Posted: May 7th, 2015

Final Intervention Project

Final Intervention Project

From Ron Taylor, Assessment of Exceptional Students, Fifth Edition.  Copyright © 2000 by Allyn & Bacon.
Used with permission.  Further use of this material is prohibited without written permission from the publisher.
The publisher’s website address is abacon.com/education/home.html.
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Appendix D
Functional Behavior
Assessment Form
FUNCTIONAL BEHAVIOR ASSESSMENT
Part One:  Assessing the Behavior
1.
Specific Target Behavior (include topography; include frequency, duration, or intensity)
2.
Setting(s) in Which Behavior Occurs
3.
Activities during Which the Behavior Occurs
4.
Time of Day Behavior Occurs
5.
Person(s) Around Whom the Behavior Occurs
6.
Factors That Appear to Set Off or Precede the Behavior
Teacher Factors
Task Explanation
Performance Feedback
Lesson Presentation
Teacher Reprimand
Teacher Praise
Individual Attention
Lack of Attention
Task Demands
Teacher Request
Consequence Imposed for Negative
Behavior
Other
Peer Factors
Peer Attention (Positive)
Peer Attention (Negative)
Other
Biting peers, 2-3 times a week, low intensity
In the classroom and outdoors
Morning during outside time
Peers, either one-on-one  or small groups
X
X
Playing in large or small groups that are physically active ie; basket ball, running, catching, playground,
dramatic play, etc.
From Ron Taylor, Assessment of Exceptional Students, Fifth Edition.  Copyright © 2000 by Allyn & Bacon.
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Setting Factors
Transition (Task; Routine)
Transition (Setting; Routine)
Transition (Task; Unexpected)
Transition (Setting; Unexpected)
Elevated Noise Levels
Presence of Unfamiliar Adults
Presence of Unfamiliar Peers
Other
7.
Factors That Appear to Be Present When the Behavior Occurs
Student Factors
Drowsy/Sleepy Appearance
Physical Complaints (e.g., hunger, pain)
Disturbed Affect ( e.g., sad, angry)
Excessive Motor Activity
Other
Setting Factors
Independent Seat Work
Group Instruction
Crowded Setting
One-to-One Instruction
Unstructured Setting
Unstructured Activity
Other
8.
Factors That Appear to Follow the Behavior
Teacher Factors
Teacher Reprimand
Teacher Praise
Task Removal
Withdrawal of Attention
Teacher Warning
Time-Out
Response Cost
Sent to Office
Communication with Parent
Predetermined Contingency Imposed
In-School Suspension
Out-of-School Suspension
Other
Peer Factors
Peer Attention (Positive)
Peer Attention (Negative)
Other
9.
Behavioral Intent or Function(s) That the Behavior Appeared to Serve
Power Control
Over Teachers
Over Peers
Over Parents

Other
Part Two:  Formulation of Hypotheses
Based on Information from Part One:
1.
What Appears to Be the Predominant Setting/Activity in Which the Behavior Occurs?
2.
What Time(s) of Day Does the Behavior Typically Occur?
3.
Around What Person(s) Does the Behavior Typically Occur?
4.
What Seems to Immediately Precede or Set Off the Behavior?
5.
What Seems to Be the Immediate Consequence of the Behavior?
6.
What Function or Purpose Does the Behavior Seem to Serve?
Functional Hypothesis
Indicate both (a) the conditions in which the behavior occurs and (b) the function that the behavior
seems to serve.
X
X
X
X
When the child is frustrated with peers either during an inside or outside activity.
Typically in the late morning after drop off before lunch time.
Peers, one-on-one, small groups and/or large groups.
Peers who may not have been nice to him, instigated him or made him upset.
Taken away from the space or the group of children to a more quiet space to
Using his body instead of words to communicate his frustration.
(a) The child is frustrated and is not able to find the words right away so resorts to biting.
(b) Attention seeking because there are significant and multiple changes happening at home.