Problem: The student hits, shoves, or pushes peers and/or adults, or uses aggressive or threatening language.

Medical/Neurological Possibility: Selective Brain Damage

Step 1: Organize observations relevant to the problematic behavior/issue

• Who is reporting the problem?
• When does it occur? (Include time of day, activities etc).
• Where does it occur?
• What tends to precede the problematic behavior/issue?
• What tends to follow the problematic behavior/issue?
• What is the age and functioning level of the student?
• Previous documentation/charts?

Step 2: Identify possible contributors to the problematic behavior/issue

In many cases, there are several contributors to the student’s identified problem. These contributors may interact with each other, therefore, it may be necessary to combine tests from different categories of possibilities. The existence of several interacting contributors may become obvious as you proceed through individual intervention experiments.

Selective brain damage: In rare cases, aggression can be a direct result of certain kinds of brain damage or unusual activation of certain parts of the brain. For example, stimulation of a part of the amygdala or of the hypothalamus in the limbic system can produce aggressive responses in otherwise non-aggressive people. When students with TBI act aggressively, especially if the aggression appears not to have a normal explanation, consultation with a physician or neuropsychologist may help staff understand the source of the aggression. Aggression that is neurologically based should be managed with a comprehensive environmental effort to prevent the aggressive behavior, possibly combined with medication. (See Tutorial on Behavior Management: Prevention Strategies.)

Possible referrals: A neuropsychologist or neurologist who may be in a position to identify the neurologic basis of aggression.