Functional Assessment Observation Form – Fill Out and Use This PDF

			FUNCTIONAL ASSESSMENT OBSERVATION FORM
	Name:
	Starting Date:	Ending Date:	Perceived Functions
	Behaviors	Predictors	Get/Obtain	Escape/Avoid	Actual
					Consequence
					Comments: (if
					nothing happened
					in a period, write
	Time				initials)

Totals

Events:

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

O’Neill, R., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997). Functional assessment for problem behaviors: A practical handbook (2nd

ed.). Pacific Grove, CA: Brooks/Cole in Snell, M. & Brown, F. (2006). Instruction of students with severe disabilities. Upper Saddle River, NJ: Pearson.

The Functional Assessment Observation form is used to collect direct observation data to validate (or disconfirm) hypothesis. In the above example, Maya’s team member is using the form to validate the team’s hypothesis that Maya is likely to stick her tongue out at peers, yell, spit at them, and/or

hit them during hallway transitions (particularly on Mondays after a weekend break from school) for the function of gaining their attention.

1)The first group of columns on the form lists the problem behaviors

2)The second group of columns lists the hypothesized predictors (antecedent triggers) for the problem behaviors.

3)The next set of columns lists the perceived functions of the problem behavior, organized into two subgroups: (a) get/obtain and (b) escape/avoid. Within each of these subgroups are listed generic functions of problem behavior (e.g., get attention, desired activity/item, self-stimulation, and escape/avoid a demand/request, activity, or person). Finally, the last set of columns provides a place to record actual consequence of a problem behavior (i.e., specific consequent events that occurred when problem behavior occurred).

4)On the Functional Assessment Observation form, problem behaviors are recorded as events, rather than frequency accounts. A single event includes all instances of a problem behavior of a given type (e.g., spitting) that are separated by no more than a 3-minute time gap. Counting behavior events is easier than trying to count every instance of a behavior, particularly with problem behaviors that have hard- to-determine beginnings and endings. Each time a problem behavior event occurs, the data collector records the sequence number of the event (e.g., 1 for the first event that occurred, 2 for the second even that occurred) in each of the relevant columns of the form.

**Note also that when no problem behavior events occur during an observed portion of as student’s routine, the observer simply writes his or her initials in the final column of the form. This makes it clear that although an observation did occur, no problem behavior occurred.

5) Validation (or disconfirming) of the hypothesis can be undertaken once sufficient data have been collected.

O’Neill, R., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997). Functional assessment for problem behaviors: A practical handbook (2nd

ed.). Pacific Grove, CA: Brooks/Cole in Snell, M. & Brown, F. (2006). Instruction of students with severe disabilities. Upper Saddle River, NJ: Pearson.