Functional Behavior Assessment - Liberty University- Educ 624

Topics: Psychology, Behavior, Lunch Pages: 3 (645 words) Published: March 9, 2013
FBA FORM

|Functional Behavioral Assessment | | | |Fictional Student Name: Michael Grand Caymen DOB: 07/30/2005 Date: 03/03/2013 | |Data Sources: X( Observation | X( Student Interview | X( Teacher Interview | X( Parent Interview | ( Rating Scales | ( Normative Testing | |Description of Behavior: | | | |Student isolates himself from others at various times of the day to include lunchtime, bathroom break time and recess; student makes inappropriate sounds during| |instructional time; student refuses to follow adult authority or follow classroom policies; student is consistently out-of-seat without permission/wandering | |about the room during instructional time. | |Setting(s) in which behavior occurs: | | | |Behavior is exhibited in the classroom, hallways, cafeteria and playground. | |Frequency:...
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