provide emotional support during task completion
Task overwhelming
Modify task & environment to ↓stimulation
Break task into manageable pieces; ↑organization of task
Difficulty adjusting to transition
Establish systems & routines
Dislikes task
Prompt: praise & reward task completion
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INTERVENTION STRATEGIES for AVOID: COMMUNICATIVE: Something Behaviors
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Task boring, not stimulating/challenging
Modify task to make it more difficult/ demanding
Enhance sensory feedback in task or instructions
↑stimulation to activity
Avoids task due to sensory
Treat underlying sensory defensiveness
Refer to sensory avoiding
Task has no meaning
↑sensory registration
Attach meaning to activity
Connect idea of task to end product
↑sensory feedback
Fear of task
If rational: see “task too difficult”
If not: see “avoid – internal systemic sensory”
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INTERVENTION STRATEGIES for AVOID: COMMUNICATIVE: Something Behaviors
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AVOIDING BEHAVIORS: SENSORY
BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory AVOID
Sensory
Sensory Medical/ Visceral
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Sensory-Based Avoidance
Frequently seen in sensory overresponsivity & discrimination disorder
Sensory Hypersensitivities/ Defensiveness
Vestibular
Tactile
Auditory
Multisensory processing difficulties
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BEHAVIOR
OBTAIN
Communicative Sensory
AVOID
Communicative Sensory
Sensory Avoidance Behaviors
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BEHAVIOR
OBTAIN AVOID
Communicative Sensory Sensory Avoidance Behaviors
Nervous system registers sensory input more intensely, & thus prone to overload
Behavioral responses
Emotional responses
Underlying problem sensory, but learned behavior often associated with avoidance
Learned to react emotionally to the actual activity & the anticipation of the event or activity
Resort to challenging behaviors to block out sensory information to calm
Often not aware of sensory overload
Nonverbal children particularly at risk of developing challenging behaviors
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INTERVENTION STRATEGIES for AVOID: SENSORY Identify elements contributing to overload
Identify appropriate sensory-based activities that are effective for calming & organizing
Teach/ guide child to:
Identify warning signs of escalating stress & overload
Recognize & communicate feelings
Use alternate activities for calming & alternate methods
Integrate calming, sensory-based activities throughout the day
Remediate underlying modulation difficulty
Systematically increase tolerance for & scope of new activities
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AVOID: SENSORY: Medical/ Visceral BEHAVIOR
OBTAIN AVOID
Communicative Sensory Pain or discomfort
Hunger
Autoimmune response & histamine reactions
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INTERVENTION STRATEGIES for AVOID: SENSORY: Medical/ Visceral
Illness or impending illness
Hot, tired, or sweaty
Assist parents to determine sensory-based vs. medically-based concerns
Teach child to recognize signs of internal body reactions
Refer & provide support
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Intervention: Sensory Diet
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Calm-Alert State & Self-Regulation Calm-alert state
Ability to function is maximized
Self-regulation
Ability to attain, maintain, & change arousal levels appropriate for task/ situation
Our goal is for the child to function at optimal arousal
Display appropriate level of attention, arousal, & effort for task at hand
What do they need to do for this to happen?
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Sensory Diets Analyze sensory needs through parent interview, observation, etc.
Sensory diets teach compensatory strategies effective in altering arousal levels
Requires the right combination of sensory input
Selection of activities & timing
Vestibular & proprioceptive strongest
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Setting Up a Sensory Diet 1. Identify child’s likes & needs
2. Identify negative factors, activities disliked or avoided, & activities that contribute to sensory overload or shutdown.
3. Establish an action plan *IN COLLABORATION WITH PARENTS*
Select sensory activities, determine length of effectiveness
Plan timing & incorporation of activities throughout daily routine
Develop routines to support activities
Modify environment to support optimal arousal
Assist family to gradually INTEGRATE activities into STRATEGICALLY PLACED intervals throughout the routine
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Sensory Diet for Sensory Underresponsivity Often fail to register sensory information within the environment
Benefit from sensory-based activities that↑their overall arousal
Arousing yet overall organizing effect
Linear vestibular movements combined with deep-touch or proprioceptive input
Repetitive, regular, & fast activities
Avoid activities irregular in speed, rhythm, or movement
Crunchy food is alerting; sour foods are alerting, arousing, & organizing; hot, spicy, or bitter flavors are more alerting; cold temperatures
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Sensory Diet for Sensory Overresponsivity May be hyperresponsive, overregister multiple stimuli, have difficulty
filtering pertinent vs. nonpertinent information, or not process information or assimilate well
Remove factors that↑arousal & defensiveness & add sensory strategies to help calm & regulate
Benefit from inhibition techniques geared toward↓arousal level & anxiety
Deep-touch & proprioceptive input
Resistive activities & isometric exercises
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Slow rhythmic vestibular input
Chewy foods, sucking, blowing, sweet foods
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Environmental & Therapeutic Recommendations for Sensory Diets
IF UNDERAROUSED…
Stronger modalities
Fast, regular, repetitive type movement
Linear vestibular movement & deep-touch/ proprioceptive input
Brightly lit rooms, colors, & fast rhythms & songs
Modify therapeutic use of self
IF OVERAROUSED…
Inhibition techniques
Slow, rhythmic, repetitive activities
Deep-touch/ proprioceptive, resistive input
Neutral warmth or swaddling
Declutter & organize, low lighting, quiet enclosed rooms, slow rhythmic songs
Modify therapeutic use of self
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Intervention: Environmental Techniques
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Environmental Intervention Techniques Primary goal of intervention is to create an environment for the child in
which he does not need to use the behaviors
Engineering the environment
Strategies to reduce distractions
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Environmental Intervention Techniques: Strategies & Systems to Increase Performance Small or subdivided room
Defined boundaries
Noise & sound levels
Visual distractions
Task presentation
Sensory distractions
Emotional environment
Maximize strategies & systems
Follow a schedule, have a plan
Minimize downtime
Make transitions as seamless as possible
Give choices & a degree of control
Set the rules
Give instructions concisely
Use positive behavioral momentum
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Intervention: Behavioral Strategies
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Behavioral Strategies to Increase Positive Outcomes
1. Identify target behavior
2. Attend to “on-task” behavior
3. Avoid punishment & reprimands
4. Reinforcers
5. Delay gratification or reinforcement
6. Demonstration & modeling
7. Prompt desired behavior
8. Shaping
9. Use Time-Outs
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1. Identify target behavior
What do you WANT to occur??
2. Attend to “on-task” behavior
3. Avoid punishment & reprimands
4. Reinforcers
Identify the targeted behavior & appropriate, individualized reinforcer
Child MUST be internally motivated & respond to secondary reinforcers intermittently
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Behavioral Intervention Strategies
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5. Delay gratification or reinforcement
Teach child to tolerate delay while continuing to work
Wait until JUST before the child reaches maximum level
Present concrete end to the task, slightly beyond their tolerance
Then provide reinforcement
6. Demonstration & Modeling: Only beneficial if child can imitate
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Behavioral Intervention Strategies
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Behavioral Intervention Strategies 7. Prompt or facilitate the desired behavior
Need to know baseline function without prompts/ assist
Physical prompts
Verbal prompts & verbal feedback
Visual prompts
Fading: Most ⇄ Least prompting & Time delay
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Ranking of Response Prompts
Type of Response Prompt
Level of Intrusiveness Fading to Teach New Skill
Fading with Chance to Respond Independently
Verbal Least (weakest)
Gestural Moderately Low
Modeling Moderately High
Physical Most (strongest)
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8. Shaping
Differential reinforcement of successive approximations of a target behavior until the person exhibits the target behavior
Forward & Backward Chaining
Rewarding approximations of desired response
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9. Use Time-Outs
Request a time-out
Good for children with anxiety, sensory overload, or regulatory disorders
Non-punitive time-out
Remove child from environment/ reinforcer & do one of the following:
Do not talk to, make eye contact with, or attend to the child
Give an exercise time-out & use heavy work to calm & reorganize
Coach the child through calming strategies
Adult Time-Out
Interrupt attention-seeking challenging behaviors to reward appropriate behavior
Stop & shut down all activity by averting gaze for 15-20 secs, then reward next appropriate behavior
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Video: Michael at daycare, play food
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Intervention: Temper Tantrums
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Temper Tantrums Developmentally appropriate ~18 mo. – 3 years
Tantrums are windows of opportunity to establish & develop:
Methods of communication between the child & adults
Self-regulation & emotional control
Appropriate environmental interactions
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Avoiding Temper Tantrums Address the child’s basic needs
Environmental modifications
Assist in self-regulation & meet internal systemic needs
Provide necessary sensory environment & activities for self-regulation
Recognize early warning signs & intervene before tantrum occurs
Sensory based activities to obtain sensory regulation, ↑activity appeal, & provide calming influence
Teach the child to work through the episode
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Proactively Avoiding Temper Tantrums Help develop communication skills
Developmentally appropriate activities
Stick to routines
Allow transition time & give a warning
Keep off-limit objects out of sight & out of reach of the child
Prep for new situations & new people
Positive attention for on-task behavior
Consistently enforce the rules & expectations
Give choices, but if there is no choice, do not phrase as a question
Avoid giving “no” answers; try to provide an alternative instead
Avoid power struggles
Choose your battles
Help the child emotionally avoid a tantrum
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If you see them getting frustrated & a tantrum may develop…
If they are trying to avoid doing something:
Don’t let them succeed in avoiding; ignore the behavior & work through the task
If needed, ↓number of repetitions/ lower requirements to ensure success
Don’t discuss the event or behavior
If you can’t do this, then ignore the behavior
If you can’t ignore the behavior, remove them from the situation (time-out) until they calm
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Basics of Handling a Temper Tantrum: IGNORE!!
Why ignore a tantrum?
They’ve lost it… reasoning does not work
Attention makes it a more rewarding experience
1. Do not react & remain calm
2. Protect yourself, others in the area, & the child from harm
3. Ignore the behavior
Don’t try to stop the tantrum in the middle or try to rationalize them
Choose your strategies based on the child’s needs & developmental level
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If they can’t calm down on their own… Many challenging behaviors provide reinforcing sensory input
Ignoring not enough; Intervention must include sensory & behavioral strategies
May need help to break the cycle
Take them out of the situation
Pick up & firmly hold to stop flailing arms & legs
Hold him firmly & hide/ cover their face
Count, sing, or say ABC’s softly & slowly (i.e., rhythmic & repetitive)
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As the tantrum is winding down… As they calm:
Move toward them & praise for calming down
Comfort them, but don’t give into demands
Respect their emotions while reinforcing ability to calm
The goal is to re-engage the child in the task & end on a positive note, not necessarily complete the task
Reward constructive & positive behaviors immediately & consistently
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Rules for this phase include:
Don’t make fun of or belittle for the tantrum
Don’t punish or label as “bad” boy or girl
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After the Tantrum Resolves Most children are vulnerable & need reassurance
The goal is to teach better ways to communicate, express, & handle emotions so they don’t need to throw tantrums
Convey that when they use words & remain calm, you will listen & tantrums don’t get your attention
Analyze the situation – what actually happened?
Once calm, acknowledge their feelings
Talk about their frustrations & try to solve the problem
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VIDEOS First Signs: Regulatory & Sensory Systems
Emotional Regulation
#2, right: Taking away book
#3, left: Balloon play
#5, left: Cleaning up letters
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References & Resources Miller, L. J., Anzalone, M. E., Lane, S. J., Cermack, S. A., & Osten, E. T. (2007). Concept
evolution in sensory integration: A proposed nosology for diagnosis. The American Journal of Occupational Therapy, (61)2, 135-140.
Miltenberger, R. G. (2004). Behavior modification: Principles & procedures. 3rd edition. Wadsworth, a division of Thomson Learning, Inc.: Belmont, CA.
Murray-Slutsky, C. & Paris, B. A. (2005). Is it sensory or is it behavior? Behavior problem identification, assessment, & intervention. Hammill Institute on Disabilities: Austin, TX.
Center on the Social & Emotional Foundations for Early Learning: www.csefel.vanderbilt.edu
Technical Assistance Center on Social Emotional Intervention for Young Children: www.challengingbehavior.org
Center for Early Childhood Mental Health Consultation: www.ecmhc.org
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References & Resources www.healthychildren.org
www.zerotothree.org
www.pathways.org
www.veipd.org/earlyintervention
www.buildinitiative.org
www.gucchd.georgetown.edu
www.firstsigns.org
www.autismspeaks.org
www.ableplay.org
www.abilitypath.org
www.sensorysmarts.com
www.spdfoundation.net
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To Tack or Jibe: Problem Solving for Sensory-Based
& Other Behavioral Difficulties
2014 Early Intervention & Preschool Conference Mobile, Alabama
November 17 – 19, 2014
Laura Schertz MS, OTR/L [email protected]