Fails to Give Close Attention to Details

Attention /On-task /Effort ** DATA: Target Behavior during 3-Day Baseline

Target Behavior / Significant
Problem / Infrequent
Problem / No
Problem / Measurement Type
(ü the method used: all 3days) / Day 1:
______ / Day 2:
______ / Day 3:
_____
Inattentive during teacher’s lessons or instruction / o # redirections
o # mins OFF-task
Off-task -> incorrect work or
incomplete work / o # redirections
o # mins OFF-task
Is easily distracted by typical classroom activities / o # redirections
o # mins OFF-task
Rushing/careless with task / o #: task errors o # mins ON-task
Avoids or delays starting work / o # mins delay o # redirections
Poor effort when challenging task is encountered / o # mins OFF-task o #: asks/help
o # mins before attempting

Organizational Skills ** DATA: Target Behavior during 3-Day Baseline

Target Behavior / Significant
Problem / Infrequent
Problem / No
Problem / Measurement Type
(ü the method used: all 5 days) / Day 1:
______ / Day 2:
______ / Day 3:
_____
Loses papers or work items / o # mins searching o #: lost items
Has difficulty organizing tasks / o # task errors o #: asks/help
Materials not ready for task / o # min OFF-task o #: redirections
Poor care of materials / o #: redirections
Does not finish tasks on time / o# min OFF-task o % missing
Not completing homework / o % missing

Impulsivity ** DATA: Target Behavior during 3-Day Baseline

Target Behavior / Significant
Problem / Infrequent
Problem / No
Problem / Measurement Type
(ü the method used: all 5 days) / Day 1:
______ / Day 2:
______ / Day 3:
_____
Talks excessively w/ wrong:
____ time ____ topic / o # calling out o # of redirections
Calls out without permission / o # impulses o # of redirections
Not waiting turn in groups / o # impulses o # of redirections
Interrupts people / o # impulses o # of redirections
Leaves assigned area/seat w/out permission / o # impulses o # of redirections
Touching/taking off-task items / o # impulses o # of redirections
o # min OFF-task
Bothers other students who are working / o # impulses o # of redirections
o # min OFF-task

Motor Self-Control ** DATA: Target Behavior during 3-Day Baseline

Target Behavior / Significant
Problem / Infrequent
Problem / No
Problem / Measurement Type
(ü the method used: all 5 days) / Day 1:
______ / Day 2:
______ / Day 3:
_____
Off-task object use in class / o# redirections o# mins OFF-task
Fidgets with hands or feet / o# redirections o# mins OFF-task
Does not walk in line or class / o# of redirections
Difficulty remaining still / o# redirections o# mins OFF-task
Off-task vocal sounds / o# redirections o# mins OFF-task

Acting Out / Social Problems ** DATA: Target Behavior during 3-Day Baseline

Target Behavior / Significant
Problem / Infrequent
Problem / No
Problem / Measurement Type
(ü the method used: all 5 days) / Day 1:
______ / Day 2:
______ / Day 3:
_____
Breaks class rule :(specify) / o # of redirections
o # mins OFF-task
o # staff to intervene
Disrupts class activities / o# redirections o# mins OFF-task
Blames own actions on others / o# redirections o# mins OFF-task
Rude/mean to peers / o# redirections o# mins OFF-task
Defies/refuses directions:
____ Passively ____ Overtly / o# refusals o# of redirections
o# min OFF-task
Becomes upset suddenly or without obvious reason / o# mins upset o # redirections
o# mins OFF-task
Loses temper with voice:
__ Volume __ Tone__ Content / o# mins upset o # redirections
o# mins OFF-task o #: asks/help
Argues with adults / o# redirections o# mins OFF-task
Damages property / o# redirections o# mins episode
o# staff to intervene
Physical aggression to peers / o# redirections o# mins episode
o# staff to intervene
Physical aggression to staff / o# redirections o# mins episode
o# staff to intervene

Attendance Problems ** DATA: Target Behavior during 3-Day Baseline

Target Behavior / Significant
Problem / Infrequent
Problem / No
Problem / Measurement Type
(ü the method used: all 5 days) / Day 1:
______ / Day 2:
______ / Day 3:
_____
Tardiness / o # mins tardyo# mins to catch-up o# mins OFF-task on arrival
Leaves class: ___ restroom/
___ clinic/ ?______/ o# requests o# mins gone
o# mins OFF-task

Additional Problems (write in below) * ** DATA: Target Behavior during 3-Day Baseline

Target Behavior / Significant
Problem / Infrequent
Problem / No
Problem / Measurement Type
(ü the method used: all 5 days) / Day 1:
______ / Day 2:
______ / Day 3:
_____
* / o# of: ______
o# mins: ______
* / o# of: ______
o# mins: ______

List Interventions attempted (include dates): ______

______

RTI: Tier I Behavior Screener/Baseline Data (sef.09.06) Page 1 of 3