1/12/17. Sensory Modulation. Modulation Disorders. The Mixed Response Person. Sensory AND Behavior. Sensory AND Behavior. Gwen Wild, MOT, OTR

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1 Sensory AND Behavior! Facebook Page: Sensational Brain! Pinterest: sensationalbrain.com Gwen Wild, MOT, OTR Sensory Modulation! The neuromodulatory process involving the adjustment of neural messages that convey information about intensity, frequency, duration, complexity and novelty of sensory stimuli.! Involves sensitization, habituation, and other facilitory and inhibitory processes in the CNS.! Sensitization: after initial reaction to a strong or noxious stimulus, the person s behavioral response to that stimulus becomes stronger (defensive).! Habituation: with repeated stimuli, the person stops responding to the stimulus. Modulation Disorders! Over- or under-responding to sensory input, usually with atypical affective response.! LD, ADD, ADHD, ASD, Fragile X, DD Modulation allows us to focus on what is important. The brain has difficulty determining what is important. The Mixed Response Person! Some people with modulation disorders, especially people with ASD, demonstrate extremes of over-responsivity in some sensory systems and under-responsivity in other systems.! Common ASD pattern: over-responsive to visual, auditory, olfactory, gustatory, and tactile input; under-responsive to vestibular and proprioceptive input. Sensory AND Behavior! Common Behaviors Rooted in Sensory Needs: " Over-reactions to routine situations " Aggression during routine tasks " Self-Injurious Behaviors " Transition Difficulties 6 1

2 Figure It Out! Assess the sensory needs of the child! Analyze the behavior in light of the child s sensory needs! Analyze the behavior itself - what is he/she getting out of it? Sensory Symptoms Checklist! Items on the checklist can be due to a variety of factors (not always sensory) - culture, psycho-social background, personal preferences, etc.! Use the checklist to look at overall patterns of responsiveness.! Refer back to the checklist after completing the behavior analysis. 7 8 Behavior vs. Sensory! Behavior Analysis " ABC behavioral analysis " A Antecedent " B Behavior " C Consequence The A of ABC Analysis! Antecedents to Consider: " People present in room " Proximity of others to the student " Lighting, sound level, smells " Task demands too high? Too low? " Time of day, day of week " Chaos level transitions, behavior of others " Frustration factor Example: Justin was asked by his paraprofessional to sit down and complete a work task. She used verbal and physical prompts to guide him toward the chair. The classroom was otherwise quiet at the time. The B of ABC Analysis! Behavior " Be specific " Length of behavior " Date and time " Sensory input provided by behavior? Example: Justin pushed paraprofessional s hands away then bit his wrist three consecutive times while grunting and stomping his foot. Less than 30 seconds before he complied with request. Sensory input provided by this behavior: proprioceptive input to upper extremities (pushing), leg (stomping) and to wrist and mouth (biting). The C of ABC Analysis! Consequence " Response to the behavior by the individual as well as by others in the environment. " Is the result anything that could be considered to by positive by the student?! If not, we may feel more confident in assuming the behavior is mostly for the purpose of sensory input.! If something perceived as positive results, we can feel more confident in assuming the behavior is mostly an attempt to get a desired result or to control the situation.! When in doubt, use a wholistic approach (sensory, cognitive, behavioral). 2

3 The C of ABC Analysis, Cont.! Consequence Example: Justin s parapro ignored the pushing, stayed close to him, did not repeat the instruction. Justin sat down and began the task without further cues. A Whole-Brain Approach to Difficult Behaviors! Proactive Intervention! Reactive Intervention 14 A Whole-Brain Approach to Difficult Behaviors Are sensory strategies proactive or reactive?! As much as possible, we want sensory strategies to be used proactively. The purpose is to meet the sensory needs on an ongoing basis to reduce the occurrence of maladaptive behaviors.! Sensory strategies can be used as rewards (reactively)for adaptive behaviors but must not take the place of proactive sensory intervention.! Sensory strategies typically should not be provided after a maladaptive behavior occurs. This could inadvertently reward the maladaptive behavior. Exception may be for calming strategies to end a meltdown. Neurochemicals and Proactive Sensory Input! Sensory Input Neurochems Emotions! Intervening at any of the above three areas will affect the other two. 15 The Sensory-Behavioral Connection! Neurochemicals involved in sensory modulation (*Please note - theories vary and much research is still needed) " Serotonin! Feel good neurochemical - plays role in positive mood, sleep, appetite, satisfaction! Low levels - depression, ADHD! High levels - manic phase of bipolar! Proprioceptive input results in increased serotonin. Self-injurious behaviors result in increased serotonin as well. The Sensory-Behavioral Connection! Neurochemicals involved in modulation: " Dopamine! Plays role in sleep/wake cycle, pleasure/reward system, and motor control! Released through rewarding experiences such as learning, praise, food, sex! Low levels - depressed phase of bipolar, ADHD! Proprioceptive input increases dopamine level. Rewarding sensory experiences increase dopamine level as well. High intensity input needed by people with low levels of dopamine. 18 3

4 The Sensory-Behavioral Connection The Sensory-Behavioral Connection! Neurochemicals involved in modulation: " Epinephrine! Adrenaline, fight or flight response. Represses parasympathetic nervous system (responsible for sleep, digestion, immune response). Increases cortisol (stress hormone) level.! Epinephrine level is increased through high-intensity sensory input, stress, anxiety. Decreased through long duration,! Neurochemicals involved in modulation: " Endorphins! Natural painkillers. Runner s high.! Released through exercise (proprioceptive and vestibular input). Also released through pain itself.! Sometimes self-injurious behaviors are endorphin-seeking in nature. low intensity exercise or sensory input Proactive Whole-Brain Approach Strategies! Sensory Program! Cognitive Preparation! Motivation (Behavioral) Reactive Whole-Brain Approach Strategies! Rewards and Undesirable Consequences (Behavioral) Proactive Whole-Brain Strategy #1: Sensory Program! Teach Self-Modulation! Implement a Sensory Diet " Sensory Breaks - a structured time for appropriate sensory input. Sensory breaks can be scheduled or as needed based on modulation cues. " Sensory Routines Sensory input built into a typical routine (i.e. getting ready for bed). " Sensory Modifications and Adaptations - Changes to the environment or task that inherently assist with sensory processing. Proactive Whole-Brain Strategy #1: Sensory Program " Resources! BrainWorks at My Sensory Book by Lauren Kerstein, available at Amazon.com! Diana Henry s Tools series available at The Alert Program at

5 Proactive Whole-Brain Strategy #2: Cognitive Preparation! Visual schedules: Use tools such as BrainWorks, pictures for PECS, or photos to set up schedules focusing on times of day or specific tasks that are problematic Proactive Whole-Brain Strategy #2: Cognitive Preparation! Social Stories " " Video Modeling " " v=j0nbatn5vuo&feature=related " Proactive Whole-Brain Strategy #2: Cognitive Preparation! Communication Support! Programs to develop social and emotional Skills " " Proactive Whole-Brain Strategy #3: Motivation Reactive Whole-Brain Strategies! Motivation is achieved through making sure the child understands the rewards and consequences. These can be added to social stories and video models, shown on visual schedules and verbal reminders can be given.! Rewards to reinforce adaptive behaviors.! Undesirable consequences to discourage maladaptive behaviors.! Our purpose is not to punish a child for his sensory issues, but rather to encourage and motivate him through rewards and undesirable consequences to replace his maladaptive behaviors with more appropriate ones

6 Finding Rewards that Work! Ideally, consult with the behavior specialist.! Common reinforcers include edibles, sensory items, and preferred items or toys.! Preference and Reinforcer Assessment App: +Assessment.aspx! Checklists available online: Rewards, Cont.! Token Economy " Children receive tokens for desired behaviors to be exchanged for backup reinforcers. " Video: " Undesirable Consequences # Consequences teach boundaries and limits. # Undesirable consequences should only be used when the student has been taught an alternative behavior. Example: Student with no method of communication receives an undesirable consequence (time out) for screaming. The consequence is not likely to be effective since he does not have an alternative means of communication. # If the behavior is rooted in a sensory issue, the sensory needs must be met and strategies for selfmodulation must be in place. At that point, undesirable consequences can be used to motivate the use of sensory strategies to replace maladaptive behaviors. Undesirable Consequences, Cont. # Natural and logical consequences $ People who hurt others cannot sit at tables with others. $ People who act in an unsafe way cannot stay in PE. $ People who throw candy do not get any more candy. $ People who are fussy need to go to bed early. $ People who throw their supplies must pick them up. $ People who poop in their pants must clean up the mess themselves Undesirable Consequences, Cont. # Planned Ignoring $ Typically recommended for non-dangerous behaviors that seem to be attention-seeking in nature such as spitting, noise-making, or incessant talking. $ Behaviors typically get worse before they get better with planned ignoring. # Loss of a privilege # Addition of something undesirable i.e. extra chores. Case Study: Karsen! Over-responsive to auditory, tactile, oral and olfactory input. Underresponsive to proprioceptive input.! Target Behavior: " Aggression during ADL s

7 Sensory and Behavioral Analysis and Plan! file://localhost/users/gwenwild/ Documents/Karsen SB A&P.docx Case Study: Kyle Case Study: Kyle! Over-responsive to auditory, tactile, vestibular, visual, oral and olfactory input.! Target Behaviors: " Reduce meltdowns " Increase flexibility in circle-time seating! Kyle s Whole-Brain Approach to Behavior Management Sensory and Behavioral Analysis and Plan! Kyle s Sensory Behavioral Analysis and Plan Research! Sensory Diet Research,

8 *Data from Gwen Wild s Study Parent s Perception of Effectiveness of Sensory Diets: A Multiple Case Study Analysis (Copyright Gwen Wild, 2012) Category of Targeted Behavior Case Studies Positve Change in Behavior Avg. % Change Emotional Over- Responsiveness % Resistance to ADL s % Sleep Issues % Impulsivity % Attn to Task % Mouth Open while Eating 1 0 0% Pressure-Seeking to Jaw/Hands % Research! Sensory Diet Research, 2014! Classroom-Based Sensory Program " Short, frequent movement breaks " Two 10-minute higher intensity sensory breaks per day " Instruction in sensory modulation using BrainWorks " Sensory tools and strategies as needed throughout the day SPM - Control vs. Experimental BASC-2 Control vs. Experimental Change Control Group - Average pre/post delta Change Control Group - Average pre/ post delta SOC VIS HEA TOU BOD BAL PLA Experimental Group - Average pre/post delta Hyperactivity Aggression Conduct Problems Externalizing Problems Anxiety Depression Somatization Internalizing Problems Attention Problems Learning Problems School Problems Atypicality Withdrawal Behavioral Symptoms Index Adaptability Social Skills Leadership Study Skills Functional Comm Adaptive Skills Experimental Group - Average pre/ post delta Bonus Case Study! Preston! file://localhost/users/gwenwild/ Downloads/Preston-SB-AP-.docx 47 8