Duration Measurement Page 8
ADVERTISEMENT
1
2
3
4
5
6
7
815.
(S)he often is noncompliant during training activities or when asked to complete tasks.
Yes
No
16.
The behavior often occurs when the immediate environment is very noisy or crowed.
Yes
No
17.
When the behavior occurs, you often respond by giving him/her brief “break from an ongoing task.
Yes
No
18.
The behavior rarely occurs when you place few demands on him/her or when you leave him/her alone.
Yes
No
Part III. Nonsocial (Automatic)Reinforcement
19.
The behavior occurs frequently when (s)he is alone or unoccupied
Yes
No
20.
The behavior occurs at relatively high rates regardless of what is going on in his/her immediate
Yes
No
surrounding environment
21.
(S)he seems to have few known reinforcers or rarely engages in appropriate object manipulation or “play”
Yes
No
behavior.
22.
(S)he is generally unresponsive to social stimulation.
Yes
No
23.
(S)he often engages in repetitive, stereotyped behaviors such as body rocking, hand or finger waving,
Yes
No
object twirling, mouthing, etc.
24.
When (s)he engages in the behavior, you and others usually respond by doing nothing (i.e., you never or
Yes
No
rarely attend to the behavior.)
25.
The behavior seems to occur in cycles. During a “high” cycle, the behavior occurs frequently and is
Yes
No
extremely difficult to interrupt. During a “low” cycle the behavior rarely occurs.
26.
The behavior seems to occur more often when the person is ill.
Yes
No
27.
(S)he has a history of recurrent illness (e.g., ear or sinus infections, allergies, dermatitis).
Yes
No
Scoring Summary
Circle the items answered “Yes.” If you completed only Part II, also circle items 1, 2, and 3
Total circle
Likely Maintaining Variable
to the left
1
2
3
4
5
6
7
8
______
Social Reinforcement (attention)
1
2
3
9
10
11
12
13
______
Social Reinforcement (access to specific activities/items)
1
2
3
14
15
16
17
18
______
Social Reinforcement (escape)
19
20
21
22
23
24
______
Automatic Reinforcement (sensory stimulation)
19
20
24
25
26
27
______
Automatic Reinforcement (pain attenuation)
Comments/Notes: _______________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________________________________________________
Adapted from the Florida Center on Self-Injury page 2 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Life