Functional Behavioral Assessment Page 2
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FBA (Page
of 4)
From the list below, indicate the factors that seem to be supporting the problem behavior by
placing a check mark in the appropriate space.
Problem Behavior:
(Write problem behavior in space above)
What triggers the behavior?
What consequences have been implemented for
problem behavior?
Lack of social attention
Demand/Request
Behavior ignored
Does not understand
Reprimand/Warning
Transition between tasks
Stated expectation
Transition between settings
Time-Out
Interruption in routine
Loss of privileges
Negative social interaction w/peers
Sent to office
Consequences imposed for negative
Communications with home
behavior
Discipline referral
Inability to process directions
In-school suspension
Other (specify)
Out-of-school suspension
Other (specify)
During what concurrent event(s) does the behavior
occur?
Does the student try to escape when he/she
misbehaves? If so, why?
Independent seat work
Large group instruction
Avoid a demand or request
Small group instruction
Avoid an activity/task (if known)
Crowded setting
Avoid a person
Unstructured activity
Escape the classroom/setting
Structured activity
Escape the school
Specific time of day
Other (specify):
Specific day of the week
With a specific teacher (s)
Does the student try to gain attention or control when
A specific subject
he/she misbehaves? If so, why?
Other (specify):
Get desired item/activity
Are there any Medical/Home factors that are
Gain adult attention
relevant to this behavior?
Gain peer attention
Medication (change/not taking)
Get sent to preferred adult
Change in home/family dynamics
Gain power
Mental conditions-Specify:
Gain revenge
Mental Health-Specify:
Other (specify):
Social Services
Judicial System
Other (specify):
Are there other characteristics of the student that
Could contribute to behavioral difficulties?
Examples: impulsivity, alienation from peers, low
frustration tolerance, difficulties reading
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