You are on page 1of 3

[District]

[Address]

Functional Behavioral Assessment

Student Name: XX DOB: 10/09/2012 Age: 5 Grade: K

Date Developed: November 20, 2017

Source of Data:
X Observation X Teacher X Related Services Provider
X Record review X Parent ____ Other:

Targeted behavior(s) that most interfere with student’s functioning in school:


Behavior: (baseline) Frequency Intensity Duration
Fleeing: defined as
physically distancing
away from adult in
classroom or hallways Approximately 2
(e.g. leaving carpet instances per 5-day Mild N/A
area during data collection
instruction, moving
body away from
activity)

Non-compliance:
defined as refusals
towards work or adult Approximately 10
directives instances per 5-day Mild-Moderate 10 seconds – 10
Mild: “no”, “I don’t data collection minutes
want to”, non- (Avg. of 2 times per
responding day)
Moderate: crawling
underneath tables,
dropping to the floor,
pushing materials
aside or off table

Factors in the environment that support or maintain the targeted behavior(s)


Behavior Events, places or Triggers/what Consequences/what
activities that are happens right before happens right after the
associated with the (Antecedents) behavior is displayed
problem behavior
(Setting Events)
Fleeing: defined as - Non-preferred - Transitions to other - Physical escorting
physically distancing activities/tasks activities/settings - Avoids classroom
away from - Challenging - Adult directives activity/task
teacher/aide in academic tasks - Challenging - Adult attention
classroom or hallways - Transitions academic demands - Reminders of
(e.g. leaving carpet between - Non-preferred choices with visual
area during activities/settings activities/tasks cues
instruction, running - Verbal prompts
away in hallways) - TCIS

Non-compliance: - Non-preferred - Transitions to other - Physical escorting


defined as verbal or activities in the activities/settings during unsafe or
physical refusals classroom - Adult directives disruptive behavior
towards work or adult - Transition to a - Challenging - Avoids a classroom
directives (e.g. “no” non-preferred academic demands activity/task
or “I don’t want to”, activity - Non-preferred - Adult attention
crawling underneath - Challenging activities/tasks - First/Then
tables, pushing academic tasks - Reminder of choices
materials aside, (writing or math) with visual cues
dropping to the floor, - Modified make-up
and non-responding) of work missed
- Verbal prompts
- TCIS

Relevant student diagnostic data or background information


XX is currently a Kindergarten student in the general education curriculum with Mrs. S. For the
2017-2018 school-year, XX receives building level Speech or Language Therapy, and AIS for
Math and ELA. Mrs. S. reported that XX has trouble regulating her emotions/behaviors, gets
frustrated with unwanted demands or challenging academic tasks, and struggles to transition
from activities/settings.

XX attended KinderCare at the age of 3 and Care-a-lot Child Care at the age of 4. Due to
emerging speech concerns, XX was referred for a full evaluation on 5/5/2017 (age 4). Results
showed XX’s cognitive abilities fell within the average range, her social-emotional ratings fell in
the average range, and her speech fell in the average range, particularly her articulation falling in
the below average range. It was reported on the evaluation that XX had occasional temper
tantrums or unpredictable emotional outbursts. XX’s mother reported that she gets easily
distracted, has difficulty attending to a variety of activities, struggles to sit for long periods of
time, and was described as “antsy” and active.

Hypothesis statement: summary statement that describes the specific, concrete circumstances
regularly associated with the occurrence or nonoccurrence of the problem behavior

Fleeing

Global Hypothesis: XX has difficulty regulating her behavior and emotions. Her impulsivity and
attention concerns affect her ability to problem-solve or cope appropriately to situations that are
non-preferred. Reported anxiety by Mrs. S. may contribute to her need to escape the situation.
Specific Hypothesis: When XX is presented with a non-preferred task or a transition between
activities, she will engage in fleeing in order to escape the non-preferred task/activity or toward a
desired object (e.g. toy). XX will leave the carpet space during instruction, will run outside of the
classroom, and will physically distance herself from her teacher/aide within the classroom.

Non-compliance

Global Hypothesis: XX has difficulty regulating emotions and behavior and persevering on class
activities/tasks when they are non-preferred or involve academic demands beyond her abilities.
XX struggles in all academic areas that impact her enjoyment for academic tasks and her
willingness to engage in them.

Specific Hypothesis: When XX is presented with a non-preferred activity, challenging academic


task, and a transition between activities, XX will engage in non-compliance in order to escape
and avoid the task presented.

Skill deficits that may cause or contribute to the targeted behavior


 Articulation and expressive language weaknesses
 Social skills deficits
 Limited problem-solving and coping skills
 Delays in adaptive functioning skills
 Suspected hearing challenges that need further evaluation

Prosocial, Adaptive and Replacement Behaviors:


When, where and with whom the problem behavior typically is not displayed:
 During preferred activities/tasks
 When she is offered a play break
 When given praise or encouragement on positive behaviors/successes

Student’s strengths and resources:


 Sensory regulating activities (hands-on)
 Strong cognitive skills
 Persistent on tasks she enjoys
 Takes pride in her successes and task completion
 Strives to be independent
 Likes routine
 1:1 adult support
 Bean bag break space within classroom

Positive behaviors, activities or roles that could potentially replace the problem behaviors and
serve the same or a similar function for the student:
 Movements/play breaks
 Hands-on/physical activities
 Positive feedback
 Visual review of her daily personal schedule and use of “first-then” language
 1:1 adult support to help foster independence
 Frequent praise and encouragement for task completion and compliance

You might also like