Problem: The student appears to perseverate or get stuck doing the same activity over and over or saying the same thing or feeling the same emotion; may have difficulty transitioning from place to place or activity to activity; requests from teachers or parents to change topics or activities may be greeted with negative behavior; changes in or disruptions of routines cause problems; the student appears to be rigid and inflexible. (See Tutorial on Flexibility.)

Medical Possibility: Medication Side Effect

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. For purposes of clarity, we have listed the possibilities separately. However, it may be necessary to simultaneously implement tests of combinations of these possibilities. The existence of several interacting contributors may become obvious as you proceed through individual intervention experiments.

Medication side effect: Some students may appear to be inflexible and have difficulty with topic shifts, attention shifts, activity transitions, and changes in routine as a side effect of medication.

Relevant observations: The student may appear sleepy or fatigued (e.g., frequent yawning). 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 fatigue-related teaching strategies or supports (See Tutorial on Fatigue): Correlate parental reports of sleep at night with ability to attend in school. Correlate attending behaviors with time of day (e.g., greater problem after lunch or late in the afternoon). Create an opportunity for a short nap at school and then look for an improvement in flexibility.
3. If the problem behavior correlates positively with sleep reports or if naps make a difference in the ability to be flixible, 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