A Resource for Teachers, Clinicians, Parents, and Students by the Brain Injury Association of New York State.
Problem: The student rarely sits still; may leave his desk without permission; frequently fidgets; appears to have difficulty paying attention (focusing, maintaining attention, shifting attentional focus, dividing attention) in academic or other domains.
Cognitive/Self Regulatory Possibility: Specific Attention Deficit / Hyperactivity Disorder

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.

Specific attention deficit/hyperactivity disorder: Some students may have a specific and isolated problem with regulation of attention and activity levels. (See Tutorial on Attention.)

Relevant observations: The student does not maintain focus for expected periods of time or on one activity at a time. The student frequently ‘fidgets’ and may have difficulty completing tasks or comprehending tasks. The student has difficulty doing two things at once (e.g., listening to the teacher and taking notes). The student has difficulty shifting from one focus of attention to another. This behavior may interfere with the student’s ability to learn and retain information and generate ideas. The student does not appear to have other problems that could explain the difficulty attending and remaining still. Medical records may indicate a neurological basis for this difficulty.

Useful experiments for assessment and intervention:

  1. Observe and record the frequency and/or intensity of the problem behavior when a new teaching strategy or support is being implemented versus when it is not being implemented.
  2. Possible activity-related teaching strategies or supports (See Tutorial on Attention): Create an environment that provides support for the student to focus, maintain attention, aqnd remain still. Examples: (a) The student may benefit from a quiet, distraction-free area to complete assignments; (b) Attention-focusing printed cues, timers, or other external strategies may help; ( c) Frequent changes in activity may help focus attention; (d) It may be beneficial to reward the student for on-task behavior; (e) With younger students, a game can be made out of maintaining focus.
  3. If the problem behavior decreases as a result of the intervention, then this student’s difficulty with attention/hyperactivity may be contributing to the problem behavior. (See Tutorial on Attention)

Possible referrals: Physician to explore possible neurological basis and possible medication intervention; school psychologist for assessment of attentional functioning

A program of the Brain Injury Association of New York State, and funded by the Developmental Disabilities Planning Council.

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The Brain Injury Association of New York State
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