Sensory vs. Behavior: Unpacking the Dangers of a False Dichotomy
If you work with a pediatric population or have a child with a diagnosed disability, you have undoubtedly heard this question before: “Is it sensory or is it behavior?”
There are entire continuing education courses dedicated to providing answers. Therapists from across disciplines spend hours “picking each other’s brains” to determine exactly which category a child’s observed target behaviors fit into (Escape? Attention? Access to a Preferred Tangible? None of those, huh? Maybe sensory, then?), but I have learned something recently—it’s the wrong question.
As a new occupational therapist with a background in Applied Behavior Analysis (ABA), I quickly wanted to make “sensory” a new function of behavior. I neatly assumed that any underlying sensory need for a client could be a synonym for an “automatically reinforcing behavior”. This made me feel good, as this was the area deemed the most tricky in the world of behavior modification. With both lenses, I was sure I could figure out even the toughest of cases, but it didn’t work. The more I dove into the world of sensory (that which is internal, and inherently difficult to observe and measure), the more confused I made myself.
“The goal of ANY sensory intervention is never to change a child’s inherent preferences, but to accommodate them in a way that maximizes both quality of life and meaningful participation in occupations.”
Case in point: let’s call my friend “Charlotte”. Charlotte has a history of plugging her ears, screaming, and running out of the classroom whenever she is presented with a task she deems difficult. The ABA therapist comes in, collects ABC data (Antecedent-Behavior-Consequence) and determines that the behavior is escape maintained. The occupational therapist then comes in, gives the child a Sensory Evaluation, and determines Charlotte has some difficulty with modulation in the areas of “auditory filtering”. During observation, the OT notices that Charlotte’s teacher gives particularly long, explanatory verbal instructions. There is also a smoke detector beeping and children whispering in pockets of the classroom. She determines that the elopement behavior is “sensory” in nature. Which therapist is right?
Well…aren’t they both?
Here is the danger of the sensory vs. behavior question—it’s too simple. It assumes a dichotomy between how a person processes sensory information in the brain and their observable, measurable behaviors. Thanks to MRI machines and other medical advancements, we now know more about the brain than ever before. One tried and true rule in the world of neuroscience is this: Sensory input equals motor output.
In simpler terms, our brains are rigorous data collectors. We are constantly bringing in information via the senses from our environment to our brain. Our brain then processes this information and (either consciously or unconsciously) uses that information to formulate a series of motor outputs (movements, or as I like to call them, BEHAVIORS). Behavior and sensory input go together like peas and carrots. We need to STOP treating them like sworn enemies, either/or, winner and loser. In actuality, they are codependent besties. You can’t honestly tease out one and still get the full picture of the other.
Behavior and sensory input go together like peas and carrots.
We need to stop treating them like sworn enemies.
We can go on for ages philosophizing about this newfound discovery. But we have children to raise and caseloads to treat, and here is what we all are really looking for—clinical implications. I am all about solution-based problem solving, and we have already determined that “Is it sensory or behavior?” is the wrong question. So here’s a less cringe-worthy alternative, “Is there a sensory intervention that would serve as an effective preventative strategy for (insert your target behavior here)?” Because here is the truth of it all—we all have individual sensory preferences. The goal of ANY sensory intervention is never to change a child’s inherent preferences, but to accommodate them in a way that maximizes both quality of life and meaningful participation in occupations.
So, to recap: Here are some Do’s and Don’ts when it comes to treating a child with unique behavioral and sensory needs (READ: EVERY CHILD):
DO:
Take a holistic approach, regardless of your particular disciple. Being able to look at a child as a whole human being, through multiple lenses, is ultimately what is best for everyone.
Take data, and expand your definition of antecedent to include that which is happening in the environment (with particularly close consideration to smells, sounds, movement demands, positioning, etc.)
Take even more data—on sensory interventions and their efficacy. This is how we make evidenced-based decisions on something that is inherently internal.
Be a team player. ABA is great. OT is great. Both are better.
DON’T:
Ever say “Is it sensory or is it behavior?”
Remember, besties.