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|         A Resource for Teachers, Clinicians, Parents, and Students by the Brain Injury Association of New York State. | 
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 Click on "MORE" after any of these possible explanations to view suggestions for exploring that possible explanation. 
 Medical #1: Medication side effect: Some students may appear to need directions repeated as a side effect of medication.  Medical Possibility #2: Chronic pain. Some students may appear to need directions repeated as a result of being in chronic pain.   Medical Possibility #3: : Fatigue, hunger, general nutrition: Some students may appear to need directions repeated as a result of fatigue (e.g., insufficient sleep) or hunger.  Medical Possibility #4: : Hearing impairment: Some students may appear to need directions repeated as a result of hearing impairment.  Medical Possibility #5: : Seizures: In rare cases, lack of compliance may be a result of seizures that may or may not be diagnosed. If seizures have been diagnosed, staff should ask the physician if difficulty persisting in activities is a likely or possible consequence of the seizures. If seizures have not been diagnosed, but are suspected, a seizure evaluation should be recommended. If seizures are diagnosed, the prescribed medication regimen should be followed along with environmental management of a possible lack of compliance. (See  
 Cognitive/Self-Regulatory Possibility #1: 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  Cognitive/Self-Regulatory Possibility #2: Weak orientation to task:  Some students may appear to need directions repeated as a result of disorientation or uncertainty regarding what is required of them. (See  Cognitive/Self-Regulatory Possibility #3: Generally weak cognitive and academic functioning:  Some students may appear to need directions repeated as a result of excessive demands placed on their memory, organizational ability, academic skill, or other cognitive ability. They may experience frequent failure in school. (See  Cognitive/Self-Regulatory Possibility #4: General slowness in information processing:  Some students may appear to need directions repeated as a result of general slowness in information processing. (See  Cognitive/Self-Regulatory Possibility #5: Organizational impairment: Some students may appear to need directions repeated as a result of organizational impairment. (See  Cognitive/Self-Regulatory Possibility #6: Attention deficit: Some students may appear to need directions repeated as a result of an attention deficit. (See  Cognitive/Self-Regulatory Possibility #7: Inhibition impairment:  Some students may  appear to need directions repeated  as a result of inhibition impairment (i.e., impulse-control problems). (See  Behavioral Possibility #1: Oppositionality:  Some students appear to need directions repeated as a result of oppositional behavior (See  Behavioral Possibility #2: Attention seeking: Some students may appear to need directions repeated do as a means of obtaining adult and/or peer attention. (See  Behavioral Possibility #3: Manipulativeness:  Some students may appear to need directions repeated as a form of manipulation. (See  Behavioral Possibility #4: Task avoidance: Some students may appear to need directions repeated as a way to avoid specific tasks.  (See  
 Social-Emotional Possibility #1: Depression:  Some students may appear to need directions repeated because they are upset, depressed, and/or lack positive relationships with peers and/or adults. (See  Social-Emotional Possibility #2: Anxiety:  Some students may appear to need directions repeated as a result of anxiety. (See  Social-Emotional Possibility #3: Frustration:  Some students may appear to need directions repeated as a result of feeling frustrated. (See  
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