“Is it sensory or is it behavior?”

That question was asked on Facebook by a pediatric occupational therapist who works in the school system and was looking for feedback in regards to a child on her caseload. She felt like she had ruled out significant sensory contributions to the behavior and was looking for confirmation. This is my reply to that question:

Occupational Therapists are often asked that question to rule out sensory sensitivities or sensory integration challenges as an underlying cause for a behavior that can’t be explained. On the surface, it is a compassionate question. It allows for the individual differences that come along with sensory challenges, and encourages adults to assume a less judgmental stance on the behaviors they are seeing.

But underneath the question “Is it sensory or is it behavior?” is the assumption that if it is not “sensory” it is “just behavior”.

It isn’t “just behavior”.

Behaviors are an announcement of what is going on inside of us. They are a communication about our felt sense of safety, our regulatory capacity, our present moment experience, our connection to the people around us, and the skills we have to be adaptable.

Ruling out “sensory” isn’t enough.

Our compassion and interventions must extend to challenges beyond sensory.

Because kids do well if they can. If they aren’t behaving well we need to dig deeper, ask better questions, and provide more support.

If you don’t know where to start, here are some suggestions of dos and don’ts:

“Dos and Don’ts” of treating children with behavioral challenges:

Don’t: Ask “Is it sensory or is it behavior?”

Do: Ask “Is this behavior rooted in sensory challenges?” This question is an important one that OTs can help to answer, if they have received training in evaluating and treating sensory integration/sensory processing challenges.

Don’t: Assume it is willful behavior when you have ruled out sensory challenges.

Do: Keep investigating underlying skills and capabilities. Kids do well when they can.  If they aren’t doing well there is some skill or ability that is lacking or under-developed. Assume that there is something you can do to help. Or refer to someone who can. But please read on before you assume that a behavior interventionist is the right person to intervene.

Don’t: Ignore or withdraw affection and attention in an attempt to change or control the child’s behavior. 

Do: Stay connected to the child. Our brains are literally built for connection and giving attention is not a reward for bad behavior.  Staying in connection, even in the tough moments, is our chance to show the child that they can make a mistake and still be seen as a valuable person. Our brains learn best when we feel connected, so staying relationally connected is supported by current neuroscience as the best way to help a child learn new behaviors. Check out our blog on connection for more ideas and information.

Don’t: Use punishment and expect more adaptive behaviors to emerge.

Do: Teach more adaptive behaviors through connected interactions that help the child to feel safe. Each time we help the child to re-regulate we are building a pathway in their brain.  With many repetitions they internalize this regulation, resulting in better self-regulation and fewer problem behaviors.

Don’t: Expect the child to stop their behavior to alleviate your own feelings of discomfort (irritation, frustration, embarrassment, anger, etc).

Do: Regulate yourself first! Notice what is happening in your body and do the things that help you to deactivate when you are triggered by a child’s behavior.  It can take practice to get good at accessing our tools when a child is misbehaving (just like our kids need practice to get good at using their tools when they are triggered). Learn more about regulating yourself starting with present moment awareness on our blog.

Don’t: Withhold sensory experiences to avoid rewarding bad behavior.

Do: Decrease maladaptive behaviors by providing input that is organizing for the brain. Sensory strategies can help the child to re-regulate and move back into their window of adaptability, allowing them to be available for learning. When we provide those inputs proactively, or even in the moment of overwhelm/bad behavior, we are not rewarding bad behavior, rather we are teaching the brain to access those strategies for regulation. If there is a frequent need for sensory strategies, take the time to figure out which strategies are effective for that individual, and be sure to build those opportunities into the child’s day, proactively.

Don’t: Expect a child to use tools and strategies to reregulate independently.

Do: Co-regulate.  Help the child by coming alongside and offering tools and options.  When they are dysregulated they don’t have access to their cortical brain (thinking brain). The less sophisticated lower brain structures (feeling brain) take over until we are feeling re-regulated. Even if they can name lots of strategies when they are calm, they will likely need help accessing them when they are upset. With practice, they will be able to access strategies that they have used successfully many times before. That’s how we learn self-regulation!

Don’t: Try to reason with the child or problem solve while they are upset.

Do: Help a child regulate before trying to find solutions.  Problem solving and reasoning can only happen when our brains are able to match the energy needed for thinking.  If their brain is too activated, they don’t have access to the cortex. Better yet, wait until a time that they are regulated and feeling connected to solve the problem collaboratively.

Don’t: Assume the child feels safe because you perceive that they are physically safe in the current environment.

Do: Learn to read the signs: How are they breathing? Is their body open and leaning in or are they withdrawing? Is their skin flushed, pale, discolored? What is the quality of their voice? Are their movements rhythmical or dysrhythmic?  Are their muscles tight or floppy or somewhere in between? Is their pain tolerance typical or do they seem to have a high pain tolerance? These signs can help us to know if a child has a sense of felt safety. A quick tip is to notice your own need to control the situation. Controlling behaviors are a sure sign that you do not feel safe, and because we are always coregulating with people around us, the child in that situation is not feeling safe either.

Don’t: Use language and reasoning with a child who doesn’t feel safe.

Do: Understand that felt safety is a product of perception and provide safety in your interactions.  We perceive things happening around us (in the environment), inside of us (from our body sensations), and relationally (between us and other people) . Our brain takes that information, compares it to things that have happened to us in the past, and decides whether we are safe or not safe, all on an unconscious level, in a split second! We can create safety for others through connected, relational ways of interacting; through rhythmic, repetitive activities; using sensory strategies; with our own body language; and by adopting a compassionate lens for the way we view others.

Don’t: Decide that the behavior should be modified by stricter rules, punishment and reward paradigms, or shaming.

Do: Offer the family and the child co regulation and a chance to been seen as doing the best they can.  We ALL do better when we feel understood and supported.  As therapists, our work is often to find the barriers in ourselves to feeling empathy and compassion for our clients and their families. We will have the greatest impact when we can stay regulated, flexible, curious, compassionate, and connected.

Don’t: Dissmiss a child as “attention seeking”

Do: Try replacing “attention seeking” with “connection seeking”.  Connection is a biological imperative.  Once upon a time we were doomed to certain death if we weren’t connected to our tribe, so nature built connection seeking into our DNA.  For some children, even negative attention feels more connected than no attention, so they will engage in behaviors that get attention in whatever way they can.  Giving them consistent connection, even when their behaviors are not meeting expectations, will build their capacity for self regulation. 

Don’t: Assume they are lazy or spoiled.

Do: Consider the executive functioning skills that are needed to have adaptable behavior. We need to know how to motivate ourselves, initiate and sustain behavior, plan and execute adaptive responses, tolerate discomfort, demonstrate impulse control, and have lots of flexibility in our cognitive and emotional responses. These are skills that we learn over a lifetime, and they are skills that can be taught when a child is lagging in their development.

Don’t: Assume that working with “behaviors” is out of the scope of OT practice.

Do: Acknowledge if you don’t feel like you currently have the skills to provide the child and their family with adequate support in matters of attachment, regulation, communication, or sensory integration. If possible, help them find someone in the area who is going to see behavior from a lens that is trauma responsive and follows current science on behavior and learning from a relational neuroscience perspective.

Don’t: Try to do this alone.

Do: Reach out to colleagues, mentors, friends, or loved ones who see others through this lens of compassion. Be gentle with yourself.  We ALL do the best we can with what we know.  We ALL do better when we feel regulated and connected. We ALL need to feel connected to learn and grow. We ALL need the skill of having compassion for ourselves and that skill is built from feeling compassion that is extended to us by others. If you are in need of connection seek out others who support this way of looking at humans. Those connections will empower you to be more Powerfully You! Learn more about self-regulation and what we can do to support children here.

Are you a professional looking for ways to support kids with challenges in self regulation?

Powerfully You teaches self regulation from a compassionate lens that values connection and individual differences.

Written by: Amy Lewis OTR/L

Co-author of Powerfully You

For more information see these sources:

The Whole Brain Child by Dan Seigel Books by Dan Siegel

Trauma Sensitive Practice Course from Kim Barthel Relationship Matters Website

Lost and Found by Ross Greene Lives in the Balance website

Beyond Behaviors by Mona Delahooke Mona Delahooke's Website

Podcasts and courses by Robyn Gobbel Robyn Gobbel's website

Parenting with Presence by Susan Stiffleman Susan Stiffleman’s Website

Self-Compassion by Kristin Neff Self-Compassion website

Self-reg by Stuart Shanker Stuart Shanker’s website

Introductory coursework in the Neurosequential Model by Bruce Perry The Neurosequential Network

The Connected Therapist by Marti Smith Book Link

Concepts from The Polyvagal Theory by Stephen Porges Stephen Porges’ website