A Resource for Teachers, Clinicians, Parents, and Students by the Brain Injury Association of New York State.
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.
Cognitive/Self-Regulatory Possibility:
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.

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:

  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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