Problem: The student appears to have difficulty transitioning from place to place or activity to activity; changes in routine cause problems; the student appears to be inflexible. (See Tutorial on Flexibility.)

Cognitive/Self-Regulatory Possibility: Specific flexibility impairment

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 flexibility impairment: Some students may be inflexible and have difficulty with transitions as an isolated deficit, a direct result of frontal lobe injury. (See Tutorial on Flexibility).

Relevant observations: The student’s inflexible behavior does not appear to be a result of any of the medical, cognitive, behavioral, or emotional possibilities listed. In some students with TBI, frontal lobe injury can produce inflexible behavior that is independent of all other problems. Medical records suggest prefrontal injury.

Possible referrals: Physician to explore possible neurological basis and possible medication intervention