A FAB Sensory Behavioral Strategy for Kids with Autism

FAB (Functionally Alert Behavior) STRATEGIES

A clinically affective strategy for children with Autism who engage in repetitive self-injurious behavior is the FAB Reinforce Sensory Match Strategy.  The FAB Reinforce Sensory Match Strategy involves replacing the automatic sensory reinforcement that encourages repetitive self-injurious behaviors with matched sensory activities, while also reinforcing the child for refraining from the self-injurious behavior.  The Sensory Profile and a sensory functional behavioral analysis assessment can help direct the intervention.  The Sensory Profile alerts the therapist to definite difference in the child’s sensory processing that only occur in 1 out of 100 kids.  The Sensory Functional Behavioral Analysis establishes base line data, determines the function served by the problematic behavior, and helps direct intervention. The Reinforce Sensory Match strategy is most effective with children who have significantly different sensory modulation styles and engage in self-injurious behavior only to obtain sensory input.

The therapist hypothesizes the automatic sensory reinforcement the child is getting from the problematic behavior then offers adaptive equipment and sensory techniques that match it.  For example, when the Sensory Profile and Sensory Functional Behavioral Analysis show that a child repetitively mouths his hand for sensory reinforcement the therapist analyzes whether the sensory reinforcement is oral input, touch on his fingers, or both.  The client is then offered various mouth and hand touch activities, and a super chew toy is found to be his favorite.  The child is offered the chewey to use whenever he wants, and is praised for not mouthing his hands for progressively longer periods of time. For particularly problematic behavior the FAB Reinforce Sensory Match Strategy can be one component of a functional behavior plan written jointly by a Certified Behavior Analyst and Licensed Occupational Therapist.


Dunn, W. (2007).  Supporting children to participate successfully in everyday life by using sensory processing knowledge.  Infants & Young Children, 20(2), 84-101.

Higbee, T.S., Chang, S., Endicott, K. (2005).  Noncontingent access to preferred sensory stimuli as a treatment for automatically reinforced stereotypy.  Behavioral Interventions, 20, 177-184.

Mays, N.M., Beal-Alvarez, J., Jolivette, K. (2011).  Using movement-based sensory interventions to address self-stimulatory behaviors in students with Autism.  Teaching Exceptional Children, 43(6), 46-52.

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


FAB (Functionally Alert Behavior) STRATEGIES

A FAB Alternative to Sensory Diets


FAB “Functionally Alert Behavior” Strategies provide a practical alternative to the use of a Sensory Diet.  In my work as a full time occupational therapist with my own sensory processing challenges, I created FAB Strategies to quickly develop individualized strategies that improve self-regulation in children with developmental and behavioral challenges.  I have been using FAB Strategies as a pediatric occupational therapist for the past twenty years.  I also share them with parents, teachers, as well as occupational, physical, speech, and mental health therapists.

Organized in four sections labeled A-D FAB Strategies sequentially include environmental adaptations, sensory modulation, positive behavioral support, and physical self-regulation strategies.  Sections A-D guide the types of strategies selected, with at least one strategy from each section included. The strategies can be implemented in any order, but alternating seated with more active strategies usually works best.

In conjunction with the team an occupational, physical, speech, or mental health professional develops an individualized goal and selects the strategies.  The strategies to be used by all team members are checked off and underlined on the FAB Strategies form.  Strategies listed in bold print are marked with an X and underlined for use by trained occupational, physical, and speech therapists. Two blanks are included on the bottom of the FAB Strategies form to allow for additional strategies contributing to goal attainment.

FAB Strategies are useful for quickly developing occupational therapy clinical and school interventions, home programs, strategies for use by teachers and therapists, and as a checklist of strategies that promote self-control in children with development and behavioral challenges.  A blank line is provided at the bottom of the page for parents to sign that they understand and agree with all the adaptive equipment and techniques before they are used.



Praxis Comic FAB Strategy

Ayres Sensory Integration describes PRAXIS as the process necessary during initial learning (functionally involved in learning tasks such as shoe tying, printing, cursive writing, keyboarding). Ayres described praxis as involving 3 components, any or all of which are difficult for children with praxis problems termed “dyspraxia”. Taking as an example building with playdoh, consider the 3 components of praxis. First, IDEATION-the idea that you want to accomplish (e.g., I want to build a snowman).

Second, MOTOR PLANNING-the plan of sequential steps to be accomplished e.g., drawing or describing the plan to 1)Make a large ball and place it on the bottom for a foundation, a medium ball placed on top of that, then a small ball on the very top for the head. 2)Make 3 tiny balls and place them vertically on the center ball for buttons then 3)On the top ball head place two tiny balls horizontally on top for eyes, another tiny ball centered below the eyes for a nose, then several tiny balls in a concave circle below the nose for a mouth.

The third component of praxis is actual EXECUTION of the actions involved in the task. If a child easily describes what he wants to make out of playdoh he has good IDEATION. If he accurately plans by drawing or describing the steps in sequence he has good MOTOR PLANNING. If he actually builds the snow man physically with fluid movements he has good EXECUTION.

Assessing the functional appropriateness of the individual IDEATION, MOTOR PLANNING, and EXECUTION components of a specific praxis task identifies for each component whether it is a strength or weakness that needs to be addressed. To improve praxis we can use the PRAXIS COMIC FAB STRATEGY to facilitate and support the praxis process. Later, ongoing review of the PRAXIS COMIC helps the child gradually internalize the praxis task through repetition.

The PRAXIS COMIC FAB Strategy helps children by having them draw and caption a comic depicting the praxis process for a particular task. It promotes behavior and independence in children with dyspraxia, particularly during group activities. We facilitate the steps of praxis by IDEATION of what we want to do, then MOTOR PLANNING sequentially the steps involved, and finally EXECUTION through drawing, describing and doing the steps involved.

Below is a praxis comic created by a small PBS group depicting the praxis process for every group session. The praxis comic has four parts: 1) move the chairs to clear a space in the class room for their group e.g., specifically involving slow linear movement combined with deep pressure heavy work to facilitate self-regulation. 2)Throw the ball underhand 3)Sit e.g., during which the group constructs feeling wheels or coping cards given the environmental structure of a seated position and 4)Play frisbee ending the group e.g., then move the chairs back now the group is over. By completing the praxis comic and reviewing it before and after each group, the children facilitated their own praxis process, enhancing their internalized organization and self-control.


Song & Dance

Song & Dance

It is important for all preschool and kindergarten children and elementary classes to provide music and movement breaks. Social skills are enhanced by playing songs like “Help” by the Beatles or “Respect” by Aretha Franklin, letting children dance, then asking them to draw.


Encouraging More PE and less TV

Movement and music brake strategies facilitate inclusion and help all students learn self control and attention skills.  Current research supports the value of music and movement breaks in promoting academic achievement and self-control in children.  A minimum exercise equivalent of 20 minutes brisk walking daily promotes academic achievement, neurological development, self-control, and overall health. Physical activity is a great vehicle for mainstreaming, as movement during and after school actually promotes rather than “steals time away from” academic achievement for all students throughout the school years.

The FAB Music and Movement Break Strategies benefit typical children and are particularly valuable for children with complex developmental and self-control challenges (including ADHD and Autism Spectrum Disorders), significantly improving behavior and on-task attention in school.  Frequently children with developmental and self-control challenges lose recess due to behavioral difficulties during or following large group physical activity.  Discipline problems can be significantly reduced by initially limiting group size, increasing structure, and rewards of bonus activity time for returning to academic effort immediately following physical activities.

The FAB Playground Structure strategy is useful for helping children who get out of control by behaviors such as pushing other children down, or misbehaving during and immediately following recess.  The FAB Playground Structure strategy involves initial individualized or small group adult supervision by a school psychologist or occupational therapist.  The child initially must select play in one limited area of the play ground to increase structure (e.g., sliding board area with a jump rope used to define the area), play for a minimal period of time in the selected area followed by clean up before selecting the next area, specific rules (e.g., need to leave the playground if any pushing of peers occurs), and a rating of average Energy Level before returning to class.

Brief individualized periods of physical activity involving sensory calming strategies can be incorporated into the daily school routine by having a child periodically move mats and desks, pass out books, or deliver packages through out the school.  Class room music and movement breaks of five minutes duration are particularly useful in typical kindergarten and the early elementary grades.  Music and Movement Breaks providing deep pressure touch and slow linear movement that are particularly helpful in facilitating self-control for children with sensory processing challenges include the Hokey pokey, Head-shoulders-knees and toes, Did you ever see a laddy, and the Ten little hot dogs song.  Useful group movement breaks that facilitate motor self-control include Simon Says, Red-Light Green-light, and Giant Steps. Strategically planned music and movement break activities have been shown to improve behavior and learning in typical students as well as those with complex developmental and self-control challenges.


Hillman, C. H., Pontifex, M. B., Raine, L. B., Castelli, D. M., Hall, E. E., Kramer, A. F. (2009).  The effect of acute treadmill walking on cognitive control and academic achievement in preadolescent children.  Neuroscience, 159(3), 1044-1054.

Pellegrini, A. D. & Bohn, C. M. (2005).  The role of recess in children’s cognitive performance and school adjustment.  Educational Researcher, 35(1), 13-19.

Trudeau, F. & Shephard, R. (2008).  Physical education, school physical activity, school sports and academic performance.  International Journal of Behavioral Nutrition and Physical Activity, 5, 5-10.



FAB Trigger and Coping Forms

Here is my newest tool for helping children with behavioral, developmental, and psychiatric challenges, the FAB Trigger and Coping Forms. Kids can use it to make coping cards, identify environmental and body triggers, or identify coping strategies. I hope you find this helpful. Take care, John

PaganoFABTriggerCopingForms copy


Energy Level

A favorite strategy I use with individuals children and small groups and especially show physical education teachers is the energy check. Adapted from the ARC program for children with an early childhood history of trauma I find it also helpful for children with sensory processing challenges. You know the kid who when the PE class is rowdy goes back to class after PE and trashes the room partly because he is hyperresponsive and can’t self-regulate. So before and after all OT groups (and PE groups) have children rate their energy and whether or not it feels alright. Low energy is sleepy, medium is average, and high energy is hyper climbing the walls and can’t be still. You explore how the activity affected each child at the end of the group.  If I or the PE teacher have a child say they are uncomfortably hyper after a group they come to my OT room and are given heavy work with linear vestibular input until they are in the average range before returning to class.  Some kids do better with pictures than words alone, so below is the chart I have students make using the thermometer from Dinosaur the dinosaur curriculum.