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Functional Behavior Assessment Form (2025)

The document outlines a structured approach for collecting data on a learner's interfering behavior, including methods for recording antecedents, behaviors, and consequences. It includes sections for anecdotal notes, a scatterplot for identifying behavior patterns, and a hypothesis statement checklist to determine the function of the behavior. The checklist prompts observers to analyze various factors related to the behavior, such as environment, social interactions, and potential triggers.

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7 views4 pages

Functional Behavior Assessment Form (2025)

The document outlines a structured approach for collecting data on a learner's interfering behavior, including methods for recording antecedents, behaviors, and consequences. It includes sections for anecdotal notes, a scatterplot for identifying behavior patterns, and a hypothesis statement checklist to determine the function of the behavior. The checklist prompts observers to analyze various factors related to the behavior, such as environment, social interactions, and potential triggers.

Uploaded by

jmata4751
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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DATA COLLECTION: A-B-C

Name: Date:
Course:

Learner’s Name: Date/Time:


Observer(s):
Interfering Behavior:
Directions: Collect data of what happens directly before the behavior (antecedent), describe the
behavior, and determine what happens directly after the behavior (consequence).
Start Stop
Date Antecedent Behavior Consequence
Time Time

ANECDOTAL NOTES:
DATA COLLECTION: SCATTERPLOT
Name: Date:
Course:

Learner’s Name: Date/Time:


Observer(s):
Interfering Behavior:
Directions: Collect data on the setting and time of the learner’s behavior to identify patterns.
Date

Time Activity

ANECDOTAL NOTES:
HYPOTHESIS STATEMENT
Name: Date:
Course:

Learner’s Name: Date/Time:


Observer(s):
Interfering Behavior:
Directions: Complete this checklist to determine the function of the interfering behavior.

DEFINE THE INTERFERING BEHAVIOR:


1. Where does the behavior occur?

2. With whom does the behavior occur?

3. When does the behavior occur?

4. What activity is the learner participating in when the behavior occurs?

5. How long has the behavior been interfering with the learner’s development and learning?

6. Does the behavior involve aggression or damage to property?

7. What are other students and adults doing when the behavior occurs?

8. What is the proximity of other students and adults when the behavior occurs?

9. What is the noise level of in the environment when the behavior occurs?

10. Number of individuals in the area:

11. Other environmental conditions:

12. Does the behavior occur because the learner is being asked to demonstrate a skill that
he/she cannot perform (e.g., talking with peer, completing a difficult math assignment

13. Does the learner exhibit other behaviors immediately before the behavior occurs
(antecedents)?

14. What happens immediately after the interfering behavior occurs (consequences)?
DETERMINE THE FUNCTION OF THE BEHAVIOR

1. To get or obtain: To escape or avoid:


❑ Attention ❑ Attention
❑ Food ❑ Difficult tasks/ activity
❑ Toys ❑ Undesirable activity
❑ Hugs ❑ Social stimulation
❑ Sensory stimulation ❑ Sensory Stimulation
❑ Other: __________ ❑ Other:_______________

DEVELOP HYPOTHESIS STATEMENT:

2. Antecedents & Consequences:

3. Interfering behavior:

4. Function of behavior:

HYPOTHESIS STATEMENT:

ANECDOTAL NOTES:

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