I. GENERAL MEDICAL POSSIBILITIES 

1.Medication Side Effect: Some students may lack spontaneity as a side effect of medication.
               
2. Chronic Pain: Some students fail to initiate activity and interaction as a result of being in chronic pain.

3. Fatigue/Hunger/General Nutrition: Some students may fail to persist and complete activities as a result of fatigue (e.g., insufficient sleep) or hunger.

4. Seizures: In rare cases, lack of persistence 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 the lack of persistence and follow through. (See Tutorials on Seizures)

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II. COGNITIVE/SELF-REGULATORY POSSIBILITIES

1.Isolated Initiation Impairment: Some students may fail to persist and complete activities as a result of initiation impairment. 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 Impairment)

2.Weak Orientation to Task: Some students may fail to persist and complete activities as a result of disorientation or uncertainty regarding what is required of them. (See Tutorials on Language Comprehension; Organization)

3.Generally Weak Cognitive and Academic Functioning: Some students may fail to persist and complete activities 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 fail to persist and complete activities as a result of general slowness in information processing. (See Tutorial on Slow Information Processing)

5.Organizational Impairment: Some students may fail to persist and complete activities as a result of organizational impairment. (See Tutorial on Organization)

6. Attention Deficit: Some students may fail to persist and complete activities as a result of an attention deficit. (See Tutorial on Attention)

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III. BEHAVIORAL POSSIBILITIES

1.Oppositionality: Some students may fail to persist and complete activities 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 fail to persist and complete activities 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 fail to persist and complete activities 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 fail to persist and complete activities 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 fail to persist and complete activities 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 fail to persist and complete activities as a result of anxiety. (See Tutorial on Anxiety)

3.Frustration: Some students may fail to persist and complete activities 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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