Functional Behavioral Assessment

Date Developed: 5/3/2020

Student Name: Soren Lundgren NYCID #: 244869871 Age: 5 years old Date of Birth: 10/17/2014
School: PS 87 Teacher/Class: Robyn Ulzheimer/Zoe Hemenway K-104 Grade: Kindergarten

1. Identify school staff who participated in the FBA team process

Print Name Title Signature
Zoe Hemenway Special Education Teacher
Carly Castle IEP Coordinator
Print Name Title
Print Name Title
Print Name Title
Print Name Title
1.

2. Identify and define the Targeted Problem Behavior(s)

8 NYCRR § 200.1(r)
Identify ONE Targeted Problem Behavior or ONE Response Class of behaviors and define the
behavior(s) in observable/measurable, and concrete terms. If there is more than one
Targeted Problem Behavior or one Response Class of behaviors, please complete a separate
FBA.

☐The ONE Targeted Problem Behavior* is: Soren engages in many off task behaviors
including: calling out, standing up from his seat, and stimming.
*E.g., hitting peers or screaming or throwing objects, etc. List one single
behavior.

OR,

☐The ONE Response Class** of behaviors is: ONE Response Class

consisting of the following behaviors: Identify Behaviors

**Response class is a category of behaviors that is followed by a list of the specific

behaviors which occur under similar circumstances or antecedents with the same
outcome or function. They usually happen in rapid sequence. (Examples include
aggressive behavior consisting of hitting, kicking or pulling hair; tantrums consisting of
laying on floor, screaming, flailing arms, and kicking legs.)

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Functional Behavioral Assessment
 2. List of direct and indirect data sources used to identify and support functional
hypothesis
8 NYCRR § 200.22(a)(2)
3a. Indirect Data
Check all that apply and attach. The sections in bold must be checked and submitted
into SESIS.
☐ Student interviews (information from the student)
☐ Parent interviews (including relevant history and current status)
☐ Staff interviews (including teachers, paraprofessionals, related service providers,
and
possibly other relevant staff such as cafeteria, bus, custodial, office staff)
/ Information from the IEP Present Levels of Performance
☐ Assessment of Student Preferences
☐ Surveys or questionnaires specific to behavior(s)
☐ Student records review (including current school status)
☐ Summary of the results of Psychological/Psychiatric Evaluations
(must check and submit if student recommended and/or receiving counseling)
☐ Medical Information
☐ Testing data
☐ Attendance data
☐ Disciplinary records (e.g. OORS report, SOHO report)
☐ Other information provided by the parent. Specify: Other information

3b. Direct Data

Direct data are gathered from direct observation across multiple settings, by more than
one member of the team identified above. The most relevant and appropriate
documentation – which includes Antecedent-Behavior-Consequence (ABC) Charts,
frequency (how often a behavior occurs), duration (the length of time the behavior
lasts), intensity (how severe the behavior is), and/or latency (how long it takes for a
behavior to begin after a specific verbal demand or event has occurred) data measures
across activities, settings, people, and times of day – must be checked, attached and
submitted into SESIS.
☐ ABC Charts
☐ Frequency Charts
☐ Duration Charts
☐ Intensity Scales
☐ Latency Documentation
☐ Other – Specify: Other information

1. Global/broad influences related to Targeted Problem Behavior(s) ( “Setting Events”)

8 NYCRR §§ 200.1(r) and 200.22(a)(3)
Using indirect and direct data sources, summarize the global/broad influencing factors
(including cognitive, social, sensory, affective factors) that relate to the Targeted Problem
Behavior. Influencing factors can include the student’s skills, health/medical, daily

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 routines, relationships, or recent or ongoing events in the student’s life, etc. Indicate and
describe all that apply.

Influencing factors (setting events) Provide specific details of the influencing factors
that increase the likelihood of
Targeted Problem Behavior(s)

☐ Impact of recent/ongoing events
☐ Family issues/home environment
/ History of the behavior
/ Skill/performance deficits
☐ Physical/health/medical issues
☐ Negative thinking habits
☐ Other:
Soren is a child with autism who engages in stimming when
he experiences moments of arousal or excitement. He is
currently developing his ability to self regulate throughout
his day and requires an adult to support him in this area.
Soren’s ability to read social cues is impacted given his
classification of autism therefore, Soren will call out during
inappropriate times.

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 5. Description of antecedent(s)
8 NYCRR §§ 200.1(r) and 200.22(a)(3)
What occurs before and triggers the Targeted Problem Behavior?
Situations/events/activities/people that seem to trigger the Targeted Problem Behavior:
/ Demand of or request to student
/ Difficult task
☐ Non-preferred activity
☐ Non-preferred social interaction
☐ Transition from preferred to non-preferred activity
/ Changes in schedule or routine
/ Environmental conditions
☐ Other: Other information

Describe items checked above in detail:

When Soren is in a large or small group setting, he engages in off task behaviors.
During large group times when new information is presented, an assignment is being
taught, or the students are listening to a read aloud, Soren will engage in off task
behaviors. When completing small group, academic work at a table, Soren engages in
off task behaviors.

Times of the school day when the Targeted Problem Behavior most often occurs:

Target behavior occurs when Soren is engaged in large group and small group times. These
group times occur throughout the school day.

3. Description of consequence(s)
8 NYCRR §§ 200.1(r) and 200.22(a)(3)
Describe the consequence(s) of the Targeted Problem Behavior(s). What happens
immediately after the Targeted Problem Behavior(s) that seems to encourage it? What
consequences increase the likelihood of the Targeted Problem Behavior(s) occurring again?
Include adult/peer responses and what happens in the immediate environment (e.g., gets
attention from peers, avoids non-preferred task, etc.).

After Soren engages in off task behaviors, his paraprofessional or classroom teacher give him
a verbal or nonverbal cue to help him re-focus. Soren is asked if he needs a break and is able
to identify if he does or does not require one. The break generally entails spending time in
the hallway to engage in a physical task such as wall push-ups or jumping jacks. If Soren
engages in stemming then he is asked if he wants squeezes. When Soren calls out, his
teacher or paraprofessional will remind Soren to raise his hand and will support him in
rephrasing his comment or making an on topic comment.

1. Function of the Behavior(s)

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 8 NYCRR § 200.22(a)(3)
Check the applicable box(es) below and provide details.
The student GETS/GAINS:
/ Teacher/Adult Attention: Soren gains our attention when he engages in off task behaviors
☐ Peer Attention: Click here to enter text.
/ Sensory/Stimulation: Soren is able to exert his need to move by spending time in the
hallway engaging in physical activities. He is also given squeezes on his arms which provide
sensory input.
/ Tangible/Preferred Activity: Soren is able to take a break from the large or small group
☐ Other: Click here to enter text.

The student AVOIDS/ESCAPES:

☐ Teacher/Adult Attention: Click here to enter text.
☐ Peer Attention: Click here to enter text.
☐ Sensory/Stimulation: Click here to enter text.
/ Non-Preferred Activity/Task: When Soren is asked to complete tasks that are challenging
for him such as writing, he will engage in the behavior.
/ A Difficult Task: Click here to enter text.
☐ Other: Click here to enter text.

4. Skill/performance deficits related to Targeted Problem Behavior(s)

8 NYCRR § 200.1(r) and 200.22(a)(2)
List skill and/or performance deficits related to Targeted Problem Behavior(s). A skill-
based deficit is when a student does not know how to perform a certain task. A
performance-based deficit exists when a student knows how perform the skill but does not
perform it at the desired level.

Soren is developing his self regulation skills, these skills are necessary in order for Soren to
be able to wait his turn to be called on in addition to regulate his emotions, specifically
when he is feeling excited. He is also developing many social skills which allow him to
engage appropriately with his classmates during large group instruction. Soren is able to ask
for a break however, he does not do so consistently and requires an adult to prompt him to
ask for one when needed.

5. Baseline data
8 NYCRR § 200.22(a)(3)
Using the contextual information above, provide a narrative data description with regard to
the frequency, duration, intensity and latency (if applicable) of the Targeted Problem
Behavior(s) across activities, settings, people, and times of day. Use the same measures for
the Behavioral Intervention Plan (BIP) and Progress Monitoring.
Click here to enter text.

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 Frequency (how often a behavior occurs): Frequency (average number per day and/or
week, etc.)
Duration (how long a behavior lasts): Duration (average length of time of behavior)
Intensity (how severe the behavior is): Intensity (average intensity of behavior)
(Use these Intensity Levels or define a scale below: 1- impacts only the student, 2- impacts
neighboring peers, 3- impacts entire class, 4- impacts neighboring classes, 5- impacts the
whole school/violent behavior) Intensity Scale
1 Click here to 2 Click here to 3 Click here to 4 Click here to 5 Click here to
enter text. enter text. enter text. enter text. enter text.

Latency (how long it takes for a behavior to begin after a specific verbal demand or
event has
occurred) (if applicable): Latency (average time after demand or event)

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 10. Diagram the functional hypothesis
8 NYCRR § 200.1(r)

Setting Events Antecedent Target Problem Maintaining Consequence/

(Conditions that (What occurs Behavior(s) Function
increase likelihood before?) (Observable/Measurable)
of behavior(s))

- Large group When Soren is in a Soren engages in many off Consequence/Outcome

times large or small group task behaviors including: What happens after the
- Small group work setting, he engages calling out, standing up Targeted Problem Behavior?
when completing in off task behaviors. from his seat, and After Soren engages in off
academic tasks During large group stimming. task behaviors, his
- Read alouds times when new paraprofessional or classroom
information is teacher give him a verbal or
presented, an nonverbal cue to help him re-
assignment is being focus. Soren is asked if he
taught, or the needs a break and is able to
students are identify if he does or does not
listening to a read require one. The break
aloud, Soren will generally entails spending
engage in off task time in the hallway to engage
behaviors. When in a physical task such as wall
completing small push-ups or jumping jacks. If
group, academic Soren engages in stemming
work at a table, then he is asked if he wants
Soren engages in off squeezes. When Soren calls
task behaviors. out, his teacher or
paraprofessional will remind
Soren to raise his hand and
will support him in rephrasing
his comment or making an on
topic comment.

Function
What does the student
Get: Sensory input, tangible
object, teacher attention.

and/or Avoid: Non-preferred

activity or task and difficult
tasks.

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 11. Statement of functional hypothesis
Narrative that describes the function of the targeted problem behavior(s) (functional
hypothesis) based on the data. Functional statement reads:
 
When Soren is in a large or small group setting, he will engage in many off task behaviors
including: calling out, standing up from his seat, and stimming and then, his
paraprofessional or classroom teacher give him a verbal or nonverbal cue to help him re-
focus. Soren is asked if he needs a break and is able to identify if he does or does not
require one. The break generally entails spending time in the hallway to engage in a physical
task such as wall push-ups or jumping jacks. If Soren engages in stemming then he is asked if
he wants squeezes. When Soren calls out, his teacher or paraprofessional will remind Soren
to raise his hand and will support him in rephrasing his comment or making an on topic
comment. Soren engages in the behavior in order to get sensory input, his teacher’s
attention or a tangible object, and to avoid completing a difficult or un-preferred task. 
This behavior is most likely to occur throughout the school day.

6. Behavioral supports and interventions previously tried

8 NYCRR § 200.22(a)(2)
Describe any classroom, small group, or individualized behavioral supports and/or
interventions previously attempted for the student and the results of these interventions.
What interventions were implemented? What data was used to determine effectiveness?
Over what period of time?

Soren is in an ICT classroom, with the support of a special education teacher. Soren has the
support of his paraprofessional throughout the school day to support him during academic
and nonacademic times. Soren is offered preferential seating during large group times to
have the support of a teacher nearby as well as to offer space for him to move his body
when needed. During large group instruction, his teacher or paraprofessional will sit next to
him reiterating everything that is presented to ensure Soren comprehends the information
being presented. When he shares his thoughts and ideas a teacher or his paraprofessional
will support him in rephrasing what he wants to say so it connects to the conversation at
hand. Soren is offered movement breaks throughout the day as well as extra time to
complete all tasks. Each academic task is modified to meet Soren’s needs.

7. Behavioral supports and interventions currently in place

8 NYCRR § 200.22 (a)(3)
Describe classroom, small group, or individualized behavioral supports and/or interventions
currently in place for student (e.g. individual counseling, check-in check-out, etc.). What
interventions are currently being implemented? What data is being used to determine
effectiveness? Over what period of time?

Soren has the support of his paraprofessional throughout the school day to support him
during academic and nonacademic times. Soren is offered preferential seating during large
group times to have the support of a teacher nearby as well as to offer space for him to
move his body when needed. During large group instruction, his teacher or paraprofessional
will sit next to him reiterating everything that is presented to ensure Soren comprehends the
information being presented. When he shares his thoughts and ideas a teacher or his
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 paraprofessional will support him in rephrasing what he wants to say so it connects to the
conversation at hand. Soren is offered movement breaks throughout the day as well as extra
time to complete all tasks. Each academic task is modified to meet Soren’s needs.

8. Describe/list student’s interests and possible reinforcers

8 NYCRR § 200.22(a)(3)
Refer to Assessment of Student Preferences, IEP, and Staff/Parent/Student Interviews as
appropriate. Reinforcement is the process by which a behavior is followed by a given
consequence that increases the probability that the behavior will occur again. There are
different types of reinforcers (e.g. attention, activities, tangibles, or sensory experiences).

Answer the questions below, and submit evidence of the student’s interests, preferences,
reinforcers, and/or motivators into SESIS.

a) What are the student’s interests or preferences?

b)
Soren loves to read books, specifically Elephant and Piggie by Mo Willems. He finds
humor in the stories and looks to connect with his teachers when reading these texts.
Soren has recently shown an interest in working and playing with his peers. Soren is a
silly student who enjoys humor.

c) What does the student find reinforcing or motivating?

Soren enjoys reading books with his classroom teachers, this is a time when he is able to
connect with his teachers in a meaningful way. Soren needs consistency, routine,
structure, and predictability in order to be successful. He responds well to silliness
especially during times of upset or frustration.

d) What is not reinforcing or motivating for this student?

Changes in his schedule or routine is unsettling for Soren.

15. Replacement behavior(s) that serve the same function and strategies for teaching
new behavior(s)
8 NYCRR § 200.22 (a)(3)
There are three essential characteristics of replacement behaviors:
a) They serve the same function as the problem behavior.

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 b) They are easier to do that the problem behavior.
c) They are socially acceptable.

Identify the replacement behavior(s) that serves the same function as the Targeted
Problem Behavior(s): Soren will ask for a break by stating “I need a break” verbally or by
using an agreed upon signal with his teachers and paraprofessional.

Provide recommendations for teaching alternative skills or behaviors that will replace the
Targeted Problem Behavior(s): Soren will be explicitly taught to say, “I need a break” “Can I
have a drink of water” or “Can I go outside” when he feels his body needs it. He will also be
taught an agreed upon non verbal signal he can use to signify his need for a break.

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