FBA Interview Form

Interview a parent or service provider of the individual you are collecting data on. Interviews
should be done face-to-face or at least voice-to-voice. You may NOT email questions, and ask
responder to write their responses. Questions should include, but are not limited to:

Interviewed: Student’s Band Teacher Mr. Schultz

1. What behavior or behaviors are problematic? What behavior is the most
problematic to you or the individual on the spectrum?
Mr. Schultz reports the problematic behaviors he observers from the student to be are making
inappropriate comments, walking around the classroom without permission, fixation on
particular topics during collaboration time, and misuse of classroom furniture and equipment.
2. Describe the problem behavior(s) in detail
Student is often off-task and disruptive and he is often fighting with the student next to him
about trivial things. Student will make negative and inappropriate comments about the teacher
and his peers and will use group time to discuss a topic of his interest and will become
combative when other classmates disagree with his perspective.
3. When and where does the behavior most often occur?
Behaviors are seen to be observed all throughout class though behaviors appear to be more
intense at the beginning, during group work, and at the end of class. Behaviors all typically
happen in the classroom.
4. What happens when the individual engages in the behavior?
When the behavior occurs the student is re-directed and reminded of classroom expectations.
During times when more than three re-directions are given the student is asked to step outside
and teacher engages in a quick conversation about his behavior.
5. Why is the behavior a problem for you and/or the individual?
The behavior is disruptive in the classroom because it takes away from the instruction needed
for other students in the classroom. In addition, the behaviors are also problematic because
more time is needed to monitor his behavior than interacting with other students as well as
student needs proximity from the teacher to behave appropriately which takes away from the
teacher’s ability to observe other students and their instruments.

Asking the same questions as above students’ math and social studies teacher were also
interviewed as well as the student himself and his parent. Below are the summaries of their
responses.

Math Teacher Interview

Ethan’s Math teacher, Anthony Zerrer, was interviewed as part of this assessment. He reports
that Ethan is often off-task and disruptive and that he is often fighting with the student next to
him about trivial things. The behaviors are observed throughout the class period unless there is
a test. Mr. Zerrer works to diminish the disruptions by promptly attending to the disputes. Every
time Ethan has a problem, Mr. Zerrer reports being nearby to extinguish it. Mr. Zerrer reports
that Ethan’s behaviors do not appear to disrupt the entire classroom directly. Instead, because
Mr. Zerrer must focus so much time on Ethan, he is not able to attend to the rest of the class as
much as he would desire. Additionally, Ethan’s behaviors directed towards his desk neighbor
are greatly disturbing to that student.

Social Studies Teacher Interview

Ethan’s Social Studies teacher, Toni Cummings, reports that Ethan likes to participate in
answering questions during Bellwork and discussions. He appears to enjoy social studies and
wants to be a part of discussions. He gets his work finished and works well independently. She
observes disruptive behavior mostly when he is working in a group. His teacher has used
numerous strategies, which have had a fair amount of success including: Up front seating and
on the end of a table group, she has him in the same seat as the beginning of the year so he
feels more comfortable, she has a girl who is helpful and kind sitting next to him, the teacher
quietly give him reminders to stop what he is doing or to start his work, she has him seated
away from the boy who he has problems with, when he seems extremely agitated about
something he can step outside to collect himself, and if he is causing a lot of problems then I
take him outside to talk to get him to calm down.

When he is working in groups and being negative with his group members, then it becomes
extremely disruptive and students get upset because Ethan will not stop talking about what he is
fixated on. 

Student Interview

Ethan was interviewed as part of this assessment. He reports that he enjoys playing and
watching football. He told the psychologist that he is a big fan of the Philadelphia Eagles. His
favorite subjects at school are Math and Orchestra. His least favorite subject is English. He
reported that he does not like the writing and considers it his most difficult subject too. Math is
the subject Ethan considers easiest. He also enjoys it because he said that his teacher is funny.
When asked if he is able to focus at school, Ethan said that he is able to focus more often than
not. He is not sure if there are any classes that are easier or harder to focus in. Ethan reports
that he is good at playing the cello and that he has good problem-solving skills for group
conflicts.

Parent Interview

Ethan’s parents shared that he is super competitive and always wants to win, regardless of who
he plays against. He has a good memory and is able to recall lot of trivial facts from subjects he
really is interested in (Eagles players and stats, planets, chess, etc.). Lately, his interest is in
chess and he has greatly improved his game.
He spends a lot of time with his younger brother and neighbor kids, playing football, playing
video games, chess, etc. He can get too competitive and focus too much on winning and less
on actually having fun. He has hard time sitting still for a long time especially when he is
wearing his shoes that he always complains that they are uncomfortable. Inside the house,
where he does not wear shoes, it is little better. He needs constant reminders to sit up straight.
Sometimes, he would burst out a scream or raise one arm uncontrollably. For example, in the
car, he would stomp his feet, kick the chair in front, constantly shift his sitting positions. His
parents observed that he is not able to sit still in a chair when visiting doctors.
No strategies have worked consistently with Ethan. They have tried both taking away his free
time and electronic privileges or rewarding him with things he wants, but those all seem to be
temporary and he cannot control himself all the time. His parents are even thinking of sending
him to occupational or physical therapy but do not know how to describe this type of behavior.
Parents are concerned because the behaviors appear to be growing more severe and they are
worried that it is impacting him across all his subjects.

Target Behaviors:
a) Ethan will engage in elopement by getting up and moving about the room when he does not
have permission.
b) Ethan will call out in class or talk about topics that no one else is interested in discussing.