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.

Medical Possibility: Fatigue

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.

Fatigue: Some students have difficulty sitting still as a result of fatigue (e.g., insufficient sleep).

Relevant observations: The student may appear sleepy or fatigued (e.g., frequent yawning). He may fall asleep in class. There is a relationship between performance and eating/sleeping times. There are other reasons to suspect fatigue. (See Tutorial on Fatigue.)

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 fatigue-related teaching strategies or supports (See Tutorial on Fatigue): Correlate parental reports of sleep at night with ability to remain focused and quiet in school. Correlate target behaviors with time of day (e.g., greater problem after lunch or late in the afternoon). Create an opportunity for a short nap at school.
3. If the problem behavior correlates positively with sleep reports or if naps make a difference, then inadequate sleep may be one of the contributors to the problem behavior.

Possible Referral: Physician who may prescribe sleep medication; counselor for home assessment and possible suggestions for parents