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What is initiation?

Initiation is about getting started. We may need to start an activity because:

  • It is time to do something (eg eat a meal; to go to a club or class).
  • We need to answer a question.
  • We need to do something (eg to tidy up our clothes, finish a piece of homework).
  • We have something planned (eg to go to a party).
  • We want to do something (eg to meet a friend).
  • Our body signals that we need to do something (eg go to the toilet; take a jumper off because we’re too hot).

Usually something prompts or ‘cues’ us to start a task, for example: the time of day; a feeling in our body; a question/instruction from someone else; a ‘want’ or desire. However, sometimes there is not a clear prompt to start something: a task that is planned for the future, for example. Many people find it useful to make their own cues for these things eg diary or calendar reminders.

Children and young people can have problems starting (or ‘initiating’) something for a variety of reasons.

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How can initiation be changed by hydrocephalus?

Initiation is one of the executive functions controlled from the ‘command centre’ in the frontal lobes of the brain. This region of the brain is connected to all other areas and structures. Hydrocephalus can change the way the brain is structured and how different areas are connected. This can change the way processes work.

For reminders or more detail about:

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Key processes involved in initiation

Problems that might stop us from initiating an activity could include a failure to:

  • Sense and pay attention to the prompt or ‘cue’ that tells us an action is needed.
  • Understand that the cue means an action is needed.
  • Work out what action is needed.
  • Plan what we need to do.
  • Process information quickly enough so that we can act when it is expected / needed.
  • Hold in mind what needs done and why.
  • Stop or ‘inhibit’ a reaction to any distractions.
  • Remember something that needs to be done at some time in the future.


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Helping someone with hydrocephalus to ‘get started’

A child or young person with hydrocephalus may have difficulties with any or all of the above processes and this can have an impact on ‘getting started’ in any situation. They may need help in organising themselves to make this easier. Some things to think about:

  • Providing prompts for ‘school tasks’ and ‘home tasks’ (eg calendars; diary notes).
  • Getting materials organised in a specific place eg a desk for homework with pens, paper; making sure that only the worksheet or book needed for a single piece of homework is on the desk when it is needed.
  • Using checklists or picture guides to help put tasks, or task steps, in the right order.

Providing prompts and cues and making sure the young person has the right materials at the right time may help the young person to ‘initiate’ tasks. It may also prevent the frustration and upset that can be caused if they usually find these things difficult.

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Diagram of key processes involved in initiation

key processes in initiation

There are many things that can affect the brain’s processing including the ability to start or ‘initiate’ activities. Take a look at the introductory page for a reminder of ‘Other things that can affect how we think and behave’.

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Possible problems

Not starting something at the right time and in the right place may cause lots of difficulties in:

  • Responding to requests / instructions or questions.
  • Completing routine / daily activities.

An inability to ‘get started’ is likely to be seen at home, in school and in social situations. It can have a big impact on how well a child or young person with hydrocephalus can get on in their lives. However, there are things that can be done to help. Dip into the Living with Hydrocephalus section to find hints and tips on how to deal with different issues and difficulties. You might find the Personal organisation and Following plans and instructions pages particularly useful.

Every individual will be slightly different in the way their thoughts and actions are affected by hydrocephalus (and associated conditions). It is important to think about each individual’s pattern of strengths and difficulties. Patience, determination and trial and error are likely to be needed to find solutions that suit your child’s unique needs.

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