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Adapted from: O'Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997).
Functional Assessment and Program Development for Problem Behavior. Pacific Grove, CA: Brooks/Cole
Publishing.
1. What are the behaviors of concern? For each, define how it is performed, how often it occurs per day,
week, or month, how long it lasts when it occurs, and the intensity in which it occurs (low, medium,
high).
2. Which of the behaviors described above occur together (e.g., occur at the same time; occur in a
predictable “chain”; occur in response to the same situation)?
removing clothing followed by self-injury and/or shutting down
1. What medications does the child take, and how do you believe these may affect his/her behavior?
no current medications
2. What medical complication (if any) does the child experience that may affect his/her behavior (e.g.,
asthma, allergies, rashes, sinus infections, seizures)?
not applicable / nothing diagnosed
3. Describe the sleep cycles of the child and the extent to which these cycles may affect his/her
behavior.
naps most days at daycare from 1PM to anywhere between 1:30PM to 4PM if he is not woken
sooner. Mom wants him to sleep less at daycare so he is more tired when he gets home –
daycare has told her that if he is tired, they are required by law to let him rest, and that he must
have quiet time on his cot for at least a half an hour at naptime. When he is awake during
naptime, he is allowed to do quiet activities like matching games, table toys, books
is usually tired at daycare around dinnertime (5PM) especially if he slept less during naptime.
Has fallen asleep on floor/in chair 4x in 2 mos.
4. Describe the eating routines and diet of the child and the extent to which these routines may affect
his/her behavior.
breakfast – small amount of cereal or a poptart with milk
lunch – some meat/fruit, a few bites of certain veggies, sometimes bread
snack – will eat a small amount of some snacks, likes cheesy crackers
dinner – usually refuses dinner at daycare at 5PM. Will sometimes eat small amount of meat
and/or fruit. Usually gets a Happy Meal on the drive home and gets to pick which kind he wants
– almost always chicken nuggets
5. Briefly list the child's typical daily schedule of activities and how well he/she does within each activity.
DAILY ACTIVITIES
6 Describe the extent to which you believe activities that occur during the day are predictable for your
child. To what extent does the child know what he/she will be doing and what will occur during the day
(e.g., when to get up, when to eat breakfast, when to play outside)? How does your child know this?
has some idea of routines and what comes next – knows to put away sheets/cot, wash hands,
and choose a quiet activity or get ready for snack after naptime.
7. What choices does the child get to make each day (e.g., food, toys, activities)?
some control over what clothes to wear and what to eat when in care of family
1. Time of Day: When are the behaviors most and least likely to happen?
Most likely:
mid to late afternoon/early evening; eating times, transitions, outside time
Least likely:
morning/late evening after nap; toileting/washing up, looking at books, playing uninterrupted
individually and/or with a chosen activity
2. Settings: Where are the behaviors most and least likely to happen?
Most likely:
construction, meal tables (brown table at daycare), outside
Least likely:
library, red (table toy/activity) table
3. Social Control: With whom are the behaviors most and least likely to happen?
Most likely:
large groups, loud groups, AM daycare teacher, new authority figures
Least likely:
Mom, PM daycare teachers, very small groups
4. Activity: What activities are most and least likely to produce the behaviors?
Most likely:
being interrupted, getting bumped or knocked into by another child
Least likely:
playing individually, coloring, looking at books, playing with play dough, one-on-one activities
with adults
5. Are there particular situations, events, etc., that are not listed above that “set off” the behaviors that
cause concern (particular demands, interruptions, transitions, delays, being ignored, etc.)?
interruptions, transitions
6. What one thing could you do that would most likely make the challenging behavior occur?
interrupt him during an activity that he has chosen and is happily playing by himself and force
him to change activities, especially if it involves going to a meal when he is not hungry/not ready
to eat/doesn't like what is served
7. What one thing could you do to make sure the challenging behavior did not occur?
let him have some control over his eating/sleeping schedule – let him eat when he is hungry and
sleep when he is tired. (This may not be easy to enact in school/daycare settings with one
teacher and a class full of children who have a certain timeframe to eat and rest in. This may
also be inconvenient/difficult for a single mother with several other children.)
D. DESCRIBE THE CHILD'S PLAY ABILITIES AND DIFFICULTIES
5. Does your child play with other children his/her age? What toys or games?
yes, he usually engages in parallel play with other children, but he is able to join groups (small
groups for most activities and large groups for chasing games) and engage in interactive play as
well; they color, play with matching or sorting toys/games, table toys, building/shaping
materials, riding toys, rolling or throwing balls, and chasing games like tag or hide-and-go-seek
6. How does your child react if you join in a play activity with him/her?
sometimes he keeps playing and either includes Mom/teachers in his play or allows them to
play alongside him
sometimes he leaves/changes activities
sometimes he shuts down, self-harms, and/or removes clothing
7. How does your child react if you stop playing with him/her?
sometimes he keeps playing
sometimes he leaves/changes activities
sometimes he shuts down, self-harms, and/or removes clothing
8. How does your child react if you ask him/her to stop playing with a toy and switch to a different toy?
1. Think of each of the behaviors listed in Section A, and define the function(s) you believe the behavior
serves for the child (i.e., what does he/she get and/or avoid by doing the behavior?)
Behavior What does he/she get? Or what exactly does he/she avoid?
self-injury gets adult attention, desired toys/activities
avoids undesired activities (like eating) or changing activities
shutting down gets adult attention
avoids sensory stimulation, undesired activities (like eating) or changing
activities
removing clothing gets adult attention
avoids undesired activities (like eating) or changing activities
verbal outburst gets adult attention
avoids undesired activities (like eating) or changing activities
a. Are the above behavior(s) more likely, less likely, or unaffected if you present him/her with a difficult
task?
more likely
b. Are the above behavior(s) more likely, less likely, or unaffected if you interrupt a desired event (eating
ice cream, watching a video)?
significantly more likely
c. Are the above behavior(s) more likely, less likely, or unaffected if you deliver a “stern”
request/command/reprimand?
more likely
d. Are the above behavior(s) more likely, less likely, or unaffected if you are present but do not interact
with (ignore) the child for 15 minutes.
less likely; at daycare, the PM teachers stay close to Rafael but do not push him to interact.
They may ask a question or make a remark every few minutes, but most of the time they give
him space and let him come to them.
e. Are the above behavior(s) more likely, less likely, or unaffected by changes in routine?
more likely
f. Are the above behavior(s) more likely, less likely, or unaffected if something the child wants is present
but he/she can't get it (i.e., a desired toy that is visible but out of reach)?
mostly unaffected, somewhat more likely
g. Are the above behavior(s) more likely, less likely, or unaffected if he/she is alone (no one else is
present)?
less likely
1. What amount of physical effort is involved in the behaviors (e.g., prolonged intense tantrums vs.
simple verbal outbursts, etc.)?
almost always low to medium energy/intensity
2. Does engaging in the behaviors result in a “payoff” (getting attention, avoiding work) every time?
Almost every time? Once in a while?
most of the time
3. How much of a delay is there between the time the child engages in the behavior and gets the
“payoff”? Is it immediate, a few seconds, longer?
self-injury – quick response most of the time; when this is repeated in a short time frame,
subsequent instances may be ignored
shutting down – delay of one or more minutes; sometimes ignored; adult usually moves closer
and keeps close without pushing to interact
removing clothing – allowed to take off clothes for a period of time if it is safe/appropriate
(shoes MUST be worn outside for safety reasons, so must a coat if the weather is cold), then
addressed when the articles of clothing are needed again.
verbal outburst – child is told immediately that the language used is not allowed and why; then
the topic is changed.
1. What are the general expressive communication strategies used by or available to the child (e.g.,
vocal speech, signs/gestures, communication books/boards, electronic devices, etc.)? How consistently
are the strategies used?
frequently speaks and uses gestures. Communication books are available but are not
used/needed
2. If your child is trying to tell you something or show you something and you don't understand, what
will your child do? (repeat the action or vocalization? modify the action or vocalization?)
usually tries repeating first; if that does not work, he will modify communication
3. Tell me how your child expresses the following:
Vocalize
Cry or Whine
Tantrum
Gaze Shift
Immediate Echo
Delayed Echo
Move to You
None
Grab & Reach
Give
le SignsSimp
Aggression
Point
Other
Self-Injury
Lead
Complex Signs
ExpresssionFacial
YouFromMove Away
Requests x x x x x x x x
an object
Requests x x x x x
an
Action
Protests x x x x x x
or
Escapes
Requests x x x x
Help
Requests x x
a Social
Routine
Requests x x x x
Comfort
Indicates x x x x
Illness
Shows x x x x
you
Somethi
ng
a. Does the child follow verbal requests or instructions? If so, approximately how many? (List, if only a
few).
yes, he will respond to requests such as to go wash his hands, use the bathroom, put away his
sheets/cot, clean up his place at lunch/snack/dinner
b. Is the child able to imitate someone demonstrating how to do a task or play with a toy?
yes, he readily tries and is often able to imitate tasks or actions
c. Does the child respond to sign language or gestures? If so, approximately how many? (List, if only a
few.)
he responds to pointing and to the signs for “thank you,” “please,” and “eat”
d. How does the child tell you “yes” or “no” (if asked whether he/she wants to do something, go
somewhere, etc.)?
he will use words, including “yes” and “no,” shake or nod his head, go along with the activity, or
shut down, pull at clothes, or self-harm
1. Describe the things that your child really enjoys. For example, what makes him/her happy? What
might someone do or provide that makes your child happy?
he enjoys learning new things, showing off his abilities, and helping
someone might give him helper-tasks, teach him something new, or play with him in an activity
in which he is confident of his ability
2. What kinds of things have you or your child's care providers done to try and change the challenging
behaviors?
giving him choices
reminding him of when transitions are coming
keeping close physical proximity
giving lots of positive attention and encouragement
ignoring repeated instances of the same behavior in a short span of time
giving him space to cool down/letting him come to them