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: Medication Interactions

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.

Medication interactions: Some students may have difficulty sitting still as a result of medication interactions.

Relevant observations: The behavior may have begun when additional medications were added to the student’s regimen. The behavior may occur when prescriptions are taken at the same time or when it is nearing the time that the next dose of medication is due.

Useful experiments for assessment and intervention:

1. Observe and record the frequency and/or the intensity of the targeted behavior when both medications are given.
2. Under medical supervision, observe and record the frequency and/or the intensity of the behavior when only one of the medications is given.
3. Systematically compare results; if the problem behavior decreases when only one medication is given, then medication interactions may be one of the contributing factors to the problem behavior.

Possible referrals: The physician who prescribed the medication for medication assessment.