Sensory Strategies in Adolescent Psychiatry

The FAB Sensory Match Strategy uses individualized sensory coping strategies and reinforcement to reduce self-injurious behaviors in adolescents with psychiatric challenges.  Effective treatment approaches for self-injurious behavior such as DBT, CBT, and ARC teach adolescents to use generalized coping strategies to replace self-injurious behaviors.  However, research reports that adolescent self-injurers have significantly increased sensory modulation difficulties and physiological reactivity to stress.  Research suggests their problem is not ignorance about coping strategies but the inability to use selective coping strategies to reduce self-injurious behavior.

Research shows that the function of self-injurious behaviors is automatic negative reinforcement (e.g., pain as an escape from negative thoughts and feelings) and automatic positive reinforcement (e.g., to feel something even if it’s pain when numb).The FAB Sensory Match Strategy combines sensory processing and behavioral intervention to develop individualized sensory coping strategies that adolescents can use as an alternative to self-injurious behaviors, and reinforces them for reducing their incidences of self-injury.  Assessment includes the Adolescent Sensory Profile, a functional behavioral analysis with base line data, and use of the FABTriggerCopingForms

Following assessment several sensory coping strategies are done with the adolescent and they select the strategies they find most helpful in reducing self-injurious behavior.  The most effective strategies are listed along with the Sensory Match Strategy on the FABSTRATEGIES TO PROMOTE SELF-CONTROL form.  Reinforcement is provided when the child uses coping strategies to reduce self-injurious behavior.  The most commonly helpful sensory coping strategies used in the FAB Sensory Match Strategy include: fidgets, comfort box (a box of fidgets and sensory toys), theraplast hand exercises,  craft kits, vibrating bath brush, surgical scrub brushing, massage on request, theraband arm exercises, therapy ball use, and mindfulness activities.

References:

Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007).  Dialectical behavior therapy with suicidal adolescents.  NY, NY: The Guilford Press.

Nock, M.K. & Mendes, W.B. (2008).Physiological arousal, stress tolerance, and social problem-solving deficits among adolescent self-injurers.  Journal of Counseling and Clinical Psychology, 76(1), 28-38.

Nock, M.K., Prinstein, MJ., Sterba, S.K. (2009).  Revealing the form and function of self-injurious thoughts and behaviors: a real-time ecological assessment study among adolescents and young adults.  Journal of Abnormal Psychology, 118(4), 816-827.

Smith, S.A., Press, B., Koenig, K.P., Kinnealey, M. (2005).  Effects of sensory integration intervention on self-stimulating and self-injurious behaviours.  American Journal of Occupational Therapy, 59, 418-425.

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