Training Modules Archive
View as PDF

Handout 3a. 6d
Individualized Intensive Interventions

Adapted from: O'Neill, R. E., Homer, 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.

FUNCTIONAL ASSESSMENT INTERVIEW FORM— YOUNG CHILD

Child with Problem Behavior(s):    Dana  
Date of Interview:    9/ 18    
Age:    3    Yrs        Mos
Sex: M *     F
Interviewer:    Lise    
Respondent(s):    Teacher    

A. DESCRIBE THE BEHAVIOR(S)

1. What are the behaviors of concern? For each, define how it is performed, how often it occurs per day, week, or month, how long it lasts when it occurs, and the intensity in which it occurs (low, medium, high).

 
Behavior
 How is it performed?
 How often?
How long?
Intensity?

1.

 Drops to floor
Resists moving 		with much strength 10-20x/ day 2-5 min. High

2.

 Whining, screaming loudly 10-20x/ day 5-15 min. High

3.

Hitting

 good force, open hand 4-5x/ day 5-15 sec. High

4.

          

5.

          

6.

          

2. Which of the behaviors described above occur together (e. g., occur at the same time; occur in a
predictable "chain"; occur in response to the same situation)?

Drops, resists moving, whining, screaming

B. DEFINE POTENTIAL ECOLOGICAL EVENTS THAT MAY AFFECT THE BEHAVIOR(S)

1. What medications does the child take, and how do you believe these may affect his/ her behavior?

None

2. What medical complication (if any) does the child experience that may affect his/ her behavior (e. g., asthma, allergies, rashes, sinus infections, seizures)?

None

3. Describe the sleep cycles of the child and the extent to which these cycles may affect his/ her behavior.
Goes to bed late (9: 30 or 10: 00) but then sleeps through the night. Mother reports he still sleeps in a
crib because he would get up in the night if in a bed.

4. Describe the eating routines and diet of the child and the extent to which these routines may affect his/ her behavior.

Eats like an adult. May not know when to stop eating.

5. Briefly list the child's typical daily schedule of activities and how well he/ she does within each activity.

DAILY ACTIVITIES
  
Activity     
Child's Reaction
8:30AM mom leaves school
Dana plays 		Cries, clings
Rigid, only plays with puzzles or computer
9:00 AM planning Doesn't want to try new things
9:15 AM centers  
10:45 AM clean up
Handwashing, snack 		Ok, but won't participate
Washes hands, then wanders/ resists direction
11:00 AM Movement circle Resists, plugs ears, cries
11:30 AM small group Wanders, resists, cries
12:00 PM Outside Resists direction, only wants to stand by gate
12:30 PM departure Cries and resists
1:00 PM    
2:00 PM    
3:00 PM    
4:00 PM    
5:00 PM    
6:00 PM    
7:00 PM    
8:00 PM    
9:00 PM    

6 Describe the extent to which you believe activities that occur during the day are predictable for your child. To what extent does the child know what he/ she will be doing and what will occur during the day (e. g., when to get up, when to eat breakfast, when to play outside)? How does your child know this?

General class schedule, Dana doesn't seem aware of what he should do.

7. What choices does the child get to make each day (e. g., food, toys, activities)?

Classroom activity choices, Dana's pretty limited in what he tries.

C. DEFINE EVENTS AND SITUATIONS THAT PREDICT OCCURRENCES OF THE BEHAVIOR(S)

1. Time of Day: When are the behaviors most and least likely to happen?

Most likely: -After 11: 00 a. m.
Least likely: -Choice time, unless adult makes demands

2. Settings: Where are the behaviors most and least likely to happen?

Most likely: -Structured Activities
Least likely: -Free choice, no structure

3. Social Control: With whom are the behaviors most and least likely to happen?

Most likely: -Unfamiliar people
Least likely: -Teacher

4. Activity: What activities are most and least likely to produce the behaviors?

Most likely: -Any activity an adult directs.
Least likely: -Computer, puzzles

5. Are there particular situations, events, etc. that are not listed above that "set off" the behaviors that cause concern (particular demands, interruptions, transitions, delays, being ignored, etc.)?

No.

6. What one thing could you do that would most likely make the problem behavior occur?

Ask him to sit for a story.

7. What one thing could you do to make sure the problem behavior did not occur?

Watch him do a puzzle.

D. DESCRIBE THE CHILD'S PLAY ABILITIES AND DIFFICULTIES

1. Describe how your child plays (With what? How often?).

Solitary play, constructive play activities (puzzle, pegboard)/ most often

2. Does your child have problem behavior when playing? Describe.

Only if adult joins

3. Does your child play alone? What does he/ she do?

Puzzle, pegboard/ focuses on the activity.

4. Does your child play with adults? What toys or games?

Only in rigid ways. Puzzles a certain way, pegboard.

5. Does your child play with other children his/ her age? What toys or games?

No, leaves area when other children join him.

6. How does your child react if you join in a play activity with him/ her?

Cries, screams, or leaves

7. How does your child react if you stop playing with him/ her?

Will ignore you or come and bring you back (if you play his way)

8. How does your child react if you ask him/ her to stop playing with a toy and switch to a different toy?

Has problem behavior

E. IDENTIFY THE "FUNCTION" OF THE UNDESIRABLE BEHAVIOR(S)

1. Think of each of the behaviors listed in Section A, and define the function(s) you believe the behavior serves for the child (i. e., what does he/ she get and/ or avoid by doing the behavior?)

  Behavior What does he/ she get? Or What exactly does he/ she avoid?

1.

 Drops, resists moving Transition is delayed, picked up by adult

2.

 Cries, screams when you play wrong Adult plays "his way"

3.

    

4.

    

5.

    

6.

    

7.

    

8.

    

9.

    

10.

    

2. Describe the child's most typical response to the following situations:

a. Are the above behavior(s) more likely, less likely, or unaffected if you present him/ her with a difficult task?

More likely

b. Are the above behavior(s) more likely, less likely, or unaffected if you interrupt a desired 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?

Does not occur

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 by changes in routine?

More likely

f. Are the above behavior(s) more likely, less likely, or unaffected if something the child wants is present but he/ she can't get it (i. e., a desired toy that is visible but out 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

F. DEFINE THE EFFICIENCY OF THE UNDESIRABLE BEHAVIOR(S)

1. What amount of physical effort is involved in the behaviors (e. g., prolonged intense tantrums vs. simple verbal outbursts, etc.)?

Tantrums last 5-15 minutes.

2. Does engaging in the behaviors result in a "payoff (getting attention, avoiding work) every time? Almost every time? Once in a while?

Almost every time we try to keep him happy

3. How much of a delay is there between the time the child engages in the behavior and gets the "payoff"? Is it immediate, a few seconds, longer?

Few seconds

G. DEFINE THE PRIMARY METHOD(S) USED BY THE CHILD TO COMMUNICATE

1. What are the general expressive communication strategies used by or available to the child? (e. g., vocal speech, signs/ gestures, communication books/ boards, electronic devices, etc.) How consistently are the strategies used?

Pulls you to object or area, some words.

2. If your child is trying to tell you something or show you something and you don't understand, what will your child do? (repeat the action or vocalization? modify the action or vocalization?)

Repeats movement, repeats word.

3. Tell me how your child expresses the following:

Functions

 Means
Grab & Reach Give Point Lead Gaze Shift Move to You Move Away from You Head Nod/Head Shake Facial Expression Vocalize Immediate Echo Delayed Echo Creative Single Word Creative Multi Word Simple Signs Complex Signs Self-injury Aggression Tantrum Cry or Whine Other None
Requests an Object X                   X   X                  
Requests an Action X                   X   X                  
Protests or Escapes                                       X    
Requests Help X                       X                  
Requests a Social Routine                                           ?
Requests Comfort X                       X                  
Indicates Illiness                                           ?
Shows You Something X                       X                  

4. With regard to receptive communication ability:

a. Does the child follow verbal requests or instructions? If so, approximately how many? (List, if only a few).

Come here; sit down; show me; come to the table; etc.

b. Is the child able to imitate someone demonstrating how to do a task or play with a toy?

Resists new tasks.

c. Does the child respond to sign language or gestures? If so, approximately how many? (List, if only a few.)

d. How does the child tell you "yes" or "no" (if asked whether he/ she wants to do something, go somewhere, etc.)?

Says "sure" for yes; rarely says "no" although he can.

H. WHAT EVENTS. ACTIONS. AND OBJECTS ARE SUPPORTIVE OR PRESENT CHALLENGES TO THE CHILD

1. Describe the things that your child really enjoys. For example, what makes him/ her happy? What might someone do or provide that makes your child happy?

Puzzles, pegboards, Dr. Seuss book, water, toy mower.

2. What kinds of things have you or your child's care providers done to try and change the problem behaviors?

Following through, don't give up. At home they verbally reprimand.

I. DEVELOP SUMMARY STATEMENTS FOR EACH MAJOR PREDICTOR AND/ OR CONSEQUENCE

Distant Setting Event

Immediate Antecedent (Trigger)

Problem Behavior

Maintaining Consequences

Function





       




       




       




       
Return to Training Modules Archive * Return to Resources
This material was developed by the Center on the Social and Emotional Foundations for Early Learning with federal funds from the U.S. Department of Health and Human Services, Administration for Children and Families (Cooperative Agreement N. PHS 90YD0119). The contents of this publication do not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial projects, or organizations imply endorsement by the U.S. Government. You may reproduce this material for training and information purposes.

We welcome your feedback on this Training Module. Please go to the CSEFEL Web site (http://csefel.uiuc.edu) or call us at (217) 333-4123 to offer suggestions.

About Us | Contact Us | Resources | Chat | Primary Partners & CCTAN | Site Map | Search | Home