The QABF (Questions About Behavior Function) and other functional assessments can prevent sensory-based interventions from accidentally worsening pediatric behavior problems (Welch & Polatjko, 2017; Lydon et al., 2017). Despite this evidence some occupational therapists are reluctant to use these behavioral assessments. My previous blog post discussed how therapist can use the sensory matching strategy by combining the sensory profile and QABF to significantly reduce self-injurious behavior that is being done for sensory reinforcement https://fabstrategies.org/2019/12/10/fab-sensory-matching-strategy/
In this post I will describe how to use the QABF and Sensory Profile to quickly develop strategies to reduce aggression in youth with complex behavior challenges.
The Sensory Profile and Trigger & Coping Strategies are the two assessments I use most frequently to reduce aggressive behavior. The Sensory Profile helps identify significant sensory modulation differences. It helps guide strategies for understanding and addressing youth aggression difficulties, which are significantly more common in youth with sensory over-responsivity.
The Trigger & Coping forms ask youth or their family members to identify their existing environmental triggers, body triggers, and most effective coping strategies. Combining the Sensory Profile with the Trigger & Coping forms empowers the client and family to contribute to improving behavior. Research suggests that use of the Sensory Profile, Trigger & Coping forms have been found to guide programs that significantly reduce restraint and seclusion in psychiatric hospitals. The Trigger & Coping forms is also clinically helpful in facilitating cooperation with clients who are resistant to occupational therapy assessment and treatment by involving them in the treatment planning and teaching them unfamiliar coping strategies during the assessment.
It is extremely important to include the QABF, particularly in instances where aggression is increasing despite consistent therapeutic intervention. Evidence suggests that sensory intervention can serve as a reinforcement, and can worsen behavior if it reinforces escape aggressive behavior (Lydon et al., 2017) The importance of the QABF can be seen in my clinical case illustrated below. I was working with a 5-year old with Anxiety Disorder, Autism Spectrum Disorder, Speech Delays, and Sensory Sensitivity who was slapping staff. Despite receiving behavioral and occupational therapy the slapping was increasing so I did the QABF showed below. Case study research demonstrated significant behavioral effects of behavior preceding a mat sandwich, indicating that sensory integration activities functioned as reinforcement of the behavior they followed (McGinnis et al., 2013). A case study showed significant improvement of reduced self-injurious behavior through combining a functional assessment, preference assessment and the Sensory Profile and a preference assessment (McCall et al., 2016)
The QABF suggested the slapping behavior was being done to receive both attention and escape. By working in conjunction with the speech therapist the team found more appropriate ways for the child to request attention and request escape. Working together we assured that we minimized attention for the slapping behavior. Research suggests that combining the Sensory Profile and QABF results in more appropriate intervention. It is time for greater interdisciplinary respect and cooperation.
Dunn, W. Sensory Profile 2: Users Manual. Psych Corporation; 2014.
Lydon, H, Healy O, Grey I. Comparison of behavioral intervention and sensory integration therapy on challenging behavior of children with autism. Behav Interv. 2017; 32(4): 297-310.
Matson JL, Vollmer TR. User’s guide: Question About Behavioral Function (QABF). Baton Rouge, LA: Scientific Publishers, 1995.
McCall J, Derby K, McLaughlin, T. The effects of matching sensory profile results to functional preference assessment for the in home treatment of aberrant behaviors in two children with autism spectrum disorders. Int Journ of Eng and Ed. 2016; 5(1): 368-390.
McGinnis AA, Blakely, EQ, Harvey AC, Richards, JB. The behavioral effects of a procedure used by pediatric occupational therapists. Behav Interv. 2013;28(1);
Welch CD, Polatajko HJ. The issue is-Applied behavior analysis, autism and occupational therapy: A search for understanding. AJOT , 2017; 70(4); 7004360020p1-7004360020p5.