I have a student that is classified with intellectual disability. He also has a seizure disorder. He has seizures anywhere from 4 to 50 times a day. They are short lasting (longest was 30 seconds). He is often tired and complains of headaches. I know from researching that even before and after seizures he most likely does not feel well. He will often fall asleep when doing work. I have him stand to try to wake him up. He takes several breaks and we have him take short walks. Sometimes this works, but often he just starts to fall asleep standing up (I am right next to him). He is well below grade level (working at pre preschool levels and is technically fifth grade age). There are days when he is truly tired and is even tired during his breaks I give him. However, other times I believe its a behavior and he just doesnt want to do the work (this is evident when he eventually earns his break and wakes right up to recieve his reward). I use the TEACCH bin system and after every three bins, he earns a break, getting to do whatever he has chosen from his choice board. He also can earn stickers at the end of the day. He has a visual schedule and knows exactly what is expected and what his day looks like (so he knows when natural breaks like lunch, walking, free time, and going home occur). What else can I do to keep him awake to do work? How can I motivate him more? I use his interests for rewards AND instruction. Any advice is appreciated.