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: Hearing 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.

Hearing impairment: Some students may appear to need directions repeated as a result of hearing impairment.

Relevant observations: The student may appear to be distracted and may not immediately respond to a request or a conversation. She may appear to be ignoring the person who is speaking to her. She may frequently ask for things to be repeated to her. She may look to other students for guidance. She may appear lost and confused.

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 hearing-related teaching strategies or supports (See Tutorial on Language Comprehension): Create an environment that allows for hearing-related instructional support. This may include (a) simplifying and repeating the directions or giving the student directions in both written and verbal form; (b) creating a visual schedule for the student to follow so that she knows exactly what she should be doing and when she should be doing it; (c) creating a buddy system so that the student can follow the lead of another student. (d) speaking clearly and with reasonable loudness; (e) eliminating background noise. In ways such as this, ensure that the student has every opportunity to be oriented to the task and succeed despite possible hearing loss.
3. If the frequency and/or intensity of the targeted behavior decreases during intervention, it may be that the problem behavior is in part a result of hearing impairment.

Possible referrals: Audiologist for hearing assessment; instructional support specialist for instructional strategies; speech-language pathologist for language assessment