A Resource for Teachers, Clinicians, Parents, and Students by the Brain Injury Association of New York State.
 

At Home #1: directions repeated

Problem: The student appears to need directions repeated; he often does not do what he is supposed to do; he either does not begin or does not complete assignments; he may at times appear to be defiant.


I. GENERAL MEDICAL POSSIBILITIES

  1. Medication Side Effect
  2. Chronic Pain
  3. Fatigue/Hunger/Nutrition
  4. Hearing Impairment
  5. Seizures

II. COGNITIVE/SELF REGULATORY POSSIBILITIES

  1. Initiation Impairment
  2. Weak Orientation to Task
  3. Generally Weak Cognitive/Academic Functions
  4. General Slowness in Information Processing
  5. Organizational Impairment
  6. Attention Deficit
  7. Inhibition Impairment

III. BEHAVIORAL POSSIBILITIES

  1. Oppositionality
  2. Attention Seeking
  3. Manipulativeness
  4. Task Avoidance

IV. SOCIAL- EMOTIONAL POSSIBILITIES

  1. Depression
  2. Anxiety
  3. Frustration


I. GENERAL MEDICAL POSSIBILITIES 

1. Medication Side Effect: Some students may appear to need directions repeated as a side effect of medication. (Instead of clicking on "more", make the live link be the title of the possibility; e.g.:"Medication Side Effect")
               
2. Chronic Pain: Some students may appear to need directions repeated as a result of being in chronic pain.

3. Fatigue/Hunger/General Nutrition: Some students may appear to need directions repeated as a result of fatigue (e.g., insufficient sleep) or hunger.

4. Hearing Impairment: Some students may appear to need directions repeated as a result of hearing impairment.
               
5. Seizures: In rare cases, lack of compliance may be a result of seizures that may or may not be diagnosed. If seizures have been diagnosed, staff should ask the physician if difficulty persisting in activities is a likely or possible consequence of the seizures. If seizures have not been diagnosed, but are suspected, a seizure evaluation should be recommended. If seizures are diagnosed, the prescribed medication regimen should be followed along with environmental management of a possible lack of compliance. (See Tutorials on Seizures)

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II. COGNITIVE/SELF-REGULATORY POSSIBILITIES

1. Initiation Impairment: Some students may appear to need directions repeated as a result of initiation impairment. The student may not start the requested activity. Alternatively, staff or parents may start the student on the activity, but when it comes to initiating the next phase of the activity, the student’s initiation impairment may block further work. (See Tutorial on Initiation)

2. Weak Orientation to Task: Some students may appear to need directions repeated as a result of disorientation or uncertainty regarding what is required of them. (See Tutorials on Language Comprehension; Organization)

3. Generally Weak Cognitive/Academic Functions: Some students may appear to need directions repeated as a result of excessive demands placed on their memory, organizational ability, academic skill, or other cognitive ability. They may experience frequent failure in school. (See Tutorials on Cognition; Memory; Organization)

4. General Slowness in Information Processing: Some students may appear to need directions repeated as a result of general slowness in information processing. (See Tutorial on Slow Information Processing)

5. Organizational Impairment: Some students may appear to need directions repeated as a result of organizational impairment. (See Tutorial on Organization)

6. Attention Deficit: Some students may appear to need directions repeated as a result of an attention deficit. (See Tutorial on Attention)

7. Inhibition Impairment: Some students may appear to need directions repeated as a result of inhibition impairment (i.e., impulse-control problems). (See Tutorials on Self-Regulation; Impulsiveness/Disinhibition)

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III. BEHAVIORAL POSSIBILITIES

1. Oppositionality: Some students appear to need directions repeated as a result of oppositional behavior (See Tutorials on Behavior and Behavior Problems after TBI; Behavior Management: Prevention Strategies)
               
2. Attention Seeking: Some students may appear to need directions repeated do as a means of obtaining adult and/or peer attention. (See Tutorials on Attention; Behavior Management: Prevention Strategies; Behavior Management: Contingency Management)

3. Manipulativeness: Some students may appear to need directions repeated as a form of manipulation. (See Tutorials on Teaching Positive Communication Alternatives to Negative Behavior; Behavior Management: Prevention Strategies)

4. Task Avoidance: Some students may appear to need directions repeated as a way to avoid specific tasks. (See Tutorials on Noncompliance; Errorless Learning; Problem Solving; Behavior Management: Prevention Strategies; Behavior Management: Contingency Management)

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IV. SOCIAL-EMOTIONAL POSSIBILITIES

1. Depression: Some students may appear to need directions repeated because they are upset, depressed, and/or lack positive relationships with peers and/or adults. (See Tutorials on Depression; Peer Relationships)

2. Anxiety: Some students may appear to need directions repeated as a result of anxiety. (See Tutorial on Anxiety)

3. Frustration: Some students may appear to need directions repeated as a result of feeling frustrated. (See Tutorials on Self Regulation/Executive Function Routines after TBI; Teaching Positive Communication Alternatives to Negative Behavior)

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