Hey CoachABA team!
Today, in the spirit of collaboration, we’ll be stepping out of the ‘Behavior Analysis’ worldview, and taking a walk in the shoes of an Occupational Therapist!
Occupational Therapists work with individuals of all ages to teach “occupations,” which, in layman’s terms, are occupations of daily living. Think grooming oneself, cleaning, and eating. While Behavior Analysts approach teaching new skills through the lens of antecedent control and positive reinforcement, Occupational Therapists take a more holistic approach that explores mind-body connection, tactical skills, and the sensory system.
Board Certified Behavior Analysts (BCBAs) have a great deal to learn from Occupational Therapists. Though traditional Applied Behavior Analysis (ABA) is based solely on observable behaviors, contemporary practice encourages clinicians to take a more holistic approach. While we can only shape behavior that we see, we can also do our best to understand our clients as whole people. From Occupational Therapists, we can gain a holistic understanding of how environments affect nervous systems.
This blog post is based on a presentation given to our ABA Fam by Nicoletta Minton, OT of N’Balance, LLC.
The 8 Senses
Let’s start by straightening out a common misconception; you have eight senses, not five. The sensory system is how the body and mind learn about the world – and it’s always operating! All day every day, every one of us is taking in information through each of these eight dimensions. They are…
- Visual (what we see)
- Auditory (what we hear)
- Tactile (touch, texture, temperature)
- Olfactory (what we smell)
- Gustatory (what we taste)
- Proprioception (body position, muscles, and joints)
- Vestibular (movement, balance, and gravity)
- Interoception (signals and cues from inside the body)
Before Behavior…Comes the Nervous System
BCBAs instinctually recognize that environmental factors affect how a person behaves. But how often do we truly consider someone’s internal state? The nervous system is constantly receiving new information, interpreting, responding, and adapting to new experiences. When a person receives too much or too little input, you end up with a dysregulated nervous system.
A dysregulated nervous system can directly affect the way a person functions. It makes it difficult to pay attention, communicate, and perform fine motor activities. We know that every behavior is a communication. Sometimes what a behavior is communicating is, “I’m dysregulated, and I need help.”
Understanding the effects of the nervous system on a person’s behavior helps us to empathize with our clients. It helps us take a step back. Instead of getting frustrated, try to meet your clients where they are. Once we meet the nervous system’s needs, the individual will be able to learn, connect, and participate.
When the world becomes too much
Why does dysregulation happen?
Have you ever been somewhere where the lights are too bright, the sounds are too loud, someone is wearing an overbearing perfume, and you just start to feel a little crazy? That’s called overstimulation. When our sensory inputs compound, and it’s more than our system can effectively regulate at one time, our body shifts into overload. Everybody’s nervous system is unique, and some people’s sensory systems are more sensitive than others! So while it may seem like certain behaviors are coming out of nowhere, it’s possible they’re linked to feelings of overstimulation.
There are several behaviors that could signal sensory overload, including…
- Covering ears/eyes
- Escaping or hiding
- Crying, yelling, or screaming
- Increased movement or pacing
- Repeating movement or language
- Becoming silly or loud
- Irritable, agitated, angry
- Shutting down or going quiet
- Dropping and withdrawing
- Hitting, throwing, pushing
- Freezing
It’s important to remember that sensory overload is just one possible cause of maladaptive behavior. While this information can inform your work as a BCBA, it should not replace your traditional observation period. Let this be a reminder to stay curious about the patterns that you see, and stay open to several possible antecedents.
Regulating Yourself
If you aren’t regulated yourself – why would you expect the learner to be? Oftentimes, the best place to start when teaching our clients how to regulate is to practice self-regulation ourselves. In other words, we lead by example.
Before you jump to trying to help a learner regulate, ask yourself about the state of your own nervous system. How are those feelings affecting your behavior? Are you rushing? Are you raising your voice? Are you trying to do more because the learner is displaying dysregulation? Is your dysregulated behavior causing others to engage in dysregulated behavior? Take a step back, relax, and remind yourself that you do not need to be perfect. You just need to notice, without judgement, how you’re feeling.
Co-Regulating with a Learner
When you begin to regulate yourself, you help others regulate. By checking in with yourself, you can notice how you’re showing up, and adjust it to help meet your learner where they are. This powerful tool is called co-regulation.
When an individual is feeling dysregulated, the last thing they need is more overstimulating input. To help them regulate, we can focus on trying to meet them where they are. Some clinicians use the motto “ Connection before correction” or “regulation before expectation.” This goes for working with parents and caretakers, too. Collectively, we must all move away from “make them stop” into “What is their nervous system saying, and how can we get through this together?”
Give your learner space; use fewer words, speak slowly and softly, allow them time to process, and find ways to be on their level without being up in their space. Remember – connection cannot be forced. Insisting that a learner make eye contact with their BCBA, giving them unwanted touch, or asking too many questions can add to their stress. Offer them steady, safe, predictable support, with respect for their boundaries.
Over time, practicing co-regulation will help you build trust and flexibility with your clients.
Your Regulation Toolkit
Now that we’ve discussed why Regulation is important for both you and your clients, we’re going to give you some practical strategies to use!
Think of these strategies as being different tools in a toolbox. Not every tool will be right for every instance. Some people will prefer certain tools more than others. There is no universal calming activity. Before you suggest a regulating activity, ask yourself, “what does this person’s nervous system need right now, in this moment?” You may have to try a few different thinks, and make adjustments. Keep what helps, change what doesn’t.
Let’s get into your tools.
Reduce Input
If a person is experiencing overstimulation, one of the best things you can do is take a step back and reduce the input. This works because it lightens the load of what the nervous system has to manage.
A few ways you can rescue input:
- Lower noise
- Use a quiet voice, earplugs, or noise cancelling headphones
- Dim lights
- Simplify visual input
- Fewer people or a bigger space
- Fewer words
- Reduce unnecessary demands
- Allow more time for processing
Add Proprioception/Heavy Work
For some individuals, heavy work can help the body feel grounded and secure. This is a great option for anybody who is feeling strained, flighty, or unfocused.
Here’s some ways to engage the proprioceptive system
- Push, pull, or carry
- Animal walks
- Climb, crawl, or use obstacles
- Wall pushes or chair pushes
- Resistance activities (bands, weights, theraband)
- Move or help with equipment or materials
Use Movement Intentionally
Movement is an incredible tool for regulating our bodies. Sometimes, the best thing you can to calm down is to get some blood pumping! Exercise has the capability to naturally lower stress hormones and boost your mood. Be mindful though – as movement can regulate OR increase agitation. Always monitor the way your learner is responding.
Some ways to get your body moving are…
- Walk
- Rock or sway
- Swing
- Jump
- Bike, scooter, or move with purpose
- Movement breaks
Support the Body
Remember; before the body can complete tasks, we need to meet its basic needs. Giving the body the support it needs lets your nervous system know that it is safe to open up and try new things.
Some ways to support the body include…
- Breathing without forcing
- Deep pressure touch (with consent!)
- Water, snack, or bathroom
- Comfortable seating or body position
- Quiet break or low-stimulation space
- Recognize fatigue, hunger, pain, temperature, tension, & emotions
Increase Predictability & Connection
Many of our learners thrive on routine and predictability. We can attribute this, at least in part, to the ways predictability calms the nervous system. It also helps build up a sense of connection and trust between you and your client.
Here are some ways you can establish predictability & connection…
- Visual Schedules
- First/Then
- Offer choices
- Allow Processing Time
- Calm Adult Presence
- “I’m here. We can figure this out together.”
Conclusion: What Board Certified Behavior Analysts Can Learn from Occupational Therapy
Let’s be real here; our learners need both Applied Behavior Analysis AND Occupational Therapy. The two practices serve different goals with different methods. One is not inherently better than the other. You can support your OT colleagues by getting curious about their pedagogy. Acknowledge the lived experiences of your clients and their relationships to the nervous system. Understand that before behavior, comes a sensory experience. Don’t be afraid to try on the OT lens from time to time to gain a new perspective on behavior.
About CoachABA
CoachABA is the educational wing of Applied Behavioral Advancements, LLC. CoachABA is both a tool for up-and-coming ABA professionals, and a platform for encouraging ongoing education for those already working in the field.
Our supervision program began from the genuine desire to figure out a better way for BCBA candidates to get supervision hours. CoachABA provides training and supervision for individuals on their way to becoming a BCBA. Our program meets all requirements of board certification, as well as competency items. Our goal is to help you pass the first time, while also assuring all your i’s are dotted and your t’s are crossed when it comes to your paperwork.
About ABA-LLC
ABA-LLC is one of the largest suppliers of Behavior Support in the State of Kentucky. Since 2007, the agency has created innovative strategies to improve the lives of unique individuals. ABA-LLC works with around 190 contractors, each dedicated to building an inclusive culture that celebrates individuals of all abilities. No matter who you are, you can reach your goals at ABA-LLC.
ABA-LLC is set apart from its competitors by its uniquely person-centered approach. The agency strives to provide services from a place of deep love for the population they serve. Their work exemplifies the belief that every individual has a right to live a fulfilling and independent life integrated within their communities. There is no objective to change a person, but rather to give them the tools they need to succeed. B.F. Skinner summarizes this vision in his quote: “I’m not trying to change people. All I want is to change the world in which they live.” Learn more about us at https://aba-llc.com/