This month’s ASAT feature comes to us from Carl Sundberg, PhD, BCBA-D
Behavior Analysis Center for Autism and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!
Some
people believe behavior analysts are “anti-sensory” — opposed to offering any
sensory-based experience for individuals with autism spectrum disorder
(ASD). The term “sensory” can be problematic and ambiguous because it
does not specify whether an individual is showing a sensory preference or
sensory aversion, nor whether the sensory experience is a “like” or a “need.”
It may also minimize or disregard other explanations for why a behavior is
occurring. These distinctions are significant when developing a treatment
plan. In
this brief article, we clarify how behavior
analysts approach sensory issues.
Not every behavior problem
should be assumed to have a sensory basis.
It
would be beneficial to discuss the many faces of motivation. Each of us, not just
children with autism, may be highly motivated by sensory experiences that vary
in modality, intensity, and duration. Ever catch yourself tapping your pencil,
twiddling your thumbs, biting your nails, or popping bubble wrap. If so, would
you say you have “sensory issues”? We
are all highly motivated by other experiences as well such as attention, a
smile, a knowing look, or laughter. Other times, it is something tangible and
specific, such as a new pair of sneakers or a piece of artwork. We all engage
in a wide array of behaviors to access these experiences. On the flip side,
sometimes we are motivated to avoid or escape certain forms of
attention (e.g., closing our office door or ignoring telemarketer
calls) or other specific things (e.g., a traffic ticket or non-preferred
vegetables). Why is this important?
First, assessment of
challenging behavior must carefully assess the function
for that behavior (i.e., underlying motivation) in order for it to have the
greatest likelihood of leading to effective intervention. We intentionally referenced the same behavior
(biting) in a few different examples to help make the distinction between form (e.g., biting) and function (e.g., to escape a demand of
gain sensory input).
- Tommy bites his teacher when she attempts to help him put on his snow boots.
- Lisa bites her father as soon as he stops playing
with her and attempts to leave the room to take a phone call.
- Sudhir bites his babysitter when she asks him to put away
his iPad.
- Melanie bites classmates when the fire alarm sounds
or her older sister plays music loudly.
- Jennica bites her father’s arm when he wears long
sleeve dress shirts.
- Mitchell’s teeth are coming in and he has been seen
biting a plastic hanger.
As
you can see, the same behavior (biting) occurs in very different contexts and
likely serves very different functions. In some instances, the motivation may
be to get or keep a preferred item or activity, whereas in other instances, the
child is trying to avoid or escape something he or she does not like. A “sensory” explanation
based on the fact that they are biting would miss the mark in most of the
examples illustrated above. If we
mislabel certain behaviors as “sensory,” the recommended sensory intervention
will not address the targeted behavior properly and may prevent access to more
effective intervention.
Not every sensory-seeking
behavior reflects a “need.”
Let’s
examine the misuse of the term “sensory need” and differentiate between a
sensory need and a sensory preference. Some individuals with autism enjoy
swinging, may be willing to work hard to earn it and show pleasure while
swinging. Whereas other children may start off agitated and appear calmer
following swinging, but it is not necessarily an experience they would choose
(children experiencing pain relief from taking aspirin may also benefit from it
but not necessarily choose it).
Activities stimulating the senses can serve multiple
behavioral functions, depending on the motivation. Jumping on a trampoline is
likely to be repeated because of its reinforcing vestibular effects — it is
fun. This leads to the question, “Does the student jump on the trampoline
because he or she needs to jump on the trampoline, or because it’s
enjoyable?” Again, the responses one engages in depend on the learning history,
communication skills, social contingencies, and the strength of the motivation.
“Sensory” concerns have profound
implications for the teaching of new skills that can be targeted through
behavior analytic strategies.
Any
discussion on “sensory issues” would be remiss without some mention of sensory
hypersensitivity. We have also observed some individuals with autism who
have extreme reactions to sensory input (e.g., loud noises, bright lights) and
there are those who are extra sensitive to textures or certain clothing (e.g.,
the tag in the back of a shirt or particular food). These children/adults learn
to engage in behaviors that reduce the aversive nature of such stimulation. But
this isn’t exclusive to autism – there are also people without autism who are
sensitive to certain stimuli as well.
There
are individuals who experience extreme discomfort when exposed to situations
which would be considered typical to most of us (e.g., loud music). Some will
engage in behaviors that relieve the anxiety, such as escape behaviors (leaving
the situation), avoidance behaviors (skipping the situation entirely), or
engaging in some incompatible behaviors (practicing relaxation techniques). In
these cases, sophisticated skills and strategies are in place.
It is unfortunate that many people with autism do not have the
skills to engage in the socially accepted methods that relieve anxiety or discomfort.
However, many other non-socially accepted behaviors have been shaped and have
proven to be effective in removing the aversive stimulation. If we were in a
room where the music is too loud, we would leave or ask for it to be turned
down. If those behaviors are not possible, we may have to tolerate the
situation. We have learned that behaviors such as biting will result in
undesired social consequences. But what if:
- We did not have the language to ask for the music to
be turned down?
- We did not know that leaving was an option, or did
not know how to ask, or were forced to stay?
- We didn’t value the social
consequences as others so? That is, we didn’t currently care how others
perceive us or if we get invited back.
If all those were true, we might engage in biting to
get the music turned off or get removed from the room once we see that this is an effective
behavior.
Now,
suppose we do have those skills, and we can always find a way to get out of
situations that cause stress or sensory overload; or we tough it out because of
the social contingencies that have been learned over our lifetime. Chances are,
no one would suggest we had sensory issues and put us on a sensory diet or
prescribe sensory integration therapy. However, a person with autism who may
have the same level of discomfort and escapes the situation in the only way he
or she knows how, is often said to have “sensory issues” when perhaps it would
be more helpful to say he or she has skill deficits.
In
summary, to
develop the most appropriate and effective treatment, one must analyze the
function, evaluate whether the behavior has a sensory basis (and whether it
reflects a “need” or a “like”) or other underlying
motivations. It is then important to identify skills (e.g., requesting)
that may either compete with and potentially replace the behavior or provide
the individual with coping skills to better negotiate his or
her environment.
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Carl Sundberg, PhD, BCBA-D, is the chief clinician and founder of the Behavior Analysis Center for Autism. He received his doctorate degree in ABA from Western Michigan University under the direction of Dr. Jack Michael. While a graduate student, he taught behavior analysis at WMU for seven years. Dr. Sundberg has publications in The Analysis of Verbal Behavior (TAVB), A Collection of Reprints on Verbal Behavior, and the Journal for the Experimental Analysis of Behavior (JEAB). Dr. Sundberg has over 30 years of experience using behavioral interventions to teach individuals with autism and other developmental disabilities. He oversees the training of all the staff at BACA and consistently spends time with the clients. Eighty percent of his time is spent contributing to the training of staff and addressing specific client programs.
David Celiberti, PhD, BCBA-D, is the part time Executive Director of ASAT and Past-President, a role he served from 2006 and 2012. He is the Co-Editor of ASAT’s newsletter, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis, and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to applied behavior analysis (ABA) at both the undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.
