Using Sensory Strategies to Improve Behavior

Sensory strategies have a significant impact on the behavior of children and adolescents with developmental, mental health, Post Traumatic Stress Disorder and sensory processing challenges. Deep pressure touch provided by pediatric occupational therapists through massage, brushing, weighted blankets, mat sandwiches and other sensory strategies are described as extremely positive experiences for children and adolescents with developmental, mental health, Post Traumatic Stress Disorder and sensory processing challenges. Finding preferred activities is helpful because motivation can be a significant problem when treating these youngsters.


A significant relationship was found between sensory and behavioral problems in children with developmental disorders. Research indicated that deep pressure sensory input functioned as positive reinforcement while matched sensory activities reduced repetitive non-purposeful behaviors in children with Autism Spectrum Disorder. Offering opportunities to use sensory strategies for self-regulation significantly reduced behavioral problems as well as the need for restraint and seclusion in adolescent and adult residential treatment centers for psychiatric and trauma challenges.


The usefulness of offering clients deep pressure sensory strategies as an alternative to aggression and restraint makes sense, as it can replace the use of restraint as reinforcement for aggression with sensory activities to reinforce avoiding physical aggression. School occupational and physical therapists have begun using sensory activities as reinforcement for avoiding aggression to reduce student restraint and seclusion. SchoolOTRedAgg  The functioning of sensory strategies as positive reinforcement makes it important for therapists to avoid using sensory strategies immediately following aggressive or inappropriate behavior. Despite bitter conflicts between behaviorists, pediatricians and therapists clients would greatly benefit from their collaboration.


Canfield, J. M. (2008). Sensory dysfunction and problem behavior in children with autism spectrum and  other developmental disorders.

McGinnis, A. A., Blakely, E. Q., Harvey, A. C., & Rickards, J. B. (2013). The behavioral effects of a procedure used by pediatric occupational therapists. Behavioral Interventions, 28(1), 48-57.

O’Hagen, M., Divis, M., & Long, J. (2008). Best practice in the reduction and and elimination of seclusion and restraint; Seclusion: time for change. Aukland: Te Pou Te Whakaaro Nui: The National Center of Mental Health Research, Information and Workforce Development.

Rapp, J. T. (2006). Toward an empirical method for identifying matched stimulation for automatically reinforced behavior: A preliminary investigation. Journal of Applied Behavioral Analysis, 39(1), 137-140.

Sutton, D., Wilson, M., Van Kessel, K., & Vanderpyl, J. (2013). Optimizing arousal to manage aggression: A pilot study of sensory modulation. International Journal of Mental Health Nursing, 22, 500-511.

Warner, E., Spinazzola, J., Westcott, A., Gunn, C. & Hodon, H. (2014). The body can change the score. Journal of Child & Adolescent Trauma, 7(4), 237-246.


Light touch and Holding Interventions

Light touch and holding strategies promote body awareness and social-emotional skills in children and adolescents with behavioral challenges. Deep pressure touch is a more common therapeutic intervention. However, light touch and holding are valuable therapeutic options for promoting attention, body awareness and social-emotional skills.



Body awareness, stress and somatic pain challenges negatively impact behavior in many children and adolescents with developmental, sensory processing, Post-Traumatic Stress Disorder, internalizing behavioral concerns and other psychiatric disorders.  Attention, body awareness, stress and somatic pain problems can be addressed through the use of light touch and holding strategies.  Light touch and holding strategies are particularly useful for improving and directing functional attention, and provide a valuable option for reducing stress, somatic pain, and social-emotional problems when deep pressure massage is contraindicated.  Particularly for young people experiencing acute pain, edema, taking analgesic medications (e.g., which can decrease pain perception) or taking antidepressant medications (e.g., which can cause light headedness and dizziness) light touch and holding are preferred.

Recent research indicates that positively perceived slow, light touch specifically activates CT afferent fibers connecting to the Insular Cortex that convey social-emotional interactions and our internal sense of self.  FAB Strategies utilizing light touch and holding include: Vibration to the Back, Arms, & Body as well as the Rolling the arm, Back X, Spine crawl, Head crown, and Foot input.  These light touch and holding techniques which are components of FAB Strategies will be described below.

It can be clinically useful to provide extremely irritable children and adolescents who have significant body awareness challenges repeated sensory experiences of the front, back, top and bottom of their bodies. FAB Strategies light touch and holding techniques were developed to provide sensory experiences of the front, back, top and bottom of the body as a foundation for improved body awareness and social-emotional skills.  In addition to the light touch and holding strategies the awareness of the front, back, top and bottom of the body is practiced through several FAB Strategies deep pressure touch and mindful movement activities.

Vibration to the Back, Arms, & Body provide light touch input.  Vibration can also be applied to various body parts with eyes open and closed, to increase body awareness by having clients identify each body part as it is touched (e.g., arm, left ankle).  Light touch can also be provided through the Rolling the arm strategy.  The therapist rolls the arm in a palm open, thumb lateral direction providing relaxation.

Trager and me Original

The Back X involves drawing an X across the back with your fist, while the Spine crawl involves moving up the spine to give awareness of the back. The Back X and Spine Crawl can be done as part of the X Marks the spot light touch game


The Head Crown involves 10 second holding on the head, first on both sides then on the front and back of the head.


Foot input involves massage and holding of the feet to provide improved sensory awareness of the feet as the foundation and bottom of the body.  Foot input can be followed by stretching exercises to help decrease the likelihood of habitual toe walking.  Light touch and holding strategies are a valuable intervention to improve attention, body orientation and social-emotional skills through interpersonal touch.  Light touch and holding can also decrease stress, pain, and provide comfort when more intense massage is contraindicated.


Beider, S., Mahrer, N. E., Gold, J. I. (2007). Pediatric massage therapy: An overview for clinicians. Pediatric Clinics of North America, 54(6), 1025-1041.

Bjornsdotter, M., Loken, L., Olausson, H.., Valbo, A., & Wessberg, J. (2009). Somatotopic organization of gentle touch processing in the posterior insular cortex. The Journal of Neuroscience, 29(29) 9314-9320.

Koester, C. (2012). Movement based learning for children of all abilities. Reno, NV: Movement Based Learning Inc.

McGlone, F., Wessberg, J., & Olausson, H. (2014). Discriminative and affective touch: Sensing and feeling. Neuron, 82(4), 737-755.

Perini, I., & Olausson, H. (2015). Seeking pleasant touch: Neural correlates of behavioral preferences for skin stroking. Frontiers in Behavioral Neuroscience, 9.


Implementing Sensory Strategies in Preschools & Kindergartens

Many excellent discussions debate the best ways to responsibly integrate sensory strategies that help young children. While I don’t have a conclusive answer for this dilemma I have been struggling with this question all of my professional life. The attachments presented in this post describe my FAB Strategies for integrating environmental adaptations, sensory modulation, positive behavioral support, and physical self-regulation strategies in preschool and kindergarten classes.

My hope is to offer an approach for teachers and therapists in the schools to help children both who have and who have not yet been diagnosed with special needs and are having difficulty learning.  The FAB “Functionally Alert Behavior” Preschool & Kindergarten Strategies form can be used by teachers and therapists for children both with and without identified special needs.  It guides home programs, serves as a check list for teachers and therapists of strategies that help children with behavioral and developmental challenges learn, and can be used to guide goal-directed interdisciplinary interventions for children receiving special education services FABPre&KStrategies

I offer small two-day workshops for occupational, speech, physical, and mental health therapists that include direct practice for developing, implementing, and consulting with parents and teachers implementing FAB Strategies (see Schedule of FAB Strategies Workshops Page of this blog). I will be releasing an additional schedule of my 10 larger, one-day workshops in January and March 2014 for teachers, parents, and school therapists.

I have included for teachers, therapists, consultants, and researchers my recently published paper describing my research supported theory of FAB Strategies for preschoolers and kindergarteners.  I am currently conducting research regarding the relationship between children’s behavioral and sensory processing challenges.



Touch Intervention to Improve Child & Adolescent Behavior

Evidence based touch strategies are an important part of my occupational therapy interventions for children and adolescents with behavioral, psychiatric, developmental, and sensory processing challenges. Although touch is a component of typical attachment and development, many excellent mental health therapists do not include touch in their interventions with children and adolescents, and warned me against using touch when I began working in pediatric psychiatry 30 years ago.   I include touch as part of my psychiatric interventions with children and adolescents based on research showing its efficacy for improving mental health and social skills in children and adolescents with Autism Spectrum Disorders, psychiatric disorders, behavioral problems, early trauma challenges, and sensory processing challenges.

Specific guidelines are needed when using touch with children and adolescents with mental health challenges, because these youngsters may have past experiences of physical abuse, sexual abuse or child neglect that make touch problematic.  I always provide touch only after getting permission from the parent and child, repeatedly urging the youngster to let me know and any time if they want me to stop immediately, and in conjunction with their mental health therapist.  Implementing touch in this manner, I have only had one incident of a child demonstrating distress as a result of being touched during my 20 years of full time practice, and have seen a dramatic reduction in physical and verbal aggression with improvements in behavior, social skills, and attention span.

My use of pressure touch in FAB “Functionally Alert Behavior” Strategies differs from traditional massage and brushing protocols.  There is evidence for massage as an intervention to improve social skills with children who have Autism Spectrum Disorders and clinical experiences of scrub brushing improving behavior in children with sensory processing challenges, but both of these methods are sensory stimulation techniques that are implemented in a prescribed manner.  In FAB Strategies pressure touch is included in the sensory modulation section as one component of an interdisciplinary program to achieve specific behavioral objectives.  The touch is individually developed and modified by the therapist to achieve the child’s goals.

Touch pressure in FAB Strategies is provided through equipment, independent exercises, brushing, massage, or joint compression strategies.  The touch pressure strategies are individualized and modified to achieve the child or adolescent’s specific behavioral goals (e.g., reduced physical aggression, reduced verbal aggression, improved communication, increased social skills).   Equipment and exercises used to provide pressure touch in FAB Strategies include: theraband exercises, wall pushups, theraplast, playdoh, hugging a stuffed animal, a weighted blanket, a pressure or weighted vest, and a body sock.  Pictures of the exercises and equipment touch strategies are identified on the FAB Coping Forms, and can be reviewed during the initial evaluation.

FABCopingForms WallpushupsProneTherapyballfar

All of these strategies provide pressure through the joints. An advantage of the exercise and equipment touch pressure strategies is that they are controlled by the child or adolescent and can be done independently as a coping strategy.  We have pressure receptors in our body (e.g., enabling us to point to our wrist with out looking) and exercises, equipment, or direct touch that activates these receptors provides youngsters with a calming sensation (e.g., like when a mother hugs her child) that can be a useful coping strategy.

Pressure touch can also be provided directly by therapists, parents, and teachers as a coping strategy using the FAB Pressure Touch Strategies.  The FAB Pressure Touch Strategies (taught in my workshops) include the: head crown, shoulders squeeze, spine roll, back protocol, back, arm, legs, feet, and face strategies. Direct touch FAB Strategies listed on the FAB Coping Forms above include get a hug and FAB Pressure Touch (a variety of massage and brushing strategies begun with touch on the back).  Direct touch may reduce physical and verbal aggression when no other strategies are affective, and can be beneficial to improve attachment and relationships.  While some of the FAB Pressure Touch Strategies are currently used by physical and occupational therapists in FAB Strategies emphasis is given to how touch “feels” in the body, affects the child or adolescent’s energy level and tension, and enables them to achieve their behavioral goals.  The link below shows the direct FAB Pressure Touch Strategies being done as a component of FAB Strategies with a preschooler who has Asperger’s Syndrome and behavior challenges http://www.youtube.com/watch?v=W8fMdJ6l0AM&feature=youtu.be


Blaustein, M.E. & Kinniburgh, K.M. (2010).  Treating Traumatic Stress in Children and Adolescents.  NY, NY: The Guilford Press.

Field, T., Henandez-Reif, M., Diego, M., Schanberg, S., Kuhn, C. (2005).  Cortisol decreases and serotonin and       dopamine increase following massage therapy.  Intern. J. Neuroscience, 115, 1397-1413.

Mass. Dept. of Mental Health Safety Tool. (2006).  MacLachlan, J. & Stromberg, N. Safety Tools.

Silva, L. M., Schalock, M. (2013).Prevalence and significance of abnormal tactile responses in young children with   Autism.  North American Journal of Medicine and Science, 6(3), 121-127.


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.


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.


FAB Pressure Touch Strategies

The FAB Pressure Touch Strategies help reduce anxiety, increase communication, and improve behavior with children who have self-control, developmental, and sensory processing challenges. FAB Pressure Touch was developed by adapting and synthesizing evidence-based Massage Techniques, QST, Knickerbocker Sensory Integration strategies, Trager Body Work, and NDT touch strategies to meet the needs of children with developmental, behavioral, and/or early trauma history challenges. However, distinct from the Wilbarger Protocol, massage, and prescribed body work sensory stimulation strategies FAB Pressure Touch Strategies are an individualized goal-directed approach that is a component of the total FAB Strategies program. Strategies that the therapist finds helpful should be taught to interested parents, teachers, and other team members but no minimal amount of intervention is required for results.

Individualized pressure touch and weight bearing activities can reduce anxiety and promote social development in children with Pervasive Developmental Disorder, other developmental disabilities, and behavioral problems. Because anxiety can increase children’s behavior problems, pressure touch and weight bearing are used in FAB Pressure Touch Strategies to significantly reduce anxiety in children with developmental disabilities. Behavioral improvement from pressure touch and weight bearing activities appears related to the activation of proprioceptive receptors that can be independently obtained through resistance exercises. If implementation of the FAB Pressure Touch Strategies improves behavior, children are also taught and reinforced for independently engaging in independent pressure touch and resistance exercises.

FAB Pressure Touch strategies include the: Head Crown, Shoulder squeeze, Spine roll, Back protocol tap, Back protocol press, touch on the back, as well as touch and joint compression through the arms, legs, and feet. The FAB Pressure Touch Strategies form can be attached to the FAB Strategies form to provide more detailed touch strategies. In my FAB Strategies workshops for therapists, goal-directed development and implementation of FAB Pressure Touch Strategies is learned as a component of FAB Strategies. An example of me providing intervention utilizing FAB Pressure Touch Strategies with a preschooler who has Asperger’s Syndrome and behavioral challenges is provided at http://www.youtube.com/watch?v=W8fMdJ6l0AM&feature=youtu.be

Beider, S., & Moyer, C. (2007). Randomized controlled trials of pediatric massage: A review. Evidence-based Complementary and Alternative Medicine, 4(1), 23-34.
Field, T., Henandez-Reif, M., Diego, M., Schanberg, S., Kuhn, C. (2005). Cortisol decreases and serotonin and dopamine increase following massage therapy. Intern. J. Neuroscience, 115, 1397-1413.
Kaufaman, L.B., & Schilling, D.L. (2007). Implementation of a strength training program for a 5-year-old child with poor body awareness and developmental coordination disorder. Physical Therapy, 87, 455-467.
Silva, L.M. Schalock, M., Gabrielsen, C. (2011). Early intervention for Autism with a parent-delivered qigong massage program: A randomized controlled trial. American Journal of Occupational Therapy, 65(5), 550-559.