Question:

Are there any specific behavior management resources, or techniques for students who have short-term memory loss? I currently have a student with a TBI and CVI who enjoys having constant verbal dialogue (singing, talking, reciting movies, etc.) Although his dialogue reflects his pleasant nature and great personality, it does interrupt the classroom environment. I have been trying to teach him that there is a time and place for this, but his short term memory loss makes behavior management very challenging. Any suggestions?

Dear Elizabeth,

Thank you for your question. I'll do my best to offer some suggestions but there are a few things I don't know:

• Age of student
• Cognitive level
• Whether the TBI is mild or severe
• Setting (i.e., general education or special day class where there is a wider tolerance for unusual behavior)
• What CVI is!!

So, I'll just offer some general comments and observations. First of all, let's try to sort out what's inherent in the child's presentation (i.e., Traumatic Brain Injury) and what is a behavior that he is using to meet his needs. To do this, let's look at what he gets out of this behavior, that is, the consequence. I use the acronym CASA to stand for the things that we all wish to achieve.

C = Control
A = Attention
S = Sensory feedback
A = Avoidance of unpleasant circumstances

Deciding what is the primary result that the student is looking for is the first step in developing a positive intervention.

1. Control - Is he primarily looking to be in charge, perhaps because his TBI has taken away the more appropriate means of independence afforded those without a TBI?
2. Attention - Does he need lots of attention focused on him, which he receives when he disrupts? Does it bolster his self esteem which has been damaged by his different sense of self?
3. Sensory - Is there some other internal force such as seizure activity? What areas of his brain were damaged?
4. Avoidance - Does he use his verbalizing to avoid an assignment that is disagreeable (too hard, boring, looks too easy to peers, etc)?

You might want to take data to get a handle on the function that the behavior may be serving. For example, what's the usual response to the behavior? Do the other students notice it and laugh, either with or at him? How does the staff address it? Does this behavior occur more frequently during some activities, for example, writing, than during others, such as art?

You may not know with absolute certainty which of the functions is correct but it's best to guess at the most likely and build your intervention around that one. For example, if you decide he uses the vocal interruptions to gain some control over his environment, come up with some novel ways to give him control in a better way. He could:

• be in charge of calling tables to line up for lunch;
• get to choose the order in which he completes assignments or whether he answers the odd or even math problems;
• learn to identify when he feels the need to vocalize, self-manage and then be rewarded for creating fewer disruptions;
• increase his awareness of how this behavior negatively impacts how he is seen by peers and teachers and use this insight to exert greater control himself.

All of the above are part of the usual strategies that are effective in increasing or decreasing a behavior. They are based on the idea that there is an antecedent for a behavior, even if it is very subtle, and that the intervention is determined by understanding what prompts the individual to behave in a certain way and what he gets out of doing it.

When the component of some neurological dysfunction is added, the same techniques that teachers use for instruction are applicable, because, really, you are still teaching. Students with memory loss benefit from:

1. Various reminders - don't limit yourself to one!
• Visual cues such as pictures of a closed mouth and a schedule which indicates when talking is ok and when it's not.
• Non-verbal cues, such as a zipper movement across the teacher's mouth or some private cue for a child with more self awareness.
• Preparing, e.g., "Van, when we go into the assembly, remember quiet mouth. After assembly is recess and then singing is fine."
2. Self-management systems: all regular readers of this site know that I am enamored with self-management. References to sources for self-management ideas can be found in previous pages. (See archives)
3. "Disinhibition is a concept that is useful to explain many functions of the nervous system and also other systems of the human body. In psychology it describes bizarre behaviors of patients who are unable to inhibit their impulses. Disinhibition is the release of inhibition, a double negative, which results in increased activity." (http://www.uth.tmc.edu/apstracts/1999/advances/November/40s.html) Disinhibition, as distinct from memory, is frequent in TBI, and no technique in the universe will be successful all of the time. (See diagram to view areas of brain with the impulses they control: http://www.nltc.com/ref_lib/disinhibition.html.)
   • Success, both for you and your student, is best viewed as even a minor decrease in the number of occurrences of an undesired behavior.
   • Educate others that this student should not be viewed as defiant and remind them that ignoring is the first option.
   • Try to impart to the student what community standards are and motivate him to work toward them while at the same time not flagellating himself for each misstep.

Good luck, and thanks for being THE ONLY PERSON to write to the lonely maytag behavior specialist. With such good odds, you should enter the lottery, or, perhaps, see yourself as the most avant of the avant-garde!