Is it Sensory, Behavior or Both?

by Chelsea Jancewicz, MOT, OTR/L

Is it sensory or behavior?  This is one of the most pervasive, problematic, and tricky questions to answer in the OT world.  Parents often have to decipher which intervention method or even which specialist to trust.  Imagine hearing from one specialist that your child is having tantrums due to a sensory processing disorder and must try sensory integration interventions, while another specialist insists that the same behavior is simply an attention seeking behavior and must be ignored using behavioral interventions.  Have you wondered…  Is my child trying to get away with something?  If I don’t let her swing, am I hindering her sensory processing development?  Should this be ignored? Am I wrong if I give my child a squeeze toy after she has been screaming?

Often, the answer to the question, “Is it sensory or is it behavior” falls somewhere in the gray area.  In other words, it may be BOTH.  The answer – and the solutions – are not always clear cut.  A child’s tantrum may simply be a behavioral tantrum.  Other times, a tantrum may be purely due to a sensory processing disorder.  Tantrums and sensory processing disorders feed into 07one another. So, how am I supposed to decide what to do, how to react, or how to help soothe my child when she is having a tantrum?!

The basics

Tantrum = an outburst that happens so the child gets what he/she wants.

Sensory Meltdown= a reaction to feeling overwhelmed by too much stimulation.

Example 1: In the behavioral world, often times we keep a written log of the event that happens right before the child is having an outburst.  The event that happens right before the outburst occurs, is called the antecedent.  So, let’s say that you just asked your child to turn off his favorite TV show before it was over (antecedent) he then becomes upset and throws himself on the floor (the behavior).  This may be interpreted as a tantrum with his behavior being interpreted as an escape from the demand (turn the TV off).

Example 2:  In the morning you help your child complete some basic hygiene tasks.  She still needs assistance with brushing her teeth.  She allows you to put the toothbrush into her mouth, but once you begin brushing her teeth (antecedent), she pushes your hand out of her mouth and begins screaming (behavior).  This may be interpreted as a tantrum due to a sensory meltdown if the child has difficulties tolerating different textures on her skin or in her mouth.  Her mouth may be overwhelmed by the amount of stimulation her toothbrush is providing.  She may even be interpreting the sensation of the tooth brush as needles in her gums of her brain.  However, once she receives intervention and is better able interpret her sensory input she should be able to tolerate brushing her teeth.

Example 3: So, let’s say that after the girl in the toothbrush scenario receives sensory integration intervention and is able to tolerate brushing her teeth without any tantrums due to a sensory overload. However, at home she continues to demonstrate tantrum behaviors with ONLY mom when brushing her teeth.  This girl may have learned that if she screams while brushing her teeth, she is getting attention from mom.  Even though the attention from her mom may be negative, the girl is still interpreting it as attention.  Hey, any attention is better than no attention, right?  This may be an example of a behavior that has been learned over time that generates attention from Mom.  But mom may be worried that her sensory system is still not regulated, when it is actually behavioral – not sensory at this point in time.

In summary, behavior and sensory processing are not simple, black and white issues. It is important to understand that sensory processing disorder requires a sensory integration approach, but using behavioral interventions simultaneously is very beneficial to the child and the family.  Remember that each child is unique and each behavior is unique.  Just as the child grows and changes, so does the behavior!  The best way to for parents to sort this issue out is to have an evaluation by an OT that understands both the sensory and the behavioral components of this complex issue.


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