Functional Behavior Assessment
Student: Grade: School:
Teacher(s): Date:
Identifying Target Behavior (Description of the single behavior which concerns you most)State one primary behavior of concern. This is a specific description of the behavior which concerns you most about this student. Use concrete terms; ex: “John is aggressive” is not concrete - change to “John kicks his desk when given a correction.” /
Severity of Behavior
(Check to indicate severity) / 1 - minor and harmless
2 - mildly disruptive
3 - moderately disruptive
4 - significantly disruptive, some threatening behaviors noted
5 - highly disruptive; student a clear danger to self or others
Frequency of behavior:
(Check to indicate frequency) / 1 - rarely; behavior was isolated incident
2 - occasionally (behavior has been seen before rarely)
3 - weekly (usually occurs about one time per week or so)
4 - daily (usually occurs about once a day)
5 - continually (occurs throughout the day every day)
When did you first notice the behavior?
Has this occurred in previous school years? Has the student been retained? If yes, what grade(s)?
Does the student have the ability to complete assigned school work?
Identifying Setting Factors (Time/place of behavioral difficulties)
During a particular class or classes:
/ During transition from one activity to another (within a class period)
Between classes (hall time) / Bus or Bus stop
Lunch / Recess
During morning classes / Presence of particular student
During afternoon classes / Other
Identifying Antecedents (Things going on prior to or during the behavior - triggers)
teacher-directed activity or lesson / seatwork that is too difficult for student (Self-Stimulation)
independent seatwork / student not interested in the lesson (Self-Stimulation)
teacher working with another student / unstructured class time (Physiological or Self-Stimulation)
teacher giving student a request / group learning activity
teacher giving student a correction / change in daily routine
student request denied or student told “no” / peers trying to talk with/provoke student
elevated level of classroom noise / student appears tired, angry, sad, (Physiological)
student did not receive medication (Physiological) / factors occurring at home upsetting to student
student lost a privilege or received a warning / Other
Identifying Consequences (What happened IMMEDIATELY after the behavior?)
teacher verbal reprimand (Social Attention) / sent out of room - either to time out or to another classroom (Escape or Access to Tangibles)
loss of privilege (recess, computer, etc) (Power/Control) / sent to guidance counselor (Escape or Access to tangibles)
teacher nonverbal reprimand (look, signal, cue) (Social Attention) / sent to in-school suspension (Escape/Avoidance)
parent conference or note home (Social Attention or Power) / out of school suspension (Escape or Power/Control)
office referral (Escape or Access to Tangibles) / recommend for expulsion (Escape or Power/Control)
peer attention - peers laughed or otherwise reacted (Social Attention) / ignored the behavior - differential attention
verbal argument ensued between student and teacher (Power/Control) / Other
Identifying Function of Behavior
(What is your best educated guess as to what function the behavior serving and why is it continuing to occur?)
(Use the functions in italics above to help decide)
Escape/Avoidance/Delay: (Check all that apply)
* escape class work
* removal from class
* avoid undesirable task
* escape certain teacher/peer
* escape the school setting (home preferable)
* other / Access to Tangibles: (Check all that apply)
* to gain access to desirable situation (principal’s
office, guidance office, etc.)
* reaction when something is denied or taken
away
Social Attention: (Check all that apply)
* peer attention
* teacher attention (positive or negative)
* draw attention to self
* effort to get parent’s attention / Non-Social/Internal Stimulation: (Check all that apply)
* as a form of self-stimulation
* when there is nothing else to do
* highly repetitive or stereotypical behavior
* unable to control impulses
Power/Control: (Check all that apply)
* effort to control environment
* effort to control teachers (gain power)
* effort to get home and control factors there
* demonstrate power to teachers and peers / Physiological: (Check all that apply)
* student is ill
* student is not taking needed medication
* appears overly tired
Hypothesized function of behavior:
STRENGTHS:
Academic areas (list):
Sports
Dance/music/art/drams or other
Works well with others
Likes to be a helper
Works well with computers
Works well with hands
Able to fix things; mechanically inclined
Supportive family
Follows directions well
Good sense of humor
Speaks his/her mind
Good memory
Kind and/or compassionate
Respectful toward authority
Respectful toward peers
Works well with animals
Works well with children
Other:
Other:
Other
Teacher Signature