Problem: The student appears to need directions repeated; he often does not do what he is supposed to do; he either does not begin or does not complete assignments; he may at times appear to be defiant.

Medical Possibility: Fatigue, hunger, general nutrition

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, hunger, general nutrition: Some students may appear to need directions repeated as a result of fatigue (e.g., insufficient sleep) or hunger.

Relevant observations: The student may appear sleepy or fatigued (e.g., frequent yawning). In the morning he may be difficult to arouse and may complain of insufficient sleep. 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 modifications in the eating/sleeping schedule: (a) Provide breakfast for the student and ensure a proper lunch; (b) Discuss sleep patterns with parents and encourage normal sleep; possibly provide rest periods at school; ( c) Move difficult academic periods to different times in relation to sleeping or eating
3. If the problem behavior correlates positively with sleep reports or if naps make a difference in the behavior, 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