Problem: The student appears to do the first thing that comes to mind; has difficulty delaying gratification; appears to act without thinking.

Medical Possibility: Fatigue, hunger, general nutrition

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.

Fatigue, hunger, general nutrition: Some students may think and act impulsively as a result of fatigue, hunger, or poor nutrition.

Relevant observations: The targeted behavior seems to be associated with the student’s apparent level of fatigue or hunger. There is a relationship between performance and eating/sleeping times. The student is not adequately fed at home; the student does not sleep adequately at night. 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 modified eating/sleeping schedule is being implemented versus when it is not being implemented.
2. Possible modifications in the eating/sleeping schedule: (a) Provide breakfast for the student and ensure a proper lunch; (b) Discuss sleep patterns with parents and encourage normal sleep; possibly provide rest periods at school; ( c) Move difficult academic periods to different times in relation to sleeping or eating.
3. If the targeted behavior decreases as a result of the intervention, then fatigue or hunger may be contributing to the problem behavior.

Possible referrals: A physician (to explore possible neurological basis of sleep or eating problems); school psychologist or social worker for assessment of eating and sleeping patterns at home