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Handout 3a. 6s
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):    Sashi   
Date of Interview:    9/5   
Age:    3     Yrs    11    Mos
Sex: M    F *
Interviewer:    Rochelle    
Respondent(s):    Assistant Director, 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.

Mouths toys Sucks and chews on toys 3-5 x/day Until redirected Medium

2.

Pulls hair Pulls hair bows, clips... 3-5 x/day 5-15 sec. High

3.

Resists moving Pulls away &/ or drops 2-3 x/day 1-3 min. High

4.

Wanders Leaves designated areas 2-4 x/day 30-sec-2 min. Medium

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)?

Wanders, then when you try to direct she will resist moving or she will physically resist if a demand is placed, then wander off.

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 (Does have a diagnosis of developmentally delayed with reactive attachment disorder.)

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 she still sleeps in a crib because she 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
8:45 AM Mother/ Father drops off on playground
Playground
Gives good-bye hug, runs to play
As children arrive, she will pull their hair bows/ clips
9:30 AM

Story Time

Pulls hair bows/ clips, sit few minutes then wanders
9:45 AM

Small Group

Needs one-to-one assistance, otherwise wanders, resists
  Wiggle Time Imitates well, enjoys moving and dancing
10:15 AM Planning Centers Flits from activity to activity, mouths, resists when redirected
 

Centers/ Snacks (cont.)

Dumps toys, uses toys inappropriately, pulls off diaper
11:30 AM Playground Loves to run, pulls hair bows/ clips

12:15 PM

Lunch Sits and eats nicely
12:45 PM Nap Rocked to sleep and then sleeps nicely
2:15 PM

Snack

Sits and eats nicely
2:35 PM Centers Dumps toys, uses toys inappropriately, pulls off diaper
3:20 PM

Playground

Loves to run, Pulls hair bows/ clips
3:50 PM   Pulls hair bows/ clips, sit few minutes then wanders
4:10 PM Dismissal Circle Sits and waits
4:15 PM Mother or Father picks up Hugs and waves goodbye.
6:00 PM    
6:30 PM    
7:00 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?

Sashi does not know her preschool schedule yet. Photo schedule is on the wall. Her behaviors are unpredictable at times.

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

Playground activities, books, snack, center activities, colors of markers, ... etc.

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: - Center Time (too much action, too many choices)
Least likely: - During Wiggle Time (all children are up and moving, really enjoys.)

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

Most likely: - Social situations (she does not know how to greet her friends).
                  - When she does not get what she wants.
                  - During Story Time
Least likely: - Snack
                  - Dismissal

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

Most likely: - Any child or adult (females) who has bows/ ribbons/ clips in their hair
                  - Adult who is trying to direct.

Least likely: - Boys

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

Most likely: - Any activity when she is required to stay focused for more than one minute.
Least likely: - Plays dress-up, especially when she is wearing a heavy item like a coat or rain jacket.

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.)?

Pulls wet diapers off during center time.

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

Tell her "no", have expectations too high (like sitting for too long).

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

Giving her lots of loving (hugs, cuddles) and attention, giving her whatever she wants, and never telling her "no".

D. DESCRIBE THE CHILD'S PLAY ABILITIES AND DIFFICULTIES

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

Loves gross motor activities (dancing, running, pulling wagon...), although her movements are a bit awkward and she can get off balance. She also enjoys playing dress up. She especially likes wearing big heavy clothing and hats. She also loves the sensory table, but someone needs to be right there with her because she tends to dump contents onto the floor or onto children's heads.

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

Is often too rough with toys and she does not seem to know how to interact with or greet the other children. She also has much difficulty staying focused for more that 1-2 minutes.

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

Yes, for very short periods.

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

Very short periods of play. Likes ball play. Legos (but gets upset when it doesn't fit together the first time), and chase.

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

No, she engages mostly in solitary play, sometimes parallel play (in house and sensory table). However, she will play chase with children, but then pulls hair.

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

No different, unless demands are placed. She will then physically resist and try to wander off.

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

She just goes about doing what she wants.

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

She will physically resist, pull away, drop to the floor and possibly wander off.

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.

Mouths toys Gets oral input and attention from peers and adults

2.

Pulls hair Adults telling her "no" and children screaming, adults help her with interactions with peers and with play with peers.

3.

Resists Moving Escaping a demand or delaying the transition

4.

Wanders Escaping an activity

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?

Wandering and resisting is 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)?

Unaffected, unless it is dress up , then it is more likely.

c. Are the above behavior(s) more likely, less likely, or unaffected if you deliver a "stem" request/ command/ reprimand?

More likely (If she is already engaging in problem behavior she just continues the inappropriate behavior).

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.

More likely

e. Are the above behavior(s) more likely, less likely, or unaffected by changes in routine?

Unaffected, she doesn't seem to know the schedule yet.

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)?

Has never been done.

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 ver-bal outbursts, etc.)?

Not much. She is not out to inflict pain.

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

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?

With adults, there is a quick payoff. (5-20 sec.)
With Children it is delayed (up to 1-2 min.)

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?

Single words, some signs and will scream and grunt.

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?)

Her requests are so basic that we pretty much understand what she wants.

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                                    
Requests an Action                                    
Protests or Escapes                                    
Requests Help                                      
Requests a Social Routine                                    
Requests Comfort                                          
Indicates Illiness                                          
Shows You Something                                          

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).

Yes, simple one-step commands (wash hands, put away water, pick up...)

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

Yes, especially if it involves gross motor skills.

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

Yes, 10+ (all done, drink, eat, help more, sit, dance, wash hands, open, pour...)

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

Vocalizes "no", sometimes screams or shakes head no
Indicates "yes" by echoing what was asked

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?

Dress up, gross motor activities, eating, dumping and pouring, being rocked.

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

Redirection, modeling appropriate behavior/ play/ interactions with other children telling her "no".

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

Distant Setting Event

Immediate Antecedent (Trigger)

Problem Behavior

Maintaining Consequences

Function





       




       




       




       
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