While individualized sensory processing intervention guided by the (SP) Sensory Profile (Dunn, 2014) significantly improves behavior done to receive sensory input (e.g., by using an activity analysis to develop activities providing similar more appropriate sensory input), intervention combining the SP with the (QABF) Questions About Behavior Function provides significantly better outcomes (Sandee et al., 2023; Matson & Vollmer, 1995). The SP and QABF can be clinically integrated to improve behavior in youth with sensory challenges while preventing sensory strategies from worsening behavioral challenges (Welch & Polatjko, 2017; Lydon et al., 2017). This evidence-based sensory behavioral strategy integration facilitates evidence-based transdisciplinary intervention for students with developmental and complex behavioral challenges.
This post presents a case study describing the integration of the QABF and Sensory Profile assessment for planning transdisciplinary intervention. A 14-year old psychiatric hospital and school student with Anxiety Disorder, Autism Spectrum Disorder (ASD), and Sensory Sensitivity forcefully punched and scratched staff and other youth. Despite receiving a functional behavior and occupational therapy program the aggressive behavior increased. For this reason a SP and QABF was integrated to guide intervention QABF and SP in ASD Combining the SP with the QABF is especially crucial when treatment is ineffective or worsens behavior.
The SP indicated Definite Difference in: Sensory Sensitivity, Sensory Avoiding, and Overall Behavioral challenges. Research indicates that adolescents with diagnoses of Autism Spectrum, Anxiety, and Sensory Sensitivity Disorder are frequently overwhelmed by sound and touch input because of neurological differences that result in not habituating (getting use to) sensory stimuli, which is significantly related to aggressive behavior (Green et al., 2016). Based on this information he was offered noise canceling headphones that reduced his anxiety in the very loud hospital setting.
The student’s FAB Learning Readiness form goal, baseline data, and QABF assessment must all be based on an objective functional behavior that is realistic and most important. For this student the target was safe hands by decreased grab/swipe at staff which was operationaly defined as forcefully punching and/or scratching staff or other youth. The QABF indicated aggression toward others was done for attention and escape. If the QABF hadn’t been used and he was consistently given sensory intervention after grabbing/swiping this would increase his aggression by reinforcing attention and/or escape. Instead, he was approached very slowly every 10 minutes and offered attention and a toy, which he could say yes or no to. This enabled him to begin requesting attention and escape appropriately.
Combining the results of the SP and QABF with clinical reasoning significantly guided development of his individualized FAB Strategies for Learning Readiness and resulted in significantly improved behavior in comparison to his baseline. FABStrategiesforLearningReadinessFormASDAggression (2) Research supports that this individualized transdisciplinary approach combining sensory processing and functional behavioral analysis significantly improves behavior in youth with Autism Spectrum and Complex Behavioral disorders (Lydon et al., 2017; Sandee et al., 2023).
References:
Dunn, W. Sensory Profile 2: Users Manual. Psych Corporation; 2014.
Green, S. A., Hernandez, L., Bookheimer, S. Y., & Dapretto, M. (2016). Salience network connectivity in autism is related to brain and behavioral markers of sensory overresponsivity. Journal of the American Academy of Child & Adolescent Psychiatry, 55(7), 618-626.
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.
SandeeP, R. S., SankaR, G. U., & RavikUMaR, M. (2023). Comparison of Functional Communication Training, Sensory Integration Therapy, and Behaviour Intervention for Challenging Behaviours in Children with Autism: A Pilot Study. Journal of Clinical & Diagnostic Research, 17(12).
Welch CD, Polatajko HJ. The issue is-Applied behavior analysis, autism and occupational therapy: A search for understanding. AJOT , 2017; 70(4); 7004360020p1-7004360020p5.