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.

FUNCTIONAL ASSESSMENT INTERVIEW FORMYOUNG CHILD

Child with Challenging Behavior(s): B
Date of Interview: 10/20/25 and 11/02/15
Age:
5 Yrs
9
Mos
Sex: F
Interviewer: Kathleen Van Fossan

Respondent(s): Miss S (teacher) and Miss B (mother)

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
1. Hitting
2.

Knocking down toys

How is it performed?
How often?
When B sees her friends playing 2-3 times a day
with toys, she will hit them.
When a friend builds a MagnaTile 4-5 times a day
tower, shell knock it down.

When a friend plays with a toy B 2-3 times a day

wants, sometimes B will walk up
and take the toy out of their
hands.
Getting up at circle time While everyone sits at circle time, 3 times a day
4.
B will get up and play with toys
3.

Taking toys

How long?
30 secs

Intensity?
Medium

30 seconds

Low

30 seconds

Medium

Throughout the Low

entire circle time
(approximately 30
minutes)

5.
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)?
The first three behaviors always occur in response to the same situationfriends engaged in ply
that does not involve B. For the last behavior, it always happens as soon as Miss S sits in her
chair.

B. IDENTIFY 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?
B is transitioning from carbamazepine to ethosuximide. With this transition, B has been experiencing incontinence and a
decrease in appetite. Also, Miss B noticed that most of Bs physical behavior (hitting, knocking down toys, stealing toys)
happened during this transition. B also has diazepam rectal for emergency situations.

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2. What medical complication (if any) does the child experience that may affect his/her behavior
(e.g., asthma, allergies, rashes, sinus infections, seizures)?
B is diagnosed with epilepsy. She will experience absence seizures almost 10 times throughout a single day. Her
seizures are usually triggered by sunlight and bright lights.
3. Describe the sleep cycles of the child and the extent to which these cycles may affect his/her behavior.
Bs sleep has been recently disturbed by the birth of her baby sister, M. M wakes up once or twice every night crying,
and it wakes B up. Therefore, she only gets about 7 hours of sleep every night.
4. Describe the eating routines and diet of the child and the extent to which these routines may affect his/her
behavior.
According to Miss S, B does not eat much throughout the day. She refuses to eat the schools food, but will eat the Goldfish her
family packs her throughout the day.
5. Briefly list the child's typical daily schedule of activities and how well he/she does within each activity.

DAILY ACTIVITIES
Time
7:00am

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Activity
Wakes up

Childs Reaction
Groggy, but seems happy

7:15-7:45

Bathroom time, brush teeth and hair, Hates having her hair done and says No! if anyone but her touches
takes medication
it

7:45- 8:15

Breakfast

Will eat applesauce and/or fruit snacks, but thats it

9:00

Arrives at Puppy Academy

Smiles, hugs teachers and friends, plays

9:30

Circle Time

Gets up when Miss S sits down, fidgets with fingers, looks around,
plays with toys around the classroom

10:00

Snack Time

Giggles, looks at friends, slowly eats Goldfish

10:30

Worksheet time

Sits, scribbles all over worksheets with large movements

11:00

Free play

This is the time where the first three behaviors will emerge. B spends
a lot of time wandering around the room with uncertainty, and will
occasionally look at Miss S or myself.

12:00

Lunch

Sits for lunch, will eat a little fruit, but usually nothing else

12:30 (Bus
Waits for bus for the Kitty School
usually arrive at
12:45)

Plays with teachers who are on break, especially myself and Miss A.
Gets on the bus with ease, listens well to bus driver.

1:15-2:30

Speech Therapy/Behavior Therapy

According to her teachers at Kitty School, B enjoys her one-on-one

sessions and loves playing with the other children. She will exhibit
some of the physical behaviors mentioned above, but not to the same
frequency.

2:30

Snack time

Sits, only eats goldfish

3:30

Free play

Will exhibit a few of the same physical behaviors, but not to the same
frequency/intensity

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4:15

Waits to go back to Puppy Academy Plays with students while waiting

4:45

Goes back to class; free play in Miss Same physical behaviors emerge
Ks class

5:30

Picked up from school

Happy to see Mom/Dad, hugs them and grabs things

6:00

Arrives home

Drops stuff at bottom of stairs and runs upstairs to play

6:30

Dinner

Sits, eats a little fruit and plain noodles

7:00-8:00

Watches Paw Patrol

Happy, calls out to Sky when she comes on TV

8:00-8:30

Bath Time

Loves playing in water, but get mad if too cold

8:30-8:50

Storytime

Snuggles in bed, sometimes too energetic to listen to stories/sleep

9:00

Bedtime

Too energetic to sleep sometimes

1:00 am

M cries

B wakes up, will sometimes cry too, has a hard time going back to
sleep

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?
B knows her schedule fairly well. She knows to go to the table when she sees everyone else go to the table. If Miss S
tells her bus, B will go to her cubbie and get her coat and seat belt.
7. What choices does the child get to make each day (e.g., food, toys, activities)?
B chooses what she wants to eat from her lunchbox during snack time, and what toys she wants to play during free play.

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C. DEFINE EVENTS AND SITUATIONS THAT MAY TRIGGER BEHAVIOR(S)

1. Time of Day: When are the behaviors most and least likely to happen?
Most likely:
Either free choice or circle time
Least likely:
Lunchtime or DEAR time

2. Settings: Where are the behaviors most and least likely to happen?
Most likely:
At the MagnaTile table or the Circle Time Rug
Least likely:
Quieter areas like the book corner and art corner

3. Social Control: With whom are the behaviors most and least likely to happen?
Most likely:
Friends who will give the loudest reaction, such as Br, L, D, and Ma
Least likely:
Friends who are quiet, such as P and Do

4. Activity: What activities are most and least likely to produce the behaviors?
Most likely:
MagnaTiles and Legos
Least likely:
Giant wooden puzzle and painting

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.)?

If B is left by herself during free play or circle time, she will start her physical behaviors with her friends.
6. What one thing could you do that would most likely make the challenging behavior occur?
If you leave B alone during play time and circle time and did not talk to her or engage her in any way, shape, or form, then
the behavior is more likely to occur.
7. What one thing could you do to make sure the challenging behavior did not occur?
Miss S has pulled out the giant wooden puzzle for B and let her play with it during free play. I also noticed that B enjoys
cutting paper by herself. If there are friends already playing with B, she is less likely to hit anyone

D. DESCRIBE THE CHILD'S PLAY ABILITIES AND DIFFICULTIES

1. Describe how your child plays (With what? How often?).
B usually plays by herself when shes not hitting/taking toys/knocking toys over. She will pull out boxes, dump them out,
lay down, and play with them. She will keep looking at Miss S or myself to see if were watching her. She will do this
every time she has free play.
2. Does your child have challenging behavior when playing? Describe.
Yes. B does not know how to enter play with friends properly. If no one is playing with her, and she sees a group of
friends playing together, she will start to hit, knock over toys, and take toys from friends.

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

Yes, B plays alone. She dumps toys like blocks, Legos, MagnaTiles, and wormblocks onto the floor and rolls them
around on the floor. She will then stack the toys and knock them down.
4. Does your child play with adults? What toys or games?
B will not play with Miss S, but she does play with me. When we play together, we cut or rip paper, play with puzzles,
and build with blocks. I usually initiate the play, although she will walk up to me and smile whenever I enter the room.
5. Does your child play with other children his/her age? What toys or games?
When I interviewed Miss S, Br, L, and D came out of their classroom and interrupted us. They said B will come up,
smile, and knock down their toys. They usually dont play with her, and B doesnt usually play with them, although this
behavior does indicate that B is interested in engaging play with these friends.
6. How does your child react if you join in a play activity with him/her?
If I join in her play, she smiles and says Hi! and well look at the toys together. If Miss S tries to join her, she will look at
her and smile. She also enjoys watching Miss S play with her.
7. How does your child react if you stop playing with him/her?
B will start to follow me around the room silently if I stop playing with her. Sometimes she will put her hand on my leg or
on my hand to get me to reenter our play. She will sometimes giggle or run around me as well.
8. How does your child react if you ask him/her to stop playing with a toy and switch to a different toy?
B will follow me and join me in playing with the new toy. Once I moved from the Legos area to the MagnaTiles area and
started playing with the MagnaTiles. She took a MagnaTile out of my hand. I stopped and asked her if she wanted to join me
in building the tower. She said, Yeah! and then sat on my lap and started building a tower.

E. IDENTIFY THE FUNCTION OF THE CHALLENGING 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
1.Hitting

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

Friends attention and teachers negative attention

2.Knocking down
toys

Friends attention and teachers negative attention

3. Taking toys

Friends attention and teachers negative attention

4.Geting up from
circle time

Friends attention and teachers negative attention

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?
All these behaviors would be unaffected
b. Are the above behavior(s) more likely, less likely, or unaffected if you interrupt a desired event
(eating ice cream, watching a video)?
All these behaviors would be unaffected

c. Are the above behavior(s) more likely, less likely, or unaffected if you deliver a stern
request/command/reprimand?
All of these behaviors would more likely occur if you delivered a stern reprimand.

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.
The above behaviors are definitely more likely to occur if you are present but not interacting with B for fifteen minutes

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

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)?
The behaviors are all more likely to occur, especially if someone is playing with a toy she wants but isnt
allowed to play with (such as MagnaTiles)

g. Are the above behavior(s) more likely, less likely, or unaffected if he/she is alone (no one else is present)?
These behaviors would not occur if she was by herself.

F. HOW WELL DOES THE BEHAVIOR WORK?

1. What amount of physical effort is involved in the behaviors (e.g., prolonged intense tantrums vs. simple verbal outbursts, etc.)?
The physical effort in these behaviors is a quick, slightly physical outburst. Even when she hits a friend she
doesnt use a lot of force, but she uses enough to get their attention. In October, we noticed that her
behavior was more forceful, but by the end of November, its been less forceful.

2. Does engaging in the behaviors result in a payoff (getting attention, avoiding work) every time?
Almost every time? Once in a while?
These behaviors result in an immediate payoff every time. Either she gets attention from Miss S or from the friend she
was playing with or hitting.

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 all these behaviors, her payoff is immediate. Either the child she hits/takes a toy from reacts right away, or the
teacher scolds her immediately.

G. HOW DOES THE CHILD 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?
B can answer yes or no questions very easily by saying yeah or no. She will do this whenever she is
asked a yes or no question. She will also take you to whatever she wants to talk to you about by holding
your hand and taking you to the object in question (her lunchbox, for example). Usually we use yes/no
questions to find out what she needs, and it works frequently.

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?)

B will usually become frustrated, sigh, and walk away. Sometimes Miss S or myself will try to reengage B
to find out what she was trying to tell us, but she will usually ignore us or refuse to answer our
questions.

3. Tell me how your child expresses the following:

Requests an Object

X X X X

X X

Requests an Action

X X X X

X X

Protests or Escapes

X X X X X

Requests Help
Requests a Social Routine X
Requests Comfort

X X X X

X X X X

X X X X

X
X

X
X X X X

NONE

OTHER

CRY OR WHINE

TANTRUM

AGGRESSION

SELF-INJURY

COMPLEX SIGNS

SIMPLE SIGNS

CREATIVE MULTI WORD

X X

Indicates Illness
Shows You Something

X X X X

CREATIVE SINGLE WORD

DELAYED ECHO

IMMEDIATE ECHO

VOCALIZE

FACIAL EXPRESSION

HEAD NOD/HEAD SHAKE

FUNCTIONS

MOVE AWAY FROM YOU

MOVE TO YOU

GAZE SHIFT

LEAD

POINT

GIVE

GRAB & REACH

MEANS

X
X
X

Request social routine: hits/throws toys/knocks over tower

Indicates Illness: seizures indicated through fluttering eyelashes, flapping hands, still body

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).
If the instructions are short, B can follow them. For example, if you say, Stop, B! she will stop and look at you.
b. Is the child able to imitate someone demonstrating how to do a task or play with a toy?
Yes; for example, after watching me get a paper towel and wipe down the table, B will get a paper towel and do the same thing. She
will wipe the table with faster, wider movements than I use.
c. Does the child respond to sign language or gestures? If so, approximately how many? (List, if only a few.)
B understands very simple gestures (such as waving her hand for Hello! and Goodbye!) She also knows to come see me when I
wave my hand towards me. She doesnt know ASL yet.
d. How does the child tell you yes or no (if asked whether he/she wants to do something, go somewhere, etc.)?
B will say Yes, if you ask her if she wants to do something, or No, if she doesnt.

H. EXPLAIN CHILDS PREFERENCES AND PREVIOUS BEHAVIOR INTERVENTIONS

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?
B loves cuddles and hugs! She especially likes it if you pick her up and walk her around the room! She also loves her
toy horse Bullseye, the TV show Paw Patrol, and painting. Her favorite colors are pink and blue.

2. What kinds of things have you or your child's care providers done to try and change the challenging behaviors?
Mrs. B talks to B about using gentle hands every morning. Miss S has previously tried putting B in time out, but B just
smiles and walks away from the chair. Ive gives Miss S a sticker chart and a fidget box to help with Bs behavior at
circle time.

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

Distant Setting
Event

Immediate Antecedent
(Trigger)

Problem Behavior

Little sister M keeps B She sees friends grouping Hitting friends

awake at night, changes intogether to play with toys
medicine, lack of
nutrition

Maintaining
Consequences

Function

Friends and Miss S

give B negative
attention

Gets attention from

friends and Miss S

Little sister M keeps B She sees a friend building a Knocks down toy/ tower Friends and Miss S
awake at night, changes inlarge tower. Usually the
give B negative
medicine, lack of
friend has back towards B.
attention
nutrition

Gets attention from

friends and Miss S

Little sister M keeps B A large group of friends

awake at night, changes inaround a box of toys
medicine, lack of
nutrition

Takes Toys

Gets attention from

friends and Miss S

Little sister M keeps B Miss S sits down in her

awake at night, changes inchair for circle time
medicine, lack of
nutrition

B gets up from circle timeMiss S gets up and

puts her back down.
Friends and Miss S
give B negative
attention

Friends and Miss S

give B negative
attention

Gets attention from

friends and Miss S