Behavior and Sensory Supports

What you need to know

Children with SMS usually have significant sleep disturbances, stereotypies (repetitive movement, posture, or utterance), maladaptive, and self-injurious behaviors. 

It is important to balance your experience of a child's challenging behaviors with the recognition of his or her many positive attributes. Many people with SMS have an engaging and endearing personality.

Individuals with SMS typically have inattention, distractibility, hyperactivity, and impulsivity.  Individuals may also have obsessive-compulsive disorder (OCD), oppositional defiant disorder (ODD) and difficulties processing sensory information.  Individuals with SMS crave the attention and company of adults.

The frequency and type of behaviors will vary between individuals with SMS.

  • Frequent outbursts
  • Temper tantrums
  • Attention seeking
  • Disobedience
  • Aggression
  • Toileting difficulties
  • Lick and flick – meaning that they lick their fingers and flick pages over and over again
  • Teeth grinding
  • Body rocking
  • Spinning or twirling objects
  • Self-injurious behaviors
    • Self-hitting,
    • Self- biting
    • Skin picking
    • Insertion of foreign objects into body offices
    • Yanking fingernails and/or toenails
    • Mouthing of hands or objects persists from early childhood
  • Quick upper body squeeze or self-hug highly associated with SMS
  • Many individuals will have autism or autistic-like features

  • Differences in level of intellectual functioning and emotional maturity may contribute to maladaptive behaviors.
  • Sleep disturbance is also known to be a significant contributor to negative behaviors in people with SMS.
  • Sensory processing challenges may be present and persist throughout childhood
    • A prominent pattern of sensory processing is recognized that is characterized by an imbalance in neurologic thresholds and a fluctuation between active and passive self-regulation

The SMS behavioral profile often escalates with puberty. The gap between intellectual attainment and emotional development appears to widen for many with SMS and this can pose challenges for older children and adults.

Adolescents may experience:

  • Rapid mood shifts
  • Increased impulsivity
  • Increased anxiety with or without fright/fight reaction
  • Aggressive outbursts are common and escalate with age
  • Pubertal onset of seizures may occur, especially with females having menses
  • Insertion of objects into body orifices may increase

Outbursts often result from frustration over:

  • Communication difficulties
  • Fine motor challenges
  • Changes in routine
  • Many people with SMS crave interaction with adults and react negatively if attention is withdrawn or directed toward others
  • People with SMS frequently have rigid ideas about their world. A prolonged tantrum may result if things do not go exactly as expected or envisioned.

Information on interventions:

  • Published data about the optimal intervention and behavioral strategies in SMS are limited to anecdotal and experiential findings.
    • Use of psychotropic medication may increase attention and/or decrease hyperactivity. No single regimen shows consistent efficacy.
  • Therapeutic management of the sleep disorder in SMS remains a challenge for physicians and parents.

What you can do

  • Provide a calm, consistent classroom. A small class size is preferred.
    • Use reinforcement and motivation techniques
    • Use visual cues
      • Use pictures and charts for transition, tasks, schedules, etc.
    • Be aware that the child may have difficulty with processing information in a sequential or step-by-step manner
  • Be aware that transitions from one activity to another or unexpected changes in the school routine can be difficult
    • Provide advance warning before transitions or special events
  • Learn and utilize appropriate behavioral therapies - they are integral in behavioral management.
    • Special education techniques that emphasize individualized instruction, structure, and routine can help minimize behavioral outbursts in the school setting.
    • Positive behavioral supports and a functional behavioral assessment should be considered.
  • Work with the child's parents to ensure a comprehensive and consistent support plan is in place both at home and in school. 
    • A structured school program with one-on-one support is important.
  • Be aware that children with SMS may use medication to treat hyperactivity.  
  • Utilize behavioral techniques that emphasize individualized instruction, structure, and routine. These can help minimize behavioral outbursts in school.
  • Help create the optimal environment for the child. This may include respite care and family psychosocial support.