0

Assessing Sensory & Behavior Challenges

Many clients have interrelated sensory processing and behavior challenges that interfere with their functioning. Sensory processing disorders are distinct from behavior disorders (e.g., Oppositional Defiant, Post Traumatic Stress, Autism Spectrum, and Bipolar Disorder) but clients who have these mental health diagnoses are significantly more likely to have sensory processing challenges as well.

It is important that clients who have both sensory processing and behavior challenges affecting their functioning receive an evaluation that addresses both difficulties. Regardless if the evaluation is done by an occupational and/or mental health therapist (psychologist, social worker, licensed professional counselor, behaviorist) it is important to assess both sensory processing and behavioral functioning. Coordinated assessment by both an occupational and mental health therapist can be extremely helpful.

It is helpful if the sensory processing and behavior assessment include observations and a norm-referenced, reliable and valid measurement tool. The sensory processing clinical observations can describe whether the client becomes overly excited during movement activities, is able to pay attention in loud environments, touches people and objects more frequently than others his age, is easily distracted, and the length of attention span for both preferred and adult directed activities. Standardized assessments include the Short Sensory Profile sensoryprofile.com and Sensory Processing Measure http://www.wpspublish.com/store/p/2991/sensory-processing-measure-spm

Behavior observations can include the frequency of inappropriate behaviors (e.g., yelling, screaming, swearing, hitting, biting, spitting) as well as the most common setting events, antecedents, and consequences related to them. Standardized behavior assessments include the Devereux Behavior Rating Scale-School Form and the Ages and Stages Questionnaire: Social Emotional.

Adaptive EquipmentPartSentBigFeelin

Whenever clients present with interrelated sensory processing and behavioral concerns related to their functioning both issues need to be comprehensively addressed. The assessment needs to include functional base lines data, prioritize functional goals, and recommend needed intervention. Comprehensively assessing the client’s interrelated sensory processing and behavior concerns guides affective intervention for both problems.

0

Sensory Strategies For Teens With PTSD

Adolescents with PTSD and sensory processing challenges can benefit from sensory strategies to improve their behavior. Sensory strategies are particularly helpful for improving attention and decreasing aggression. While too seldom used for PTSD I have found that deep pressure touch sensory strategies can be particularly effective for reducing aggression and improving attention in teenagers with PTSD.

Therapists can help help teens understand that past traumatic stress experiences can lead them to overreact to stress. I tell teens “some people who have experienced bad things in the past overreact and get into trouble when they have really big feelings, and benefit from noticing when they first start having big feelings so they can use coping strategies to be successful”. The energy level meter strategy can help teens identify whether their current energy level feels “High”, “Medium” or “Low” and whether they feel “OK and Comfortable” or “Not OK Uncomfortable”. If a teen is too hyper to behave appropriately but rates his current energy as “High Energy and O. K. Comfortable” then the therapist is alerted that the teen is use to having a high energy state. The therapist would try to gradually modulate down the teen’s energy level by beginning with quick and intense tasks then gradually decreasing the speed and intensity in a structured way.    http://www.traumacenter.org/

Visual chart for rating arousal level and if it feels comfortable

Visual chart for rating arousal level and if it feels comfortable

Other teens find it more helpful to use an anger meter that monitors how angry they are feeling so they can leave the situation or use coping strategies to avoid aggressive and self-injurious behavior.

AngerMete

 

Many teens are helped by using movement and deep pressure activities rather than only talk therapy as a coping strategy. This is because our joint receptors (e.g., muscle spindle fibers and Golgi Tendon Organs) convey deep pressure touch input that is typically calming and nurturing, like when a parent calms an upset child by hugging them. An example of input from our joint receptors is that we can identify our index finger with out looking at it, and our experience when walking down stairs in total darkness of feeling off balance because we thought there was another step but we were at the bottom of the stairs. It is important for teens with PTSD to understand that experiencing PTSD as a child can interfere with typical neurological development, the development of body awareness, and functional attention skills https://fabstrategies.org/2013/07/06/sensory-strategies-for-childhood-trauma/

Activities combining deep pressure input (through our body weight as well as lifting or pushing heavy objects) with linear movement can be an extremely effective coping strategies for improving self-control. Teenagers can use pushups, wall pushups, and isometric exercises as coping strategies to avoid aggression and help maintain attention.

Wallpushups http://www.traumacenter.org/products/pdf_files/Can%20the%20Body%20Change%20the%20Score_Sensory%20Modulation_SMART_Adolescent%20Residential%20Trauma%20Treatment_Warner.pdf

It is also helpful to teach teenagers to incorporate deep pressure and linear movement into their daily routines to maintain attention at school (e.g., moving tables, passing out books) and home (e.g., weight training, lawn mowing, vacuuming).  Research supports the use of occupational therapist guided sensory processing strategies to improve self-control of teens with PTSD challenges http://www.traumacenter.org/products/pdf_files/Body_Change_Score_W0001.pdf

Although it is considered a taboo by some mental health professionals I have also found that offering touch, brushing, vibration and massage with FAB Touch Pressure Strategies http://www.youtube.com/watch?v=W8fMdJ6l0AM is a powerful sensory strategy for teenagers with PTSD. Particularly with teens who did not receive nurturing touch growing up and show significant differences in sensory processing on the Sensory Profile sensoryprofile.com I have found FAB Pressure Touch Strategies useful in improving their self-control. It is extremely important to first teach about personal boundaries and always get the parent and teens permission before using touch, but with these guidelines I have found this an extremely effective intervention.