|        A Resource for Teachers, Clinicians, Parents, and Students by the Brain Injury Association of New York State.|
Step 1: Organize observations relevant 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.
Initiation impairment: Some students may appear to need directions repeated as a result of initiation impairment. The student may not start the requested activity. Alternatively, staff or parents may start the student on the activity, but when it comes to initiating the next phase of the activity, the student’s initiation impairment may block further work. (See Tutorial on Initiation Impairment).
Relevant observations: The student may initially be compliant and do what she is told to do, but then stop when further initiation is required. She appears to be dependent on direction and activation from others. 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:
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
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