A Resource for Teachers, Clinicians, Parents, and Students by the Brain Injury Association of New York State.
Problem: The student does not begin assignments; rarely initiates interaction with peers or adults; is not spontaneous.
Cognitive / Self-Regulatory Possibility:
Isolated initiation 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.

Isolated initiation impairment: Some students may lack initiation and fail to act spontaneously as a direct result of frontal lobe injury. (See Tutorial on Initiation).

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

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 initiation-related teaching strategies or supports (See Tutorial on Initiation; Self-Regulation/Executive Function Routines): Create an environment that provides initiation support for the student. Examples: Give the student extra time on tasks. Initiation prompts may be useful (e.g., starting the response for the student). Work collaboratively with the student. Prompt asking for help as a general problem-solving strategy.
  3. If the frequency and/or intensity of the targeted behavior decreases during intervention, it may be that this student’s problem behaviors are in part a result of general difficulty with initiation. (See Tutorial on Initiation.)

Possible referrals: Physician to explore possible neurological basis and possible medication intervention; school psychologist for initiation assessment; instructional support specialist for instructional strategies; behavior specialist for behavior management strategies

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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