Problem: The student appears to do the first thing that comes to mind; has difficulty delaying gratification; appears to act without thinking.

Medical Possibility: Chronic Pain

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.

Chronic pain: Some students may think and act impulsively as a result of chronic pain.

Relevant observations: The student may appear agitated or frequently complain of aches and pains. He may also appear fatigued, tired, and/or restless. Impulsiveness may appear to increase with increases in pain.

Useful experiments for assessment and intervention:

1. Compare the frequency and/or intensity of the targeted behavior under the following conditions.
   1. Under medical supervision, observe the student’s behavior when not receiving any type of pain management. These observations should take place across a variety of settings, such as during math class, in the cafeteria, and during recess.
   2. Under medical supervision, administer the prescribed pain management. Again observe and record the frequency and intensity of targeted behavior.
2. Compare the student’s behavioral differences when receiving pain management versus when not. Specifically look to see if the targeted behaviors have decreased under pain management conditions.
3. If the targeted behavior has decreased under pain management conditions, then chronic pain may be one of the contributors to the problem behavior.

Possible Referral: The physician who prescribed the medication or other clinician responsible for pain management.