Jackson Functional Behavior Assessment
Childwith Problem Behavior(s):Jackson Date of Interview:9/25
Age:4 Yrs*Mos Sex: M* F
Interviewer:Lise Respondent(s):Carey
A. Describe the Behavior(s)
1. What are thebehaviors ofconcern?For each, definehow it is performed, howoften it occursper day, week, or month, how long it lastswhen it occurs,and the intensity in which it occurs (low, medium, high).
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Behavior
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How is it performed?
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How often?
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How long?
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Intensity?
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Screams
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4-10 x/day
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Brief
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Very disruptive
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Throws toys, objects
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4-10 x/day
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Brief
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Very disruptive
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Yells shut-up
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4-10 x/day
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Brief
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Very disruptive
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Throws chair
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2x in past 6 months
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Dangerous
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2. Which of the behaviors described above occur together (e.g.,occur at the same time;occur in apredictable"chain"; occur in response to the samesituation)?
Maystart with screamingor saying shut-up, and thenwill throw object.
B. Define Potential Ecological Events that May Affect the Behavior(s)
1. What medicationsdoes the child take, and how do you believe these may affect his/her behavior?
None
2. What medicalcomplication(if any) does the child experience thatmay affect his/her behavior (e.g., asthma, allergies, rashes,sinus infections,seizures)?
None
3. Describe thesleep cyclesof the child and the extent to whichthese cycles mayaffect his/herbehavior.
No issues
4. Describe theeating routines and dietof the child and the extent to which these routines may affect his/her behavior.
Eats well, very healthy 4 year old
5. Briefly list the child's typical daily schedule of activities and howwell he/she does within each activity.
C. DailyActivities
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Time
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Activity
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Child's Reaction
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6:00 am
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Arrival
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A little stiff; looks out window; difficulty joining group
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7:00 am
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Planning
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Needs prompts
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8:00 am
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Centers
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Does okay; rigidity of activities; favorite activities are computer/blocks with cars; may have problems with peers or when asked to do an activity
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9:00 am
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Hand washing/Snack
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Does okay unless it's not the snack he wants
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10:00am
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Wiggle time/Small group
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Reluctant to participate; needs prompts; sometimes refuses to participate; moves to books; is explosive when redirected
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11:00 am
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Story Time
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Resists; gets own book
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12:00 pm
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Outside
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No problem; restricted repertoire of activities and partners
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1:00 pm
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Lunch
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Does well
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2:00 pm
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Outdoor play
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No problem; restricted repertoire of activities and partners
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3:00 pm
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Afternoon circle
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Can be difficult; often does not want to participate; resists and, if I insist, can be explosive
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4:00 pm
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Dismissal
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Animated to see parents; leaves without problems
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1. Describe theextent to which you believe activities that occur during the day arepredictable foryourchild.To what extent does thechildknow what he/she will be doing and whatwill occur during the day (e.g., when to get up, when to eat breakfast,when to play outside)?How does yourchildknow this?
Knows schedule
2. What choices does the child get to make each day (e.g., food, toys, activities)?
Understandschoices
D. Define Events and Situations that Predict Occurrences of the Behavior(s)
1. Time of Day:When are the behaviorsmost and least likely to happen?
Most likely: Early morning
Least likely: Outdoor play in morning and afternoon
2. Settings: Where are the behaviors most and least likely to happen?
Most likely: Classroom, small group
Least likely: Outside
3. Social Control: With whom are the behaviors most and least likely to happen?
Most likely: Teacher
Least likely: Peers who will not make demands on him
4. Activity: What activities are most and least likely to produce the behaviors?
Most likely: Structured activity, demands, social interactions, sharing objects
Least likely: Reading a book by himself
5. Are there particular situations, events,etc. that are notlisted abovethat "set off" the behaviors that cause concern(particular demands, interruptions, transitions, delays, being ignored, etc.)?
Ifhefalls orgets bumped
6. What one thing could youdo that wouldmost likely make the problem behavioroccur?
Insist on participation in something he does not wantto do
7. What one thing could youdo to makesure the problem behaviordid not occur?
Give himall the cars he wants; talk about cars
E. Describethe Child's Play Abilities andDifficulties
1. Describe how your child plays (withwhat?how often?).
Solitary - fine
Parellell - o.k.
Limited socialplay
2. Does your child have problembehavior when playing?Describe.
If peerssuggest he play adifferent wayor takehisvehicles
3. Does your child play alone?What does he/she do?
Cars, Car "World,"computer
4. Does your child play withadults?Whattoys or games?
Not well, issues with turn taking, object exchange
5. Does yourchild play with other children his/her age?What toys or games?
Not often, he preferssolitary play
6. How does your child reactif you join in a play activitywith him/her?
Sometimes tells adult to goaway orsays "shut-up" in response to a play to a playsuggestion
7. How does your child react if you stop playing with him/her?
No problem
8. How does your child reactif you ask him/her tostop playing with a toy and switchto a different toy?
Problembehavior
F. Identify the "Function"of theUndesirable Behavior(s)
1. Think of eachof the behaviors listed in Section A, anddefine the function(s)you believe the behavior servesfor the child (i.e.,what does he/shegetand/or avoid by doing the behavior?)
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Behavior
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What does he/she get? OR What exactlydoes he/she avoid?
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Shut-up
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People move away or give him what he wants or allow him to do the activities he desires
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Throwing
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People move away or give him what he wants or allow him to do the activities he desires
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Screaming
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People move away or give him what he wants or allow him to do the activities he desires
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2. Describe thechild's most typicalresponse to the followingsituations:
a. Are the above behavior(s)more likely, less likely, or unaffected if you present him/her with adifficult task?
More likely
b. Are the above behavior(s)more likely, less likely, orunaffected if you interrupt adesired event (eating ice cream, watching a video)?
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
e. Are the above behavior(s)more likely, less likely, or unaffected bychanges in routine?
More likely
f. Are the above behavior(s)more likely, less likely, orunaffected if something thechildwants is present but he/she can't get it (i.e., a desired toy that is visible butout of reach)?
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
G. Define the Efficiencyof theUndesirable Behavior(s)
1. What amountof physical effort is involved in the behaviors (e.g., prolonged intense tantrums vs. simple verbal outbursts, etc.)?
Simple outbursts that are brief, but highly disruptive
2. Does engaging in the behaviorsresult in a "payoff" (getting attention, avoidingwork) every time? Almost every time?Once in a while?
We try to keep him calm, we usually givein right away
3. How much of a delay is there between the time the child engages inthe behaviorand gets the "payoff"?Is it immediate, afew seconds, longer?
Immediate
H. Define the PrimaryMethod(s) Used bythe Childto Communicate
1. What are thegeneral expressivecommunication strategies used byor availableto the child?(e.g., vocal speech, signs/gestures,communicationbooks/boards, electronic devices, etc.)How consistently are the strategies used?
Goodverbalcommunication; advancedin his language on some topics
2. If your child is trying to tellyou something or showyou somethingand you don't understand, what will yourchild do?(repeat the action or vocalization?modify the action or vocalization?)
Doesn't repair well; is mumbly ifyou don't get itthe first time
3. Tell me how your child expresses the following:
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Grab & Reach
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Give
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Point
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Lead
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Gaze Shift
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Move to You
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Move away from You
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Head nod/Head Shake
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Facial Expression
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Vocalize
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Immediate Echo
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Delayed Echo
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Creative Single Word
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Creative Multi Word
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Simple Signs
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Complex Signs
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Self-Injury
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Aggression
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Tantrum
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Cry or Whine
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Other
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None
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Functions
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Requests an Object
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X
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Requests an Action
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X
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Protests or Escapes
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X
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Requests Help
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X
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Requests a Social Routine
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X
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Requests Comfort
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X
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Indicates Illness
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X
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Shows you Something
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X
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Notes:
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4. With regard to receptive communication ability:
a. Does the child follow verbal requests or instructions?If so, approximately howmany?(List, if only a few.)
Understandseverything you may say
b. Is the child able to imitate someone demonstrating how to do a task or play with a toy?
Yes,but may refuse
c. Does the child respond to sign language or gestures?If so, approximately how many?(List, if only a few.)
Understandswell
d. How does thechild tell you "yes" or "no"(if asked whether he/shewants to do something, go somewhere, etc.)?
Speaks
H.What Events, Actions, andObjects are Supportive or Present Challenges to the Child?
1. Describe thethings that your childreally enjoys.Forexample, what makes him/her happy?What mightsomeone do or providethat makes your child happy?
Computer, cars, blocks, round food, chairs with thewordtaped to it, the coloryellow, and things that are yellow
2. What kinds of things haveyou or yourchild'scare providers done to try and change the problem behaviors?
Warnings - effective
Follow through - "I'll help you"
Don't rush him.Reprimand may set himoffmore.
I. DevelopSummary Statements for EachMajor Predictor and/or Consequence
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Distant
Setting
Event
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Triggers
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Problem
Behavior
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Maintaining
Consequence
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Function
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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.