Unpacking the Dangers of a False Dichotomy

If you work with a pediatric population or have a child with a diagnosed disability, you've undoubtedly heard this question before: "Is it sensory or is it behavioral?"

There are comprehensive continuing education courses dedicated to providing answers. Therapists of all disciplines spend hours "picking the brains of others" to determine exactly what category a child's observed target behaviors fit into (Escape? Attention? Access to a preferred tangible? None of those, huh? ? Maybe sensory then?), But I've learned something recently, it's the wrong question.



As a new occupational therapist with a background in Applied Behavior Analysis (ABA), I quickly wanted to make "sensory" a new function of behavior. I clearly assumed that any underlying sensory need of a client could be synonymous with "automatic reinforcing behavior." This made me feel good, as this was considered the most difficult area in the world of behavior modification. With both lenses, he was sure he could solve even the toughest cases, but it didn't work. The more I immersed myself in the sensory world (that which is internal and inherently difficult to observe and measure), the more confused I became.

"The goal of ANY sensory intervention is never to change a child's inherent preferences, but to adapt to them in a way that maximizes both quality of life and meaningful participation in occupations."

Case in point: let's call my friend "Charlotte." Charlotte has a history of plugging her ears, yelling, and running out of the classroom whenever she is presented with a task she finds difficult. The ABA therapist walks in, collects ABC (Antecedent-Behavior-Consequence) data, and determines that the behavior remains escaping. The occupational therapist then comes in, gives the child a sensory evaluation, and determines that Charlotte has some difficulty with modulation in the "auditory filtering" areas. During the observation, the occupational therapist notices that Charlotte's teacher gives particularly long explanatory verbal instructions. There is also a smoke detector that goes off and kids whisper in the pockets of the classroom. She determines that the escape behavior is "sensory" in nature. Which therapist is right?


Well ... aren't you both?

Here's the danger of the sensory versus behavioral question: It's too simple. It assumes a dichotomy between how a person processes sensory information in the brain and their observable and measurable behaviors. Thanks to MRI machines and other medical advances, we now know more about the brain than ever before. A tried and true rule in the world of neuroscience is this: sensory input equals motor output.

In simpler terms, our brains are rigorous data collectors. We are constantly providing information through the senses from our environment to our brain. Our brain then processes this information and (either consciously or unconsciously) uses that information to formulate a series of motor outputs (movements, or as I like to call them, BEHAVIORS). Behavior and sensory input go hand in hand like peas and carrots. We have to STOP treating them as sworn enemies, winners and losers. They are actually codependent best friends. Honestly, you can't unravel one and still have the full picture of the other.

Behavior and sensory input go hand in hand like peas and carrots.

We have to stop treating them as sworn enemies.

We can go on philosophizing for centuries about this new discovery. But we have children to raise and many cases to treat, and this is what we are really looking for: clinical implications. I'm talking about solution-based problem solving, and we've already determined that "Is it sensory or behavioral?" is the wrong question. So here's a less shameful alternative: "Is there a sensory intervention that serves as an effective preventive strategy for (insert your target behavior here)?" Because here's the bottom line: we all have individual sensory preferences. The goal of ANY sensory intervention is never to change the child's inherent preferences, but to accommodate them in a way that maximizes both quality of life and meaningful participation in occupations.

So to recap: here are some dos and don'ts when it comes to treating a child with unique behavioral and sensory needs (READ: EVERY CHILD):


Take a holistic approach, regardless of your particular disciple. Being able to see a child as a complete human being, through multiple lenses, is ultimately best for everyone.

Take data and expand your definition of antecedent to include what is happening in the environment (with particular attention to smells, sounds, demands for movement, positioning, etc.)

Get even more data on sensory interventions and their effectiveness. This is how we make evidence-based decisions about something that is inherently internal.

Be a team player. ABA is great. OT is great. Both are better.


Did you ever say "Is it sensory or is it behavior?"

Remember, best friends.