Welcome to guest blogger and OT Joanna Blanchard MOTR/L
Occupational therapists are often asked if a client’s actions are either sensory or behavior related. Most often the answer is both.
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Behavior can be a response to a skill deficit or inability to regulate one’s body or emotions. It can also be a response to triggers that are out of one’s control. When clients have difficulty communicating their thoughts and feelings, we need to investigate what we know; background, physiological factors, emotional skills, self-regulation strategies, etc. Are current strategies safe and effective or are there holes in support systems? With this background information, we start to piece out what’s behind the client’s actions and how to help.
Most of us have strategies to keep ourselves in check or to mask our feelings. This may look like self-talk, avoiding a trigger, deep breathing, etc. Sometimes we find ourselves being snappy or impatient when anxious. Even in situations out of our control, we reach deep for the tools we have. For example, getting stuck in heavy traffic; we may turn down the radio to reduce noise as our stress level rises. Traffic can’t be changed, so inevitably we settle in to be annoyed, possibly late and stressed. We know we’ll get there eventually and have control of the entertainment (podcast or radio?), temperature, seat position and light exposure (sun visor). So we call our boss, slide down in the seat and put on sunglasses to keep from spiraling. Maybe we gracefully let someone cut in front of us, or maybe feel like honking and glaring; we have the choice.
When our clients are in similar scenarios, but don’t have the means to ask for help, remove themselves or enact coping strategies independently, they will show us with actions or “behavior”. Sitting in the same traffic, running late with no control over the radio, heat/cool air, sun and people cutting in, feels vulnerable and may be physically painful from sensory overwhelm. They might not be able in that moment to ask questions or let someone know they are late or feeling car sick. If they aren’t able to enact self-soothing strategies, express distress, or ask for help, they may spiral into panic, anger, or shut down/dissociate. They may start to exhibit unsafe behavior; I know I probably would.
When looking for the root of a behavior, we hunt for triggers and locus of control by asking:
· What and how are they communicating? (consider non-verbal cues and body language)
· What are they currently doing to get what they need? (The behavior: running, hiding, crying, pushing, other strategies)
· Do we know of specific issues contributing to triggers/discomfort? (sensory, memory, emotional…)
· Is the behavior predictable? Is it in a particular place, time or day?
· Can we talk to caregivers about successful strategies at home?
· How can you help set this client up for success proactively?
Of course, not being able to communicate in a situation doesn’t ever completely reflect a client’s helplessness or ability. Gaps in skills are not synonymous with gaps in intelligence, but at times everyone needs help that preserves dignity and respect.
The biggest question is how would we feel in our client’s shoes. What would we do in a similar situation? Can you give the client some options to be in control of their own experience? With that perspective, labeling what is behavior vs. sensory becomes less important and the focus becomes problem solving in partnership with our clients.
