Writing Functional Analyses – Introduction

The first real steps in any Functional Assessment of Behavior involve planning and conducting systematic observations and collecting data from corroborating sources.  It is important that you are thinking about now, from the very beginning of the process, the conditions in which you will observe the behaviors that you’re analyzing.

All sciences recognize the primacy of observing phenomena directly.  The behavioral science of Applied Behavior Analysis regards data collected from systematic direct observation as the most valid and reliable source possible.  The founders of the field stressed that analysis procedures meet a set of standards for being systematic.  They upheld requirements that procedures be “Technical;” that procedures are based on coherent “Conceptual Systems” and be able to demonstrate effectiveness.

Technological

“Technological” here means simply that the techniques making up a particular behavioral application are completely identified and described…

…The best rule of thumb for evaluating a procedure description as technological is probably to ask whether a typically trained reader could replicate that procedure well enough to produce the same results, given only a reading of the description. 

…procedural descriptions require considerable detail about all possible contingencies of procedure.

Baer, D.M. Wolf, M.M., Risley, T.R. Some current dimensions of applied behavior analysis; Journal of Applied Behavior Analysis 1968, 1, 91-97

For the purposes of collecting data during your observation of behavior, “technical” means using a data recording procedure that provides for consistency.   In practical terms, this usually means that you use some kind of Data Form.  The form should provide data collectors with a detailed “Operational Definition” so they can agree upon what exactly it is that counts as an event of behavior – what the behavior is and what it is not.   The type of data form should also be designed to measure one or more aspects of the behavior (e.g., how often does it occur? how long does it last? where does it happen and where does it not happen? etc.).

  • Data Forms adaptable for a wide variety of situations are available by contacting our office.
Conceptual Systems

…procedures are not only precisely technological, but also strive for relevance to principle… 

…the total description shows the reader how similar procedures may be derived from basic principles. 

…This can have the effect of making a body of technology into a discipline rather than a collection of tricks. Collections of tricks historically have been difficult to expand systematically, and when they were extensive, difficult to learn and teach.

Baer, D.M. Wolf, M.M., Risley, T.R. Some current dimensions of applied behavior analysis; Journal of Applied Behavior Analysis 1968, 1, 91-97

For the purposes of collecting data for your Functional Assessment, this affects what procedures you use to collect data.   An important principle for instance would be that the behavior must be described in the most tangible, observable and quantifiable way possible (e.g. ‘countable’ in terms of how often? how many? how much? how long? how severe? etc.) that facilitates numeric measurement.  It would require the focus of recording to be on observable and discrete events.

Another principle that applies to observation and measurement is precision.  The design of the form would include places to put specific types of data and should be easy enough to use so the observer can pay more attention to the behavior going on.

Effective

If the application of behavioral techniques does not produce large enough effects for practical value, then application has failed.  

…In application, the theoretical importance of a variable is usually not at issue. Its practical importance, specifically its power in altering behavior enough to be socially important, is the essential criterion.

…identified methods of observing behavior that ensure that data can be recorded that is believable and reliable. 

Baer, D.M. Wolf, M.M., Risley, T.R. Some current dimensions of applied behavior analysis; Journal of Applied Behavior Analysis 1968, 1, 91-97

What this means for data collection is that the procedure you devise should be replicable.  Poorly designed collection procedures can result in wildly different measurements from separate observers.  This is usually due to the behavior not being defined sufficiently, or that it is unmeasurable because it is not really a discrete event or class of events (e.g., “defiant”), or some other source of “measurement error.”

Beginning the Functional Assessment

The Functional Assessment of behavior actually begins with a Functional Analyses of General Conditions.    Briefly, this section and its various subsections provides the background and history of the behaviors, diagnosis, prior interventions, sensory, health, and developmental factors that help the reader understand how the functions relate to the behaviors.  Each of the subsections and the content that we want put into them is described below.

Daniels’ Dictum: The principle that solving behavior problems with behavior analysis is more difficult than it appears.

Daniels is known for telling people, “If you think this stuff is easy, you’re doing it wrong.”

In addition to direct and systematic direct observation using data forms, you should also plan for the collection of information from:

  • Parent Interviews using formal Clinical Interview methods such as Behavioral Inventories, Checklists, Questionnaires, etc. (these must be administered via interview and not simply “filled out” by the interviewee).
  • Testing and other Evaluative Data available in records
  • Information from other Clinicians and Stakeholders

Specific Instructions for completing Basic Information and Background Information sections of Functional Assessment Reports

The Manual will now step down through sections of the report in the order in which you will see them on report templates.  (If you do not have a blank Functional Assessment of Behavior report template, please contact the office).

The Title and/or Section of the Report will appear in blue (it could be a link to another section).  Examples with appear in green.

Instructions for filling out the section, as well as any related theoretical or clinical specifications accompany in black print.

The Heading Boxes

The heading boxes contain basic identifying information and personal data. It is at this point in the Manual that we stress that this a person whose behavior is currently under evaluation.  We want a holistic evaluation of the behavior in the context of what the person knows and needs.  This must be understood in contexts beginning with the person’s relationship with himself or herself or his or her developmental capacities, the demands of the person’s internal as well as external environment that appear related to certain behaviors – and not just as a set of behaviors to be changed or manipulated.  Assessment Analysis must be organic and useful in the situation in which it occurs. It must be person-centered – not behavior centered.

Reports of Behavior Assessment naturally focus on problem areas.  It is very easy to focus only on the behavior, and not see much about the intangible features of a person’s history and current experience and unique ways of making meaning of the world.  Therefore, in every section that follows, the subject or phenomenon of interest in that section must be related back somehow to the behaviors in question.  Section by section, we look at the behavior from another possible point of view.  By the end of the process, hypotheses that you develop about the behavior are better informed, and the subsequent recommendations that you make more likely to work.

Students of Behavior Assessment: Information regarding the person whose behavior you are studying should be pseudonymous.  Do not give real names, names of schools or districts, Teachers (unless it is yourself), birthdays (make sure you don’t change the Student’s real age and grade)

Contractors: Be sure to get proper spellings, dates of birth, grade levels, etc. from reliable sources.  It is best to compare information obtained from interviews with Primary Stakeholders and information from the referral or from records.

The purpose of a Functional Assessment is to examine the behaviors of a person for some reason.  This is the person to whom the referral primarily concerns, and it is that person’s behavior that is the subject of assessment in the report.  In Mental Health settings, this person is referred to as the “Identified Patient.”

TheIP

The concept of the “Identified Patient” was developed to stress the fact that a person’s behavior affects larger systems they are involved with.  A system takes form when one variable is affected by another variable in an ongoing relationship.  The Identified Patient refers to the person who engages in the behaviors of concern in the Assessment.   For instance, the Identified Patient may be a teenager experiencing multiple conflicts and rule-breaking at home; poor relationships with her family and failure at school.  Her behaviors affect her, her family, her Teachers, other classmates, as well as her potential to participate further in these systems.  Identified Patients can be preschool aged children involved in early intervention for their development; Students, etc.  Each are surrounded by systems of various kinds, and their behavior, intentional or not, affects the others in the system.  All of these people will change in some way as the result of intervention.

But the term “Identified Patient,” is associated with a medical model of diagnosis and direct treatment of the patient and adapted by some branches of psychology.  We work in non-laboratory, applied settings, where the person interacts with multiple people and contexts, and the changes we make will likely affect what happens in other, overlapping systems in which the person is involved.  Therefore, “Identified Person” or “IP” seems to be a better fit, and it will be the term in which we use to replace “the person whose behavior is currently under examination.”

Behavior of the Person and Family, Caregiver, School and other Systems

Behavior affects what happens next. Behavior affect the other components of the “system” in which it occurs.

An occurrence of a behavior has some sort of “effect on the self,” “others,” or “the environment,” which are among the larger systems in which the person is involved.  Other persons in the system are somehow affected by the behavior, even if the effects aren’t immediate – or the setting is specialized to manage the behavior somehow.

In response to the occurrence of the behavior, each person that responds is by definition – changing somehow.  The changes may not be obvious or overt.  The changes can range from subtle, covert changes in opinion, predisposition to highly specialized arrangements and reactive and compensatory strategies developed by experts.  Ideally, the system should have a capacity to take in information necessary to function well, when and where necessary.  Many systems do.  They function for long periods of time in relatively stable and well-working forms.  Joyful, experience-sharing events, such as a game on the playground, a conversation, a backyard BBQ, where the main reason for wanting to be involved  – is the new stuff that will come up as a result.  We look forward to the jokes we might hear, or the reactions we anticipate when we tell the others what we did, etc.  These are all new products; new behaviors and configurations of the system that we welcome.  They are usually the result of spontaneity and many, many moments of novelty and minor uncertainty.

The behavior may only serve to change internal states of the IP (e.g., to feel good or better; to feel calmer; to regulate boredom or negative feelings, such as in drug use or self-stimulatory behavior).  We tend to start analysis by look at systems from the individual himself or herself as a system of mind and body, to relationships emanating outward from natural family and home settings to school and community settings where the behaviors under examination occur.

But even the most seemingly self-directed, self-absorbed behaviors affect larger systems of family, Caregivers, Teachers and other Stakeholders.  When the behavior occurs, it affects other people – which are the most important other parts of the system.  They usually undergo internal changes – such as the formation of attributions regarding the behavior and a set of responses that usually match those attributions.  These undergo change over time.  Even if there is no real change in the form or function of the behavior, the behavior is always undergoing a strengthening, weakening, or self-regulatory maintenance.  The behavior occurs to regulate feelings and internal body states.

The point we are emphasizing at this point – before you even fill out the statistical information in the Heading Boxes, is that this is a person whose behavior is currently under assessment.

“A person whose behavior is currently under assessment” is too long and cumbersome phrase to use for “Identified Patient,” so we use “Identified Person” or “IP.”  The Heading Boxes is where you enter formation on the IP, as well as others specified that are involved in the Assessment and/or Treatment plan.

Report Date

This is the date in which the report was completed. in the following manner: mm/dd/yyyy

Name

Lastname, Firstname, MI (opt.) or Nickname (in quotes) of the IP.   A lot of the time, children are not referred to by their given name around the house.  It is actually more appropriate to refer to the person of concern in your report by the name that he or she goes by, but please specify that you are doing so in the “Referral Information” section of the report.

For Students of Functional Assessment that are submitting reports for training purposes, DO NOT USE THE IP’S REAL NAME.  Use a pseudonym.  In order to fully protect the confidentiality of the IP, change the names of schools, Teacher names or any other identifying information.  Authors of reports should be listed by title only – their names are not necessary for training purposes.

In the case of nicknames or other names the child goes by, indicate early it on in the report.  Then indicate which of the available names you will use for the rest of the report.  You should generally use the name in which the person is typically referred in the setting.

Ex.: “At school, Francisco is known as ‘Paco. ‘ Therefore, from this point forward we will refer to Francisco as ‘Paco.’ “

Date of Birth

Reported in this format: mm/dd/yyyy.  Always get date of birth directly from knowledgeable individuals – not from other reports or referral information.  Sometimes referral information is incorrect, so we want to get this kind of information directly from them.

Chronological Age

Chronological ages are reported in Year-Month form: “4-2” = 4 years, 2 months old. Note that chronological ages are reported with a dash between the year and month (e.g., 5-7  = 5 years and 7 months old).   Children’s ages under 5 are often reported in months (e.g., “30 months”) – this is common in assessments of preschoolers.

Grade levels are reported with decimal points.  Therefore a Student in the seventh month of the second grade would be listed as “4.2.”  We rarely if ever report grade levels

Date(s) of Assessment

List the dates in which the assessment process began and when observations and reviews of records have been completed.  Time spent writing the report is not considered as part of the Assessment Report period.

Assessor

This is you.  Give your First and Last name, any letters that you have after your name, and your Title.

Students of Functional Assessment: Indicate your relationship to the person whose behavior is being analyzed

Contractors: List your title as per your contract: (e.g. “Functional Analyst” if BCBA or BCABA; “Assessor” otherwise)

Supervisor

For the time being, this will always be David Sponder L.E.P.

Referral Source

Give the name of the agency or private sponsor of the Functional Assessment.  This is not about who initiated the referral (that comes later), it is about the funding source and who will review the document.   List the name of the Agency or Source and the Contact person.  The following are common referral sources:

  • School District (Name of District; Contact Person/Title)
  • Regional Center (Name of RC; Contact Person/Title)
  • Insurance Company (Name of IC; Contact Person/Title)

Students of Functional Assessment: You are the referral source.  Indicate your position in regards to the person whose behavior is under assessment.  Don’t give actual names of Districts or Schools.

Margarita Martin; 4th Grade Special Day Classroom Teacher; Suburban School District

Tom Collins:  District Behavioral Services, working on my BCBA.

Contractors: This will be some contact person that called the office.  This could be an agency or insurance referral or private self-referral.  If you do not have information regarding the source, please contact the office.  

Usually, you will deal almost exclusively with the Identified Patient and the Stakeholders involved.  Along with the person whose behavior is the concern, Stakeholders are usually family, school, residential or special employment personnel.  You should have the names, addresses, phone numbers and email contact information for

Things can change rapidly and radically.  You want to know what the concerns were at the the time they made the call, and what they are currently.

Referral Information

  1. Open the section with a few statements that briefly describe the reasons why the source contact us/you for services, vis-à-vis the person’s behavior.
  2. Close the section with a statement about what the Referral Source’s primary concerns are, why they’re requesting Functional Assessment, and what that person expects from the Functional Assessment process…
  • Why did the source contact us?
  • Why was this person referred for our help?
  • What do they expect as the outcomes of the referral?  (e.g., Functional Assessment that provides information for making decisions regarding [person involved]

The source contacted us because there was some issue involving a person’s behavior or development or both.  The referral source, usually by way of an interested Contact Person, is the first “Stakeholder” that you encounter.   This is very likely to be someone you already know, such as a Student of yours, or someone already involved in an educational (school; classroom; special education  or other group educational setting) and/or a specific behavioral health intervention that you work with (often referred to as “ABA Services,” “Autism Therapy,” “Behavioral Intervention” “Behavioral Treatment,” etc.)

Students of Functional Assessment: You are the source and the contact person.  You may even be a Primary Stakeholder.

  • Describe your role and your responsibilities in relationship to the intervention currently going on.
  • the person is a Student of yours in your classroom;  you observe the behavior directly in the setting or one of the settings where it occurs
  • this is a person involved in a school program (academic; special education) or behavioral health intervention that you work with; you observe the behavior directly in the setting or one of the settings where it occurs
  • the person is a Student of yours or of another Teacher, this is a person involved in a school (academic; special education) or behavioral health intervention that you you are somehow involved in.  You may be a Teacher; Primary Interventions, or a Specialist associated with a team.
  • the person is a Student of yours or of another Teacher, this is a person involved in a school (academic; special education) or behavioral health intervention that you have a relationship with.

Use a statement that describes why this Student requires a Functional Assessment of his or her behavior in general terms.

Important: Describe how the behaviors present an impediment to academic, emotional, behavioral, or social progress.  Be sure to describe the impact the behaviors have on the Student’s life, his or her family, and his or her classroom.  Impact on the classroom alone is not enough.

Examples (You must use your own wording)

Shelley is a Student in my third grade Special Day Classroom.  When we ask her to do something she doesn’t want to do, she will flop to the floor and refuse to move.  She’s too heavy for adults to lift.  If we insist that she cooperate with us, she can become aggressive and strike out at us if we get too close to her.  This can happen between 7 and 22 instances of some form of this behavior per day, according to most recent records and observationsThese behaviors influence almost her entire day and interfere significantly with her ability to benefit from education.

The purpose of this Functional Assessment is to help me find ways to increase Shelley’s cooperative behavior, as well as to put strategies in place for dealing with her flopping and aggressive behaviors.”

Roni is a Student in my 4th Period Algebra class.   She comes into my classroom and goes to sleep.  We are presently taking data on the rate in which she sleeps, as well as aspects of her performance when she is awake.  Typically, when presented with demands to attend to classroom activities and instructions, she puts her head down and feigns sleep.  If others try to repeat the demand or show some insistence upon performance, she can walk out of the classroom and leave school.  This has happened 4 times since September this year.”  This behavior is seen in other academic settings and because of her sleeping and resisting academic demands, she is not accessing the curriculum and she is expected fail Math and other academic subjects.

The purpose of this Functional Assessment is to gain a better understanding of the factors related to Roni’s sleeping behavior, and to develop IEP goals and objectives and a Behavior Service Plan for her IEP.”

“Shaun is a 7th Grade Student in a non-public school.  I am on his behavioral team.  Shaun has explosive meltdowns where he trashes the room and completely disrupts the entire classroom.  If adults try to stop him, he throws things that them, or he runs out the door.  He remains on the school campus, but his behavior can escalate further where he may require physical restraint to keep him and others safe.

The purpose of this Functional Assessment is to determine factors that influence Shaun’s meltdowns in order to know what environmental supports that he needs in order to improve his ability to regulate his behavior.   The Assessment should identify external and environmental factors that have a relationship to the behavior.   Functional Assessment will focus in particular on any identified discrepancies between the current demands of the environment in which behavior occurs, and Shaun’s current skills for adapting to them (e.g., emotional, cognitive, and communication capacities for meeting current environmental demands).   Finally, Functional Assessment should inform the development of compensatory and/or remedial treatment plans throughout his school day.

“Lucy is my 4 year old daughter.  She is currently showing some regression in her behavior since her little brother was born (he is now 15 months old).  I have to watch her constantly when she’s around her brother, because she can become rough or aggressive with him.  This can happen when they are playing around each other, or when one of them is getting attention at the moment and the other is not.  Lucy has recently insisted that she was the baby and not her brother.

Lucy and her brother are developing typically.  The purpose of Function assessment is for me to better understand what to do for my daughter and to improve both siblings ability to play together.

Contractors:

“This is a referral from Generic Regional Center for the purposes of assessing Marianne’s development and behavior.  Marianne was recently diagnosed with autism, and this assessment will determine current levels of development, behavior, and functioning within her family.  After describing the results of assessment, this report will provide recommendations for treatment.”

“This is a referral from Local School District for the purposes of assessing José’s behavior and developing recommendations for treatment at school.  José’s Teachers report difficulty with José’s acting out behavior and a pervasive lack of cooperation with demands and limits in the classroom.  They are seeking recommendations for improving José’s cooperation in the classroom.

“Parents contacted the office following a referral from Dr. Psychologist about Franks’ behavior at home.  Parents report that Frank is very inflexible at home, and because of that, he is becoming increasingly withdrawn from family activities.  When he’s with the rest of the family, the others typically defer to Frank’s wants in order to avoid tantrums they anticipate would happen if they don’t ‘give in’ to him.  Parents are looking for ways to better deal with Frank’s behavior.  Functional Assessment will look at factors related to why and under what circumstances the behavior occurs, and what skills both Parents and Frank can learn to increase Frank’s motivation and ability to be more involved with his family.  Parents also want to know how to deal with Franks’ uncooperative behavior when it occurs.”

 Referral Concerns

The primary purpose of this section is to set up the functional analyses and treatment plans to follow.

  • You give the Behaviors a Title that in just a few words describes what all forms of the behavior have in common
  • The section is made up of a few brief statements describing…
    • the forms the behavior takes
    • anything known or suspected about why it occurs or
    • what variables it is typically associated with
      (e.g., what events or circumstances are most associated with the behavior and the consequences the behavior typically produces in the IP, others and the environment).

Specificity and Positivity in Stating the Referral Concerns

  • Form: Describe what the behavior looks like in terms of actions – not emotions.  Describe what the person does when they engage in the behavior.  Describe the physically observable actions and effects that are part of the behavior.  At this point, you do not have to describe the behavior as specifically as you will later.
  • Circumstances in which the Behavior Typically Occurs: There may be sets of variables or patterns of events that typically go before and after the behavior, and that have a lot to do with why the behavior occurs.  Give any information known or believed about these circumstances here.
  • Function: Based on the ‘variables or patterns of events’ known or believed to be associated with the behavior.

A focus on identifying the discrepancy between the demands of the environment, the moment, the circumstances, etc., and the skills that the IP can bring to bear at that moment runs through all sections of the report.

Any statements you make about the function or reasons why a behavior occurs should be stated in terms of skills that are not yet developed, but that could be developed in order to obtain results.

There is a difference between stating that the IP does not do something or even “fails to do” something and, stating that the IP cannot or will not do something.  At this point, we do not yet have enough information abut what the IP knows or why he or she engages in the behavior or what the nature of the developmental differences are to proscribe treatment in any way.

Later on, in the Functional Analyses sections of the Report, you will describe in detail and provide evidence for your hypotheses regarding the IP’s behavior.  Among the most important, if not the most important sources of evidence are the demands of the environment (the circumstances), and the skills and capacities the IP currently has.  Whether the referral concerns have to do with identifying and possibly treating atypical development, or they are focused on a narrower set of behavioral excesses, there is a theoretical set of replacement skills that the IP and the Stakeholders can learn to improve behavior and developmental/behavioral function in general.

  • Positive phrasing of Referral Concerns:  Referral concerns often refer to things the IP does or does not do.  These are stated as positive assertions of what the behavior is or is not or both.   Referral Concerns should help keep the focus on what can be learned and changed – rather than what cannot. It is for this reason that when phrasing referral concerns, you want to avoid words implying intervention is a waste of time.  These might include phrases with “cannot…,”  “unable…,” or other words that imply a fixed behavior or trait.

There is a clear difference between “cannot…” and “doesn’t know how to…” for instance.  Positive phrasing allows referral concerns to flow in terms of learning objectives.  That is, instead of remarking on what the Student cannot or does not do, it is better to frame the concern in terms of what the Student needs to learn or the support that the Student needs in order to improve functioning.

The following phrases are much better:

”doesn’t yet know how to…”
”has not yet learned to…”
”needs to be taught to…”
”has difficulty with…”
”requires support in order to…”

Some thoughts and guidelines on the use of an unfortunately too-common term…

Non-compliance:” A favorite among behaviorists, this term carries connotations that I believe affect adult attributions adversely.  Therefore, we avoid using the term if we can.  First of all, the term identifies what the Student is “not doing” rather than what she is doing.  There any number of reasons why a Student does not “comply” in one instance or another.  While you can go on to identify specific reasons/functions in your analysis of the behavior, the range of functions can be quite broad, and you might actually be defining two classes of behavior (e.g., difficulty shifting or dividing attention, inability to understand, failure to reference, etc. v. not wanting to obey rules or do what is asked…).

Another connotation is that children are supposed to comply without question.  Humans are not designed to do that normally.  No matter what they are asked or told, rules and directions always interact with the receiver’s personality: what they believe or want; what is gong on with them at the moment; how they feel about the requester, etc.

Finally, people can be made to comply with just about anything if they are sufficiently coerced.  Forcing people to do things always brings about adverse side-effects (e.g., resentment; retaliation; withdrawal; depression, etc.).

Cooperation:” This is the term we would like you to use instead of non-compliance.

A very important concept is that children (people) grant authority to others – they give license to those trusted caregivers whom they understand have their best interests in mind.  When we have legitimate issues about what we are asked to do, these people will take our needs into consideration.  This is where the “co-“ in cooperation and co-regulation comes from.

To clarify, we are not suggesting that everything between Teacher and Student is negotiable, and that there must always be agreement on the part of the Student.  There are a lot of rules and directions that Guides give to their children that are not at all negotiable, or at times not even subject to question (e.g., holding hands when crossing the street).

There are however, a lot of things that we can do to increase the likelihood of willing cooperation from children.  A list of things to do is described in the sections on intervention.

Basically, there are a few broad concepts that apply here: Teacher/Student attunement (the adult attempts to know the feelings and beliefs that the Student has – unconditionally); the adult has a realistic idea of the Student’s capacity to understand (developmental), and/or the adult comprehends fully the contextual considerations (the Student’s previous learning and episodic memory).  Again, our approach towards intervention is thorough assessment, so that we can help increase Teacher’s knowledge and possibly change their attributions of the Student’s behavior.  One way to start is to use the term “cooperation” or even “non-cooperation” (implying the Student’s unwillingness to engage in problem solving interaction) – rather than “non-compliance.”

Examples of Referral Concern Titles and Statements
List the titles of the behaviors next to the bullets and use similar language to the examples below.  Describe behaviors in the present tense.  Describe the behavior in terms of what it looks like and what effects it has.  Give examples whenever possible.   Give some indication of Stakeholder’s expectations for outcomes of assessment and intervention.

These are examples…use your own original wording

Failure to Cooperate with School Routines and Demands: Firstname frequently does not follow directions, school and classroom rules, or make transitions from preferred routines to non-preferred routines in a timely or cooperative manner.  As a result, Firstname spends a majority of his time unavailable for instruction and learning opportunities, which seriously impacts his academic progress and behavioral adaptation to the demands of school.

Tantrums: Tantrums represent an extreme form of the above (failure to cooperate) and include verbal and physically threatening behaviors, property destruction, and other behaviors that are dangerous to himself or others. Classroom Staff are looking for recommendations for what can be done to increase Firstname’s willingness and capability to participate successfully in typical classroom routines and to meet reasonable and typical classroom demands.

Peer Conflicts: Firstname engages in frequent conflicts with peers over minor issues.  Frequent peer conflict correlates with the fact that Firstname does not have any close peer relationships in school and the fact that peers generally reject him in school social situations.  Without adult intervention, these conflicts can escalate into physical altercations.  Teachers would like suggestions regarding how to improve Firstname’s peer relationships and social thinking skills in school, as well as strategies they can learn to deal with conflicts when they occur.

Verbal Aggression: Firstname engages in verbal aggression (e.g. calling other’s derogatory names or making utterances that produce hostile reactions from others) with her peers and Teachers throughout History class.  She will often say things that provoke peers immediately upon seeing them, or while otherwise engaged in social interaction with others.  Firstname also frequently interjects verbally aggressive statements into classroom discussions.  Sometimes, verbal aggression is directed at the Teacher in the form of statements about ‘what she will’ or ‘will not’ do that she apparently knows are contrary to the rules and demands of the classroom.

Stealing: Firstname has been caught in the possession of items that belong to other Students in my 3rd period Science class.  He has denied stealing up until the point in which items were found on him.  He has maintained that he did not know the items belonged to someone else, or that he somehow was entitled to possess them.  In some of the cases, Firstname stated his full understanding of the rules and who owned the items, but blamed the victim for being careless or leaving the item out for him to take.  Punishments administered for stealing, which have included penalties of loss of privileges and responsibility for restitution, resulted in some reduction.  Functional Assessment may provide useful information regarding motivations and maintaining variables for stealing behavior, and that lead to more effective strategies for dealing with occurrences of the behavior.

Personal Responsibility: Mr. and Mrs. Lastname report difficulty in teaching Firstname to take more responsibility for himself and in his role as a member of the family.  Currently, Firstname needs multitude of reminders and prompts to finish basic hygiene, household chores and homework routines that are appropriate for his age and well within his demonstrated capability.  Parents would like assistance in teaching Firstname to take more initiative and demonstrate more self-motivation and responsibility in his morning, afternoon and evening routines.

Following Directions: Parents express concern about Firstname’s lack of cooperation with directions related to making transitions (e.g., turning the TV off; taking a shower; starting homework, etc.); failure or refusal to initiate or follow through with parental requests to follow limits, boundaries or household rules (given spontaneously or routinely, e.g.,  go to bed and comply with bedtime rules and limits, start and finish chores before play, taking the trash out) or; practically any request that is contrary to his apparent intentions (i.e., g).  In response directions such as these, Firstname typically protests by whining, yelling, refusing verbally, slamming doors, or throwing things instead of following the direction.  Parents would like for Firstname to cooperate better with reasonable demands, directions, rules and limits they give him.

Social Withdrawal: Mr. and Mrs. Lastname spent the last 5 years enrolling Firstname in social skills classes, CBT therapies, and pro-social groups (i.e., scouts), yet he still almost always chooses if he can to avoid social situations with peers, preferring instead to interact with his parents.  He does not yet talk about or mention that he has friends.  He rarely sees age-mates outside of therapy/controlled situations, and he has experienced serious bullying and social rejection in unstructured situations in the past.  Daniel’s parents are seeking ways to support Daniel’s capabilities for friendships, pro-social interactions with others, and self-advocacy.

Resistant/Aggressive Behaviors: Firstname’s parents are very concerned with Firstname’s resistant, aggressive, and dangerous behaviors.  He will engage in a temper tantrums when things do not go his way, (e.g., being denied chocolate milk, or preferred food/activity).   He has related difficulty with transitions from preferred to non-preferred activities and when he is told, “No.”  Tantrums can include intense screaming, crying, stomping, throwing himself on the floor, throwing objects, and hitting.  Both parents are concerned with the number and severity of tantrums he has within his day.   Tantrums/meltdowns can last from 1-25 minutes, typically resulting in Firstname obtaining some form of reinforcement for the power struggle.

Communication/Attending:  Firstname’s parents are seeking assistance with expanding his communication ability and his attention span.  Firstname utilizes gestural and verbal communication to get his needs met.  For example, he will bring a cup to his parents to signify that he is thirsty, and typically attempt to verbalize his need with one or two word utterances.  He will use scripts/words to protest prompts, ask questions, to tell a story, and self-talk with a somewhat rigid style and vocabulary.  His parents would like to improve on his speech and his ability to attend to tasks that are verbally presented/prompted.

Independence Skills/Picky Eating:  Firstname has not yet exhibited an ability to perform self-care/independence routines without assistance or prompts.  He is toilet trained however; his ability to pick up on other routines (cleaning, getting dressed, washing himself, morning/night routines) has not yet developed yet.  Firstname also displays a preference for playing in solitude, when prompted for group activities/play, he will adamantly refuse and assert his preference to do something different. His parents would like guidance in helping Firstname become more independent with routines and to play cooperatively with his peers/adults.  Firstname also experiences challenges with rigid food preferences, only eating the food he wants, or a tantrum will ensue.

IMPORTANT: Each referral concern identified must receive its own functional analysis and treatment plan later on in the report.Therefore, it is best not list more than 3 referral concerns in any report.  If necessary, behaviors can be grouped by functional similarity (i.e. power struggle, transition problems, and tantrums grouped as “uncooperative behaviors”).  For example, a Student who screams, hits and kicks and bites is having a tantrum or a meltdown, and therefore, the behaviors of screaming, hitting and kicking and biting could be grouped under a title such as “Tantrums” or “Meltdowns.”

An even better way to do this is to title behaviors by their functions or uses for the person.   This is a way of identifying a class of responses that produce similar consequences (e.g., that end up getting attention; that delay or defer or avoid demands; that access reinforcement or preferred activities, etc.).  For instance, the person may resort to screaming, hitting, etc. for the purpose of protesting.  Therefore, the referral concern can be given the title of “Protest Behaviors: …” in which you would describe the various forms of protesting that have become the problem. 

Summary Statement

Give a brief statement summarizing all of the referral information above, as well as a transitional statement or phrase indicating overall goals and next steps of the Functional Assessment.

Examples

This Functional Behavior Assessment will attempt to determine the possible psychoeducational, environmental and/or relationship-based factors contributing to the behaviors of concern cited above.   The assessment will also lead to treatment plans addressing the underlying cause of the behavior and that lead to objectives for teaching functional equivalent replacements behaviors.  This plan will also describe teaching strategies that match Firstname’s developmental and learning needs.

This Functional Behavior Assessment will attempt to determine the influence of a variety of factors related to the issues behaviors described above.  Data will be collected on the behaviors of concern, as well as the ecological variables related to them.  The information will help develop working hypotheses regarding why the behaviors occur and what variables should be changed.  Examination of both the Firstname’s current developmental capacities and skill sets and the nature of demands related to behavioral difficulties will lead to the development of goals and objectives for increasing Stakeholders understanding of the behavior,  as well as goals and objectives for the development of replacement skills and behaviors.

This Functional Behavior Assessment is performed in order to find out more about why Firstname avoids paperwork assignments in Math and Reading.  Functional Assessment will look at internal setting conditions that include the functioning of related psychological processes, history of success and failure with various related concepts and teaching interventions tried or not yet tried, as well as current external conditions such as differences in performance under various modes of instruction and levels of scaffolding.  

This Developmental and Functional Behavior Assessment will examine variables related to Firstname’s overall development and behavior.  It will look at her current developmental capacities in domains including but not limited to her emotional, social, communicative, cognitive and motor planning function and development; her current skills for learning and exploration, for bringing her current developmental capacities to bear for participation in her environment and for problem solving in various areas.  We will then summarize her current developmental and behavioral strengths and needs in light of behavioral deficits and excesses described above the Referral Concerns.                                    

Background and History

The background and history section concerns mainly the background and history of the behaviors, not necessarily the person or the environment.  We want to look at the overall evolution of the behavior as it encountered reinforcement in the environment.  Information that goes in this section includes any information relative to understanding how the behavior came to be the way it is now.  It is helpful to look at filling out this section in terms of answering some generic questions:

Then

  • How and when did the behavior start?
    • When and how was it first observed?
    • What do you know about the IP’s intentions or knowledge of the consequences at the time it first occurred.
  • What do Stakeholders believe was the reason for the behavior at the time?
    • What consequences did the behavior produce?
    • What goals did the behavior seem intended to meet
    • How did other people typically respond to the behavior, and what happened if they responded one way or another?
    • What was tried?  (Ask this is an open fashion… “Tell me what you tried.  Can you tell me what you know about what works and doesn’t work so far?”)

Try not to go through a series of “Have you tried X?  Have you tried Y? Have you tried Z?” questions.   You will often get defensive and ‘Yes-but…’/’No but…’ responses to such questions.

 How did the behavior change?

  • Did the behavior start for one reason and turn out to be used over time for several more reasons?  For example, what originally started as innocent play may have gotten attention.  Then, the IP engaged in those play behaviors for attention.
    • What events or responses led to these changes?
    • Was the behavior the result – at least in part, of what the IP saw others do?
    • Was the behavior a possible side-effect of an intervention, punishment or attempt to change behavior in another way?

Now

  • Why is is still going on?
    • Are there new reasons for engaging the behavior?
    • Why has it resisted change?

Once the reader has a good idea of how the behaviors started and how they evolved into their current states, the Background and History section is then divided into several subsections as follows.

Available Records/Prior Assessment Data
  • Records provide important history of the behavior and intervention for the behavior.  They provide documentation of what has worked and not worked.
  • Records provide testing information that give you insights into the current developmental and processing issues related to the behaviors of concern (you must identify the skills and developmental deficits in your discrepancy analysis in the Function Analysis sections later on)
  • Records can show diagnoses and medications that describe behaviors and symptoms.
  • Records contain historical information and a developmental/behavioral timeline according to observation and reports in the past

The table below is similar to what you will see in the Assessment Report templates.  They are there so that you can provide a listing of records that you reviewed for the purposes of writing this report.

Use any of the following records available for review prior to the writing of the report:

Document Date Source
Psychoed Report (required for LACOE/BTSA) School Psychologist
IEP (required for LACOE/BTSA) Name of School and District
Teacher Interview (required for LACOE/BTSA) If you are the Teacher, interview Paras or others who are familiar with the behavior in school Teacher
Parent Interview (Required for Contractors; highly recommended for LACOE/BTSA)
Parent
Behavior/Incident Reports Source: Agency or Discipline of Author, not name
Behavioral Checklist (that you perform – required): LACOE/BTSA: Ask your School Psych or BICM.  Contractors: call our Office
Source: Agency or Discipline of Author, not name
Records pertaining to pertinent early history Source: Agency or Discipline of Author, not name
Records pertaining to events that seriously impacted the Student’s development or behavior Source: Agency or Discipline of Author, not name
Report Cards that show when the decline started Source: Agency or Discipline of Author, not name
Developmental Information (e.g., from Occupational, Language, Resource or other Specialists that yield insight into processing issues related to the behavior) Source: Agency or Discipline of Author, not name
Data Sheets and Records from Direct Observations (required)
Functional Assessment of General Conditions

The word “Functional” has been used a lot so far and will continue to be in the succeeding sections.  In almost all applications, the word “functional” refers to how relative the information is to the issues of concern.  The principle of Parsimony is one of the characteristics of identified as a critical element in Applied Behavior Analysis and Behavioral Treatment.  You don’t want to give unnecessary, misleading, or presumptive information.

In your report, give the First name, age, gender, and living/school situation in one or a few succinct sentences.

Contractors: You enter real names and schools and other Stakeholders.

Matthew is a four-year-old boy who lives at home with his natural Guides in Culver City, along with his six-year-old sister and two-year-old brother.  Matthew attends preschool nearby three days per week, and is cared for by his grandmother in the afternoons.

Students of Functional Assessment: Enter pseudonymous information regarding the IP’s name, school, date of birth or any other specifically identifiable information for purposes of confidentiality

Megan is an 11-year-old girl who lives with her Foster Parents and two foster siblings (ages 10 and 12) in West L.A.  Megan attends a public 7th grade, Special Day Class at the Middle School.

Ages of adults are not necessary, unless relevant to the referral issue (i.e. very young or very old parents; a history of multiple placements and/or foster care; a history of abuse and/or neglect; a Student who is not but should be enrolled in school; whether or not the Student is home-schooled, etc.).  You will have to use your judgment to determine what is relevant to the referral concerns and what is not.

Please do not list subjective descriptions such as “handsome,” “cute,” “well groomed,” etc.

Developmental History

This is an optional section for many Behavior Assessments but is required for all Behavior/Developmental Assessment Reports.  Include information from this and any of the subsections below – only if it is relevant to the referral concerns. 

Keep in mind that current levels of development are assessed in the next section.  The purpose of this section is to describe things that have happened earlier on in development that seem to affect current behavior.  Include in this section any:

  • Major developments or incidents in the person’s history that have or may have had an effect on the behavior
  • Changes in Caregiver that are out of the ordinary; differences in typical standards of empathic care; placements or adoptions out of the home
  • Separations from parents or important Caregivers
  • Presence or history of chaotic or toxic environments, or environments not conducive to proper development
  • Developmental milestones related to current development or behavior (not all milestones, such as reported in a Psychological or full-blown Developmental evaluation or medical report).
  • Developmental Psychopathology: Describe how known neuro- or bio-physical factors caused development to deviate and how (for Behavior/Developmental Assessment Reports)
Birth History

Birth events are usually not relevant to current behavioral concerns, so “Birth History” is an optional section and rarely part of our reports.  Do not give a birth history simply to include it or because you found it in some other report.  If you do put information in this section, include only information believed relevant to current behavior.

Information relevant to this section could be but is not limited to:

  • Prematurity or other birth factors that caused brain damage, and that the brain damage is believed to be relevant to the behaviors of concern or the pattern of atypical development.
  • Epilepsy, cerebral palsy, acquired traumatic brain-injury (ATBI) factors believed to be relevant to the behaviors of concern or the pattern of atypical development.
  • Conditions of deprivation of early empathic care (e.g., attachment-related; failure to thrive) that are believed relevant to current referral concerns.

If any of the above are considered relative to the behavior believed to be relevant to the behaviors of concern or the pattern of atypical development, include a brief statement describing the conditions when they occurred and the specific impacts they’ve had on development and behavior.  Give a short statement of why the conditions are believed related.  (There will be much more opportunity to go into detail later).

Chronic Health Conditions

Some chronic health conditions limit the life and living choices available and can greatly affect overall quality of life and psychological disposition.   In the same way, health issues can also prevent an IP from engaging in developmentally necessary experiences, with subsequent arresting effects.

Chronic health conditions can include asthma, epilepsy, diabetes, chronic digestive disorders; pain; intrusive and psychologically traumatizing symptoms or treatments, etc.   The basic effects of the condition need to be described if relevant.  If there are no chronic health conditions that have had or continue to have bearing on the behaviors of concern, than this is an optional section.  If there are relevant chronic health conditions, perhaps because they impose limits on function (describe these impacts if they apply), or impairments of health or physical function have taken on psychological, emotional or behavioral consequences relative to the behaviors of concern, than describe them here and why they are considered relevant to the behavior.

Severe sensory perception issues can interfere with the IP’s perception and ability to explore objects, events, and interpersonal relationships.  This has an overall delaying or arresting effect on the domains affected.  Your comments in this section gives the reader an idea of how severe sensory perception issues such as blindness, deafness, extreme aversions to sensory stimuli for example, have prevented the IP from engaging in experiences that foster development.  You do not need to go into detail at this point about the nature and typography of the issue; you need simply to point out the fact that such issues had a significant “skewing” effect on development, and in particular, the behaviors that make up the current referral concerns.

Typical health issues that have such an effect include prolonged hospitalizations; inability to ambulate; inability to use one’s hands; chronic and preoccupying pain; intrusive medical interventions; prolonged helplessness and dependence, and so on.

Neonatal and Infancy Factors

It is very important to point out here that the neonatal, infant and toddler periods are best described and understood in terms of the Mother (Caregiver)/Infant dyad.  Nothing happens to the infant of any importance that does not affect primary Caregivers in some way and the nascent relationship in some way.  All subsequent behavior is in some way related to early life experiences, but we have to be more specific and parsimonious here.  This section is optional if these early experiences have no discernible effect on current issues.  Discernment is the key in the hands of the Assessor, so the consulting following information should be helpful before deciding whether or not to include a section on Neonatal or Infant Factors.

The infant develops and calibrates registration levels for various systems that process different forms of stimuli (light waves/vision; sound waves/hearing; chemical information/taste and smell; chemical information/interoception or the ability to monitor and perceive changes in the body, as carried by chemical-electric messengers such as neurotransmitters and hormones.  These develop separately early on, based on interaction of individual systems with specific types of stimuli.  Later on in infancy and through the rest of the life span, sensory systems have to learn to ‘sync up’ in order to provide a person with a singular and coherent perception of reality.

Neonatal factors affect early neurological and sensory development and response to the world.  Early life is about establish “homeostatic” function, where foundational processes of sleep, eating, digestive, sensory processing and related regulation of the Autonomic Nervous System are “wiring up” and “tuning genes on and off” in response to interaction with the environment.  One of the most vital psychological and emotional tasks of infancy is to develop the ability to achieve and maintain a calm and alert state and to show interest in the world.

You obtain information about early development from interviewing the mother Primary Caregiver, or, by accounts given in the earliest and most reliable reports.  Accounts of dysregulated infants and/or otherwise atypical patterns of development are often found in early Pediatrician; Neurologist; Occupational Therapy; Speech and Language Therapist and/or preschool records.  It is important to describe in this section or in any one of the bullets below, factors related to birth and early infancy that have some direct or indirect effects on current behavior.

  • In the infant, early feelings and experiences can lead to resolution, repair and resilience or an overall approach stance towards other people and the world, or to negative anticipations and a tendency focus behavior on making the world static and withdrawing from challenges and uncertainty. Sensory and nervous system development can take a long time to become homeostatic.  The dyad can experience extremely long and unrelenting periods of unresolved stress that bring on lifelong and cascading emotional and psychological effects.  Infants can, from such frustrating or pointless effort, begin to develop feelings of mistrust and a lack of reliance on Caregivers and relationships – if not fears of relationships, because it can be impossible to help the baby without making the problems worse.  This may have led to (subconscious by now) early experiences of deprivation, loss, trauma, etc., and resulted in stunted or distorted neurological development (i.e. severe mood or arousal instability);
  • Adults experience their own, but similar psychological stances in response to disability and  behavioral challenges.  They can be very active and focused on promoting the child’s abilities and advocating for the child, signs of resilience, or they can experience predominant feelings of distancing, dejection or inadequacy that lead to a passive or “withdrawal” attitude towards parenting.  Parents have different thresholds for tolerating and withstanding prolonged stress due to being around an infant whose stress cannot be relieved.  Long after specific physical or neurological issue may resolve themselves, lingering relationship effects can be seen in the present day.

In this section, you would mention any outstanding challenges in infancy that could related to current issues, either by chronic effects (they have never stopped), accumulations of stress or depletion of emotional, economic  or other resources, and subsequent vulnerabilities that remain within the IP, current Stakeholders, and the environment in which behavior occurs.  Report especially if the Student had to spend any time in an incubator, or was otherwise deprived of early feelings of parental caress, comforting, or nourishment.  Describe any prolonged separations, the presence of early abuse; multiple foster homes; or experiencing intrusive environmental, psychological or medical events early on.

  • Prematurity: Prematurity usually results in a nervous system that is not ready to process the typical environment, which can result in failure to register sensory stimuli or “over-registration” or “over-arousal” of the Sympathetic Nervous System, accompanied with inadequate Parasympathetic Nervous System development.  This can make the infant chronically irritable and difficult to soother or calm.  This can lead to ‘hard-wired’ tendencies towards anxiety, mood extremes and volatility and perhaps explosive tendencies later on. Prematurity is also often accompanied by forced separation from parents and anxiety on both ends of the dyad; intrusive medical procedures and perhaps a feeling of not trusting that one can be protected; or for the parent, feelings of vulnerability about her baby that can affect a Caregiver’s willingness to the let the child take risks and individuate, etc.
  • Early Deprivation of Empathetic Care: Most obviously related to children from orphanages, deprivation of empathetic care affects development of the nervous system and subsequent emotional and behavioral development for long afterwards if not the life span.  These children can come to the family from Foster Care, adoption agencies, relatives unable to care for the child or removed from the child’s life, or from birth parents that for reasons of their own mental health or substance abuse issues could not provide attuned care.  Children who experience early deprivation of empathetic care or long separations or denials of early nurturing often show distorted patterns of emotional, psychological and behavioral self-regulation (i.e. as in attachment, conduct, or other sociopathology disorders).  Children deprived of early attachment security can spend their emotional lives overly-devoted to issues or concerns about survival – long after successful adoption and resolution of abuse/deprivation issues.  They can continue to resist involvement in relationships or intimacy and sabotage efforts to engage in intersubjective relating.  They can show relationship anomalies such as being unusually avoidant or withdrawn, to the other extreme of ingratiating and promiscuous.  They may have survival related symptoms that even they don’t understand: chronic lying; hoarding food; hiding in dark, tight spaces, etc.  These behaviors are considered symptoms of attachment disorders if they come from documented deprivation of early empathetic care.
  • Extreme Distress: Deprivation of early attachment security can happen even in the midst of capable, loving and consistent parents.  Children who experienced extreme, sensory input-regulation distortions and chronic sensory or interoceptive dysregulation early in life can grow up with a tendency to be insecure – even with the best Caregivers.  This is caused when the IP experiences prolonged states of distress and the Caregiver was unable to figure out what was wrong or to be able to help resolve the distress.An infant born with severe sensory integration dysfunction can be easily overloaded by normal aspects of that typical Caregivers are not aware of.  When they try to help, they usually add sensory input (in the form of cooing, picking up and bouncing, rocking, stroking, holding, etc.) to an infant that is ‘already drinking out of a sensory fire hose.’  Efforts to calm and resolve distress end up making problems worse, leading to the infant’s growing associations between feeling bad and Caregivers making it worse!  This does not bode well for the beginning of healthy interdependence and use of relationships as means of coping with life’s challenges.  If current behaviors have the effect of pushing others away, or the referral concerns reflect underlying difficulties engaging in social and emotional problem solving, then it is helpful to provide any information from early development that sheds useful light on the referral concerns.Comment whenever trauma, separation, abuse/neglect or other major events have occurred in development that are relevant to current behavior.  If this is the case, the events deserve description and it is important to make some effort to help the reader understand the connection between historic events and current behavior.  You do not need to go into this connection at length here, but you should make some comment that this connection will be addressed further in the functional analysis.
Neuroregulatory

This section can function as a follow up to the above in cases of neurodevelopmental differences from early on, or in cases of acquired brain injury from epilepsy, disease, stroke or trauma, or from traumatizing environmental events – that continue to affect the IP’s current emotional, psychiatric (thought or mood) and/or behavioral function.  This section is also optional if there are no outstanding issues of neuroregulation.

Keep in mind that behavior described as explosive, meltdown, disorganized, hyperactive, inattentive, distractible or impulsive, compulsive, or emanating from acute anxiety, depression, or atypical mood states is considered to be related to neuroregulation. Behaviors related to neuroregulatory dysfunction: include explosive behavior and/or meltdowns; high-aggression; oppositional or acting out behavior; extremes of behavioral disorganization such as high-impulsivity, anxiety, obsessions, phobias, etc.  If this is the case, you are likely to find a history of irritability/inconsolability (often referred to as “colic” incorrectly by Caregivers [1]) associated with early development).

  • Therefore, in this section you want to describe:
  • Caregivers and current Stakeholder’s difficulties soothing the distressed IP
  • the forms the IP’s distressed behavior took at the time and take now
  • the measures they had to take in order to soothe the him or her
  • how long it took to get the IP to calm down typically
  • what worked and what didn’t, and whether medication was ever wear is now used as an intervention for mood and/or behavior.

[1] Colic correctly refers to gastrointestinal distress.  In our culture what parents are really talking about is an irritable, fussy baby, whose immature nervous system cannot process sensory input, or a baby who had difficulties establishing regular rhythms of sleep, comforting, eating, etc.  These were early signs of neuroregulatory dysfunction and would be relevant if the behaviors being analyzed included explosive behavior and extreme behavioral lability, and high-aggression.

The extent and type of neurological dysregulation involved in the behaviors of concern is unknown at any given time, and environmental factors may be the primary cause.  A report about explosive meltdowns and extremes of arousal and activity should have some information in this section – even if only to describe how underlying difficulties with homeostatic neurological regulation affect current thresholds or trigger points for the behaviors of current concern.

Clues to the role and influence of underlying neurological factors can be found in Psychological or Medical evaluations, as well as through interviews with parents and other historians of the IP’s development.  If Psychological or Psychiatric/Medical evaluations were performed, there are probably diagnoses related to neuroregulation found there such as: anxious, depressive or or other mood disorders; bipolar disorder; mood dysregulatory disorders; explosive behavior disorders; oppositional defiance and attentional disorders.  Diagnoses of developmental disorders such as Autism Spectrum and Attention Deficit/Hyperactivity Disorders often subsume these behavioral symptoms.  Describe in particular how neurological factors appear to be related to thresholds of behavior and toleration for negative feelings.  Mention whether the person is undergoing psychiatric of medical treatment for neuroregulatory disorders.

Medications

Medications commonly can affect behavior.  This section is meant for you to list medications that might have some sort of effect on perception, emotional, neuroregulatory, sleep, attention or mood function and behavior.  Describe how primary and side effects (from looking them up in a reference book or using the SCS databases) of medications could possibly be affecting any referral behaviors. Look mainly for sedative, hyperstimulating, or mood effects.  Indicate whether medication has been prescribed for behavior management.

You will see a table in the Report Template.  If the IP takes no medication relevant to behavior, you may write “None” here and erase the table below.

Medication Indication Side Effects Relative to Behavior/Developmental Concerns? 

Medication: In the first column, list the Brand or Generic name of the medication.  Dosages are optional, but should be mentioned if the IP takes an unusual dosage of the medication.

Indication:  The “indication” of a medicine has to do with what the medicine is being used for, or what the medication is typically used for.  In the cases we see, the drug manufacturer’s list of indications may not match any characteristic that you know about the IP and his or her behavior.  This is because Doctors often prescribe medications for their secondary or side effects.  For instance, many seizure medications are used to help regulate mood and behavior.  So-called “anti-depressants” (SSRI) are used to treat a variety of stress, anxiety, and obsessive-compulsive disorders.  Some medications indicated for psychosis or psychotic behavior, can be used to regulate agitation.  Medications indicated originally for the control of heart rate and blood pressure have also been used in the treatment of behavior.

List the indications of the medicine for the IP – not simply what it says on the manufacturer’s website.

Side Effects Relative to Behavior/Developmental Concerns?: Indicate whether the behavior may be related to side effects of medication.  Medications affect arousal, clarity of thinking, response time and overall feelings of well-being, so side effects of medicines may play a significant role in current behaviors.  If side effects of medicines are likely related to behavior – list any medicine the child is taking with such potential behavioral side effects – even if the drug is not prescribed for behavior or mood (e.g., Albuterol, a medicine often prescribed for asthma and other autoimmune disorders can cause mood and behavioral differences, especially in young children).

Vitamin Supplements and OTC Medicines: It is optional to list vitamin supplements, herbal remedies, creams, etc.  List them only if you think they affect behavior.  Keep in mind that so-called “natural,” “homeopathic,” “herbal,” etc. can be psychoactive.  For instance, B-vitamins, Ginkgo Biloba, Ginseng, cold/flu medications, etc. can be hyperstimulating, and; Melatonin, Benadryl, and even chamomile can be sedating.

DO NOT GIVE MEDICAL ADVICE!  Tell the family that they should always consult their doctor or pharmacist regarding effects and side effects, or whether or not medication is a good choice.  

If Stakeholders ask, “Should I try medication?” or “Do you think it’s the medication?” just tell them to ask their doctor.  This is a decision for the family to make along with their doctor.  Just remember, all medications have side effects, and there is always a chance that unpredictable side effects can occur with anyone.”

  • Psychiatrist: If your recommendations concern medications for psychiatric conditions, attention, or behavior, we generally recommend that families consult a Child Psychiatrist, especially one who is familiar with issues related to developmental disabilities.
  • Neurologist: If your recommendations have to do with an epileptic (seizure) disorder, Tourette’s Syndrome, or Neuropathy (conditions having to do with the peripheral nervous system such as pain, tingling, numbness, etc.) we generally recommend the family consult a Neurologist.
  • Pediatrician: For all other health conditions, we generally recommend the family consult a Pediatrician.  Note that Pediatricians are not usually as well trained for behavioral, attention, or psychiatric medications as Child Psychiatrists and Neurologists.However, it is often the case that Psychiatrists know very little about treating the behaviors of some kinds of developmental disorders, while some Neurologists and Pediatricians know a great deal.
Motor Handicapping Conditions 

Briefly describe any comorbid motor disabilities. Chronic, diminished motor function eventually affects a person’s estimate of their own abilities and general motivation, as well as the expectations of others.  There is a strong tendency for IPs that experience severe motor limitations, to use helplessness as a way of relating to caregivers, and they are often more dependent than they need to be.  Erase this section and its heading if you don’t need it.

Hearing and Vision

This is a Required section.  This has to do with simple nearsightedness, farsightedness, or some mixed version of the two.

Remark on visual acuity: How well does the Student see out of either eye?  Does the IP require eyeglasses?  Will she wear them?

Remark on hearing acuity.  How well does the Student hear sounds at either end of sonic/phonic range?  Does the IP require aids for hearing and will he or she use them?

If hearing and vision acuity are normal, you may use this statement: Hearing and vision acuity are reported to be normal and are not relevant to the referral concerns.

However, acuity is not usually the main problem associated with behavioral excesses and atypical development.  It is the development of the sensory perceptual/brain systems and the relative synchrony and coherence between these systems that matters most.  Below is some information that will help you understand what perceptual anomalies relate to behavior and development overall.

Hearing

Hearing, as with any other form of sensory perception, guides and affects behavior.  In this section, we are primarily concerned with hearing acuity: the function of the ear and the neural connection to the brain, rather than aural perception, which is how the brain interprets the messages from the ear.  Remark on the degree of hearing loss in the right ear, left ear of both; audiogram results that might show degrees of hearing loss and the frequency ranges in which hearing is better or worse.  Remark if correction is needed in the form of a hearing aid or other device.

Conduction v. Sensorineural Hearing Loss

There are two main types of hearing loss, each resulting in different effects upon the perception of sound and language.  A conductive loss is generally less severe than a sensorineural loss, because sensorineural loss has to do with the nerve connections between the inner ear and the brain (see Appendix: Types of Hearing Loss).  Conductive losses are more easily corrected by amplification.

Conductive Hearing Loss

This is due to damage to the pathway for sound impulses from the hair cells of the inner ear to the auditory nerve and the brain. Possible causes include:

  • acoustic trauma (injury caused by loud noise) to the hair cells
  • viral infections of the inner ear (may be caused by viruses such as mumps or measles)
  • Ménière’s disease (abnormal pressure in the inner ear)
  • certain drugs, such as aspirin, quinine and some antibiotics, which can affect the hair cells

Sensorineural Hearing Loss

This is due to damage to the auditory/vestibular nerve or damage to the vestibular and cochlear organs and oscillating bones of the ear.  Possible causes can include:

  • acoustic neuroma, a benign (non-cancerous) tumor affecting the auditory nerve
  • viral infections of the auditory nerve (such as mumps and rubella)
  • infections or inflammation of the brain or brain covering – eg meningitis
  • multiple sclerosis
  • a brain tumor
  • a stroke
Vision

Vision, as with any other form of sensory perception, guides and affects behavior.  In this section, we remark on vision as it pertains to the function of the eye and visual acuity, not necessarily functions related to how the brain interprets messages from the eye, such as visual discrimination, figure-to-ground perception, visual-spatial perception etc.

Factors that affect Visual, Spatial/Depth and Motion Perception

Behaviors involved in or required in tracking the environment, shifting visual attention smoothly, forming gestalt perceptions of parts and wholes, seeing continuity among moving or changing shapes, navigating and exploring the environment along with other forms of sensory exploration, judging amounts and distances, among others, rely on the ability of the brain, the muscles of the eye and the nerves carrying messages between the two to register light wave sensation properly. 

Related visual cortices must then be able to make meaning of sensation patterns in the forms of shapes, colors, visual features, as well as perceptions of movement and directionality, spacing, and the relationships between parts of a scene to the meaning of whole (the ability to abstract meaningful and predictive patterns in the environment).  These are the building blocks of visual percepts and concepts derived from the environment and from teaching – collectively referred to visual thinking or visual motor planning issues. 

Below are sources of visual perceptual error at the sensory registration level (the site of basic light wave collection – focusing of the lens and positioning of the eye for central or peripheral vision, etc.).

Astigmatism

Astigmatism is the most common visual acuity problem, causing blurred vision.  It may accompanied by nearsightedness or farsightedness. Usually it is caused by an irregularly shaped cornea (called corneal astigmatism). But sometimes it is the result of an irregularly shaped lens, which is located behind the cornea; this is called lenticular astigmatism. Either kind of astigmatism can usually be corrected with eyeglasses, contact lenses or refractive surgery.  Children may be unaware of the condition, and they are unlikely to complain of the blurred or distorted vision.Astigmatism occurs when the cornea is shaped more like an oblong football than a spherical baseball, which is the normal shape. In most astigmatic eyes, the oblong or oval shape causes light rays to focus on two points in the back of your eye, rather than on just one. This is because, like a football, an astigmatic cornea has a steeper curve and a flatter one. Usually astigmatism is hereditary: many people are born with an oblong cornea, and the resulting vision problem may get worse over time. But astigmatism may also result from an eye injury that has caused scarring on the cornea, from certain types of eye surgery, or from keratoconus, a disease that causes a gradual thinning of the cornea.

Amblyopia

Amblyopia is reduced vision in an eye that has not received adequate use during early childhood.   Amblyopia, also known as “lazy eye,” has many causes. Most often it results from either a misalignment of a Student’s eyes, such as crossed eyes, or a difference in image quality between the two eyes (one eye focusing better than the other.) In both cases, one eye becomes stronger, suppressing the image of the other eye. If this condition persists, the weaker eye may become useless.

With early diagnosis and treatment, the sight in the “lazy eye” can be restored. The earlier the treatment, the better the opportunity to reverse the vision loss.  Glasses are commonly prescribed to improve focusing or misalignment of the eyes.  Surgery may be performed on the eye muscles to straighten the eyes if non-surgical means are unsuccessful. Surgery can help in the treatment of amblyopia by allowing the eyes to work together better.  Eye exercises may be recommended either before or after surgery to correct faulty visual habits associated with strabismus (below) and to teach comfortable use of the eyes Nystagmus and Strabismus are the visual disorders we most commonly see:

Nystagmus

This is an involuntary eye movement which usually results in some degree of visual loss. The degree and direction of eye movement, amount of visual loss and resulting impairment varies greatly from person to person.  The involuntary, rhythmical, repeated oscillations of one or both eyes, in any or all fields of gaze; may be pendular (with undulating movements of equal speed, amplitude, and duration, in each direction) or jerky (with slower movements in one direction, followed by a faster return to the original position). Movements may be horizontal, vertical, oblique, rotary, circular, or any combination of these.

The cause of nystagmus is unknown. Reduced acuity is caused by the inability to maintain steady fixation. Head-tilting may decrease the nystagmus and is usually involuntary (toward the fast component in jerky nystagmus, or in such a position to minimize pendular nystagmus). Head nodding often accompanies congenital nystagmus. Dizziness or vertigo may be experienced if oscillopsia (illusory movements of objects) occurs. Nystagmus may be induced with an optokinetic drum or through the stimulation of the semicircular canals. Congenital nystagmus of the pendular type usually accompanies congenital visual impairment.  Nystagmus may also accompany a number of neurological disorders, and may be a reaction to certain drugs (including barbiturates).

Strabismus (esotropia, exotropia, hypotropia)

Strabismus is the condition where the eyes are misaligned.  Different types of strabismus include crossed eyes (esotropia, the most common type in children), out-turned eyes (exotropia), or vertical misalignment (hyper or hypotropia).  The problem may be present intermittently or constantly.  Treatment options depend upon the type of strabismus, and may include glasses, prism lenses, and/or surgery.

In most cases of strabismus in children, the cause is unknown. In more than half of these cases, the problem is present at or shortly after birth (congenital strabismus). In children, when the two eyes fail to focus on the same image, the brain may learn to ignore the input from one eye. If this is allowed to continue, the eye that the brain ignores will never see well. This loss of vision is called amblyopia, and it is frequently associated with strabismus.

Some other disorders associated with strabismus in children include:

Adult Attributions of the Behavior

This is Required in all reports for the basic and very good reason that people do not respond to reality – they respond to their perceptions of reality.  You will hear that theme time and again throughout this manual.  Similarly, Stakeholders, Parents, Caregivers, Guides, as well as the IP operate what their perceptions tell them – the attributions they form about the nature and intent of the behavior.  In other words, people respond to other people’s behaviors based on their attributions of what the behavior is about

This goes in all directions in social interaction.  Between a Guiding adult and a child IP for instance, each partner forms attributions of the other’s behavior.  The adult may think the child’s behavior is due to being “spoiled” and the child may perceive the adult as arbitrary and “mean.”  It doesn’t matter whether those attributions are true or not – it matters what the parties believe.  That has more to do with their potential responses than almost anything else.

For our purposes, an “attribution” is a belief about the behavior that influences how the Teacher responds.  In this section, you describe the Teacher’s beliefs about why the behavior occurs.  Below, are the most common general attributions: “Developmental/Self-Regulatory,” (which we think is best); “Oppositional;” “Part of the Disorder,” or “In denial.”

Developmental/Self-Regulatory Attribution Set

This means the caregiver understands the Student’s needs and generally responds appropriately.  They understand that their Student’s behavior is the result of the interaction between developmental capacities and what they have learned from their environment.  They might also understand that behavior is a way of regulating anxiety or maintaining alertness, and that what is currently seen as a problem is the Student’s adaptation to the environment.  These Guides just need someone with expertise to collaborate with them to solve a unique problem.Characteristics of a correct, developmental/self-regulatory attribution

  • Stakeholder Guides demonstrate some understanding of the IP’s developmental capacities.
  • Stakeholder Guides have realistic and appropriate expectations for the Student’s performance.
  • Stakeholder Guides understand that parental behavior or environmental factors will have to change.
  • Stakeholder Guides have realistic expectations for the outcome of treatment.
  • Stakeholder Guides are mindful of their parenting and are aware of the important effects parenting has on development
The Concept of Mindful Guiding

Many adults, especially those who have been under acute or chronic stress, can become reactionary in regards to the IP’s behavior.  In this way, they are not fully present in the moment, and their minds can lack the ability “…to sort through a wide variety of mental processes, such as impulses, ideas, and feelings, and come up with a thoughtful, nonautomatic response.”[1]

According to Daniel Siegel,

“…When we are mindful, we live in the present moment and are aware of our own thoughts and feelings and are also open to those of our children.…children don’t need us to be fully available all the time, but they do need our presence during connecting interactions.  Being mindful as a Teacher means having intention in your actions.  With intention, you purposefully choose your behavior with your Student’s behavior with your Student’s emotional well-being in mind.”

Very importantly, people develop feelings and belief systems based on their exposure to behavior.  These feelings then become antecedent conditions that influence their own responses to the behavior.[2]  This works the same way in children too – the after-effects of their behavior (consequences) influence their learning, and later can become antecedent conditions – but you have already described this relationship in your Antecedent Analysis (see).

“Oppositional” Attribution Set

This means that caregivers view the Student’s behavior as willful, untoward, overly-entitled, self-absorbed, or “spoiled.”  They may also attribute the Student’s behavior to innate factors (e.g., born that way, takes after an unpopular relative, “bad seed,” etc.).

Characteristics of an “oppositional” attribution

  • Stakeholder Guides believe the IP almost always knows what to do but chooses to do otherwise.
  • Stakeholder Guides might not yet understand why the Student has difficulty deferring needs or delaying gratification, or why the Student resorts to coercive behavior.
  • Stakeholder Conflicts often end in power struggles.
  • Stakeholder Guides are stressed by the behavior in such a way that it affects their ability to solve problems logically.
  • Stakeholder Guides believe that the Student is trying to upset them, or is only happy when they’re upset.
“Part of the Disorder” Attribution Set

Guides frequently attribute behaviors to being caused by the disability, when they might not be due to the disability.  Guides who have recently received their IP’s diagnosis have a tendency to attribute too much to the IP’s disability, rather than to more obvious environmental or developmental factors.   Guides who are normally quite competent and/or who have raised neurotypical children successfully can feel a great loss of confidence in their judgment upon getting a diagnosis.  They need to be reminded that their judgment is still pretty good, but even good Guides need the help of others in figuring out very unique problems.

Characteristics of a “part of the disorder” attribution

  • Guides over-attribute behaviors to the disorder.  They tend to believe that their Student’s behavior is really a manifestation of symptoms.  Guides often ask, “Is that because of the autism?” or state that the behavior is because the Student has autism, and there are other logical explanations for the behavior that have little to do with diagnosis.
  • Guides express doubt about how to set expectations for their Student.  There is a good chance that there will be disagreement between Guides and/or other caregivers.
  • Guides can err on the side of expectations that are either too high or too low.  Briefly:
    • If expectations are set too high, there is a higher likelihood of mutual frustration and anxiety.  This can lead to an attribution that the IP is oppositional, when in reality he or she is reacting adversely to expectations that are too high.
    • If expectations are too low, there is a higher likelihood of infantilizing the IP, stunting emotional growth, and creating “learned helplessness.”
In Denial” or “Disagreement” Attribution Set

Guides may deny needs or behaviors exist, or they may disagree with each other whether the IP has a problem or not.  These Guides can be ambivalent about intervention, or they may feel hopeless.

The wise Consultant realizes that denial is often a defense against overwhelming anxiety – in this case, the overwhelming anxiety about their Student’s future.  It is important to be sensitive to this, and not to try to force the Teacher from their beliefs.  In some ways, this belief helps them have hope.   The best approach is always to focus on specific developmental factors and the environment that are related to the specific problem at hand, rather than on the global understanding of the disability.

Characteristics of a “denial/disagreement” attribution

  • Guides express a belief that the Student will “grow out of it”
  • Guides see symptoms as “normal,” when they are obviously pathological
  • Guides attribute failure to learn or failure to develop skills as a lack of motivation or effort
  • Guides attribute symptoms to their own failures as Guide


[1]    Siegel, D. (2003).

[2]    The advantage of listing these here is that you do not confuse Student-centered antecedent conditions (as you have done in the Antecedent Analysis) with environmental consequences that later become antecedent conditions for parental or environmental behavior.

Educational History

This is almost always important in some way for Assessments of Student behavior in the context of the school setting and is required for Functional Assessments of Behavior and/or Development in school.  

  • Educational Histories can reflect patterns of placement failure due to the presence of behavior or atypical development, especially if they show a pattern of going from lesser to more restrictive environments each time the IP is re-enrolled.   If this is the case, it is important to consult prior behavior intervention plans and progress reports regarding the results of prior interventions.
  • School performance can provide a good baseline for comparison to other settings where different amounts of behavior occur
  • School performance reflects many more peers social opportunities and demands than they do at home in the lives of most IPs
  • Educational histories may also be reflective of a highly mobile and/or transitory lifestyle, and/or the possibilities of disorganized home life.  This section is optional for many Behavior Intervention Reports, if the behaviors are related only to home or community and not to school, and educational placement issues or history factors have no significant relationship to referral behaviors.

For children being assessed for early intervention, it is necessary to list programs that they have attended for children under 3-years old (usually operated by Occupational Therapy clinics).

It is very important here not to make independent value judgments regarding school placement.  The Teacher may very well comment that the school placement is inappropriate, and they may blame what goes on in school for causing the behavior at home.   Subjective opinions of school should be prefaced with statements regarding the source (e.g., “Mother believes that the stress of dealing with other children who are loud and that have behavior problems causes Michael to come home in a highly agitated mood…” “Guides report that Jonathan lacks friends and is often teased in school.  They believe this is the cause of a lot of his oppositional behavior prior to school.”).

The IP’s educational history is relevant if his or her school placement (or the lack of a school placement) is a major stressor in the home.

Homework

Homework is a legitimate issue to be addressed at home, but that also involves school.  In many school districts unreasonable amounts of homework cause undue amounts of stress at home and undermine Student’s independence.  Guides and children are spending inordinate amounts of time on homework, and the Guides are often trying to do the jobs of teachers.

Homework, for some families, has become a relationship destroyer between parents and children.   A lot of the time, the Consultant cannot also afford to ignore the fact that homework may be a root cause of family dysfunction and behavior problems.   Intervention may be needed both at home and at school.  However, the Consultant cannot make recommendations for modification or reduction of homework independent of the school.  It is necessary for the Consultant/Assessor and the Teacher to coordinate directly or through the parent.

Teachers can and should design and make modifications to homework demands based on an individualized and coherent value system.   Too often, this is not the case.  Decisions about homework are too often policy-driven, not individual-driven.

If homework appears to be relevant to the referral concerns, give brief mention of it in this section.  Also indicate that the related issues will be addressed in greater detail in the Functional Analysis and Treatment Plans sections occurring later on in the report.

Protocol when visiting a school
  • The Teacher must arrange the visit ahead of time with the school.  It may or may not be left up to you to arrange the time and duration of your school observation, but it is up to the Teacher to obtain permission for the visit.
  • When visiting a school campus, be sure to check in at the School Office firstNever walk into a classroom directly.  At the office, ask for a ‘Visitor Log’ and sign it when you enter, and when you leave the campus.  Inform the School Secretary of which Student, whose classroom and/or the room number (if you know it).

Historical Antecedents to the Referral Concerns

This section is Foundational to Functional Analysis of Behavior and is Required.

Theoretical Considerations

Behaviors evolve over a lifetime of interaction with the environment.  The behaviors being analyzed today may have started as other behaviors and were shaped considerably by experience in the world.

Those of us who were trained in traditional behaviorism are taught to emphasize only the ‘here and now.’  In my opinion, ignoring the history of the behavior deprives us of important information regarding how the IP’s current perceptions and feelings were formed.  Unlike traditional behaviorists, we do care about how children think and feel, and we know that how Stakeholders think and feel governs their relationships with them.

Here again, we remind the Analyst that people operate on their perceptions of reality – which is in great part shaped by their histories with similar stimuli.  People do not operate on data from the environment like machines.  They organize it into personal percepts and concepts.  They develop ways of thinking and processing information and their experience in the world is shaped by their developmental capacities to make meaning of the information. They develop attributions and inferences about other people’s intentions.

It is important to note in this section that the behaviors under consideration at the moment represent a history of reinforcement and shaping by the environment.  This section emphasizes the role of experience in the behaviors of concern today (the Referral Concerns).

A common example would be an IP whose aggressive behaviors over time have shaped others to avoid or severely lower demands they give to her.  This is a history largely marked by negative reinforcement of aggressive behaviors.

What kind of Information goes in the Historical Antecedents to the Referral Concerns section

This should be between 1 and 3 paragraphs briefly summarizing how the behavior has been shaped over time by reinforcing and punishing factors.  Describe what these factors were, the changes that resulted, and the degree of influence or control Stakeholders have or believe they have over the behaviors of concern

Describing typical ways parents handle behaviors is a good way of organizing the information in this section.

  • In this section, describe when the behaviors were first noted, and what Stakeholders tried to do to deal with them.  Describe the reasons that Stakeholders give for the behavior now, and then.  Describe how they currently feel about what they tried in the past and whether they believe it worked or not.
    • Pay attention to the forms (e.g. the behaviors themselves such as tantrums, lying, refusing bedtime, etc.), 
    • as well as the functions (e.g., defending, clarifying, regulating, etc.[1]), and
    • how the above evolved over time.  For instance, the forms of the behavior may have changed but the functions have remained the same (e.g., the IP used to wine and tantrum, but this has escalated to self injurious behavior), or vice versa (e.g., the Student used to tantrum only when frustrated [a self-regulatory function], but now uses the behavior to coerce adults even when the stakes are much lower).
  • Describe the consequent-related factors that tended to make behavior more likely (reinforcement) or less likely (antecedent controls/modifications of the environment or demands; acquiring more appropriate replacement behaviors; removal of reinforcement; punishment or aversive consequences)

In addition to the direct shaping effects reinforcement has had on behavior over time and development, there are cumulative effects that also result.  Toleration changes and thresholds for triggers change for instance.  Attributions and theories of the behavior change.

  • Due to our emphasis on how relationships affect behavior and how behaviors affect relationships, it is important to give the reader an idea of the level of confidence, discouragement, optimism, pessimism, etc. that the history of behavior has caused.  The history of behaviors and consequences have a lot to do with the feelings and expectations all parties have when behavior occurs, and determines to a large extent how they react.For instance, we are usually the first ones to draw a Stakeholder’s attention to the level of abstract language they use with their children.  Speaking in overly abstract terms has caused a history of frustration between Parent and child, and perhaps a parental attribution that the IP’s behavior has the purpose of antagonizing the parent.  In turn, the IP, who has a history of not understanding what the parent wants from them, becomes anxious whenever directions are given or expectations are made, and the current behaviors reflect more of a defensive posture now, than an oppositional one.  Due to this history, the parent may report feeling burned out, and that they are afraid to place expectations on the IP.  This may have led to the IP using coercive behavior such as tantrums or dangerous behavior to control the parent.In another instance, there may be a history of marital discordthat has affected the child at home.  This could have led to a pattern of insecure behaviors were the IP is preoccupied with making sure the parent (or Surrogate Attachment figure – such as the Teacher in school) is always in proximity.  Therefore, oppositional behaviors, dangerous behaviors, helpless behaviors etc. may really be attempts to keep Attachment Figures close by.  Perhaps, for instance, the marital problems were resolved.  Yet, the IP’s behavior has not changed.  If this is the case, you would want to help the reader see the relationship between past events and what is going on now.Here are some other types of factors that could be relevant in this section:
    • The family moved and/or the Student changed schools and this is believed to have caused a change in behavior
    • A new baby was born; someone died or moved away that was important to the IP
    • There was some sort of an abrupt separation between IP and Caregiver/significant other (especially when looking at insecure behaviors)
    • There was some sort of change in the IP’s health status that affected the behavior

 


[1]     Note that these functions of behavior are quite different than the traditional behaviorist functions such as “protest,” “escape,” “self stimulation,” etc.  This has much to do with the theoretical point of view that we use — which has to do with species-driven attachment behavior as the original functions of behavior.  To understand these, you will have to read about them.  Materials are available through the office.

Behaviorist functions such as “protest,” merely describe behavioral forms on only a slightly deeper level.  It’s important to know why the Student protests — which is usually a problem of perception and conception, and perhaps previous experiences that influence how the Student perceives or conceives of a situation.  For instance, a little boy maybe playing with his Legos and his mother wants him to go to the bathroom.  Perhaps it would be really nice if the Student were simply cooperative and didn’t protest but this wouldn’t address why the Student protested.  A further, [more thoughtful] analysis might reveal that this little boy has trouble with sequential thinking and cannot visualize going to the bathroom and returning to his project.  Due to motor planning problems (which were noted earlier in the Student’s developmental history by the thoughtful Analyst), problems with sequential thinking are also related to working memory.  This is a level of analysis unheard-of in traditional Functional Analysis, but that is a trademark of this organization.

Care Arrangements

The minimum information given in this section has to do with identifying Primary Caregivers at home and at School, as well as other significant Caregivers and people that experience and respond to the behaviors of concern.

  • Who does the IP live with and who is involved in their care in that setting?

Students of Functional Assessment: Give pseudonymous information.

Contractors: Give identifying information regarding actual care arrangements.

Firstname lives at home with his natural parents and 2 older brothers in Local City.  He attends Local Middle School, where he is enrolled in a 6th Grade Resource Specialist Classroom.  Firstname participates in regular education P.E. and Social Studies.  He spends his afternoons at his Grandmother’s house in Nearby City.

Firstname is a Student attending a 3rd Grade Special Day Classroom for children with emotional difficulties at Local elementary in Local City.  He has a 1:1 Behavioral Assistant.  The classroom has 7 Students, a Special Education Teacher, and two other Para-educators in the room.  Firstname lives in a Group Home.  Mrs. Lastname is the Primary Foster Parent and Caregiver for Firstname and two other children.   Mrs. Lastname reports plans to adopt Firstname.  Mrs. Lastname’s adult daughter also lives, works and provides care in the home full time.

This section is important when considering the IP’s levels of development and subsequent capacities for self-control and well-regulated behavior.  High-needs children place significant strains on home environments.  In this section, list those that are Primary Stakeholders.   Primary Stakeholders have a vested interest not only in the behavior, but also the IP’s development, education and overall welfare.  Their interests are always on what they perceive will lead their child to higher Quality of Life.  There can be and often is disagreement between Primary Stakeholders as to what will best benefit the IP.

Therefore, list Primary Stakeholders according to their “stake” or role with the IP:

  • Who is the Stakeholder and what relationship does he or she have with the IP?
  • What role does he or she play in the IP’s care?
  • What is the Stakeholder’s role in responding to the behaviors of concern?

We consider it essential in this section for there to be a description of the emotional, personnel, economic and other resources available to the IP by significant Stakeholder/Caregivers.  The quality of care provided an individual should be based on developmental capacities more so than chronological age.   In typical development, we afford smaller adult to child ratios for younger children.  As children get older and more developed, the Care the receive during larger parts of the day spent in school or at work is less personal and available.

Therefore, it is important to look at factors related to:

  • The ratio of caring, trained or qualified Caregivers available to children is appropriate to their true developmental needs throughout the day or at critical times
  • The amount and type of cooperation between adults (e.g., Parents and Teachers; Parents and Grandparents/Family) corresponds to the children’s capacities to relay information reliably.  Adults tend to communicate and cooperate directly in the care and supervision of younger children.  For older children, the children themselves act as the source of information that goes between their Caregivers.
  • For IPs with developmental differences, needs for supervision and guidance can remain high and intractable despite chronological age, or even made worse by it (it is usually more difficult to deal with the behaviors of bigger individuals).   Therefore, one question arises,
    • Do the above factors meet or detract from the IP, given his or her true developmental and skill capacities?” A related question arises,
    • Are the ratios and amount of cooperation [read: personal, social, economic and emotional resources] available to Caregivers sufficient to provide quality care?
    • Do Caregivers have the resources to be emotionally available in a developmentally appropriate manner throughout the day or at those times when referral behaviors are present?
    • Can Caregivers maintain high expectations and consistency, especially if home-based treatment plans are an expected outcome of the Functional Assessment?
    • Do Caregivers have adequate emotional and supervisory support to maintain low demand environments?
    • Have Caregivers reduced their expectations to custodial levels of care?
    • Are Caregivers aware or interested in as yet undiscovered but potential abilities in the IP?

While all of these factors do not have to be documented in this section, the complexity and sophistication of treatment plans must provide for reasonable expectations that the current Stakeholders can do.  Failure to consider the above cited factors is an especially likely source of mistakes made by novice Assessors.  Specifically, because novice Assessors rely more on templates, it is a common mistake to place a Treatment Plan more suited to a different family and a different set of resources.  This section of the report is judged on it’s ability to help match Treatment Plans to the resources Caregivers actually possess.

Secondary Care Arrangements

The information that goes in this section has to do with the resources of the IP.  It answers questions related to whether or not the IP gets adjunct therapies or services he or she may need, or on the other hand, whether the IP is over-scheduled and too emotionally taxed to respond well to intervention or therapy.

The simplest way to fill it out is to fill in the table of Schools and Therapies.

Place Type Frequency
 Local Elementary School  Speech Therapy  2x/30 minutes week; during school hours
 In Home Behavioral Health Intervention  ABA/Autism Therapy  4 days/wk; 2 hrs. per day
Local Parks  T-Ball  3 days/wk

This section may identify problems with under-programming (Student isn’t getting necessary support services [i.e. speech therapy, OT] or services necessary to ensure success of treatment plans) or over-programming that are relative to referral issues.

  • List schools, and the hours and days of the week (frequency) the Student attends.
  • List therapies, and the hours and days of the week (frequency) the Student attends.
  • Identify if scheduling problems might affect treatment or consultation.
  • Remark if other providers are working on the same referral behaviors.  This would be relevant mainly when the Student is receiving Language/Speech or Occupational/Physical Therapies and there is overlap with our own developmental interventions.

 Place: Indicate the School; Clinic; Care-Facility (Students of Functional Assessment use pseudonymous information)

Type: Indicate the type of activity or Therapy conducted there.

Frequency: Indicate how often the IP attends the activity or Therapy

Prior Interventions
Informal

Describe what Stakeholders and Caregivers have already tried in order to deal with the behavior.  Described what worked or didn’t work and why in about a paragraph or two.

Formal

List any other providers the family is working with, as well as any formal behavior interventions (i.e. by professionals), that the IP has had.  If relevant, describe whether approaches worked, or if any of the current concerns were the result of other therapies (e.g., for instance, when Discreet Trial Training has caused escape-motivated aggressive behaviors) in about a paragraph or two.

Diagnosis

The primary purpose of the “Diagnosis” section is to make sure diagnosis has been considered in the evaluation of the referral behaviors.   List all diagnoses, physical and mental.  Merely provide a list – narrative is not necessary in this section.

The IP’s “diagnosis” should not be confused with his or her special education “IEP Eligibility” (below).   Diagnoses are usually given by Medical Doctors and Clinicians such as Clinical Psychologists, Occupational Therapists, Physical Therapists, Language/Speech Pathologists/Therapists, etc., not by School Psychologists (School Psychologists have a primary role in determining the Student’s eligibility for services in school).

The IP may have more than one diagnosis:

  • Diagnoses related to Emotional/Mental Health and Developmental Disorders usually come from the Diagnostic and Statistical Manual of Mental Disorders (DSM, current version DSM-IV-TR).[1]  The DSM includes developmental disorders of Cognition, Communication, Motor Function and Behavior in addition to Psychiatric Conditions.

The DSM uses a multiaxial or multidimensional approach to diagnosing because rarely do other factors in a person’s life not impact their mental health.  It assesses five dimensions as described below:

  • Axis I: Clinical Syndromes: Mental Health Conditions (e.g., depression, schizophrenia, social phobia)
  • Axis II: Developmental Disorders andPersonality Disorders
    • Developmental disorders typically first evident in childhood that include autism and mental retardation
    • Personality disorders that are longstanding clinical and that have to do with  the individual’s way of interacting with others.  Examples include Paranoid, Antisocial, and Borderline Personality Disorders.
  • Axis III: Physical Conditionsthat influence or have some effect on the development, continuance, or exacerbation of Axis I and II Disorders:
    • Physical conditions such as epilepsy, brain injury or HIV/AIDS that can result in symptoms of mental illness are included here.
  • Axis IV: Severity of Psychosocial Stressors:  Events in a person’s life that impact the disorders listed in Axis I and II.  These events are both listed and rated for this axis.
  • Axis V: Highest Level of Functioning: A clinical rating of the person’s level of at the present time and at the highest level within the previous year.
Other Diagnoses/Comorbidity

Comorbidity refers to the existence of more than one condition or diagnosis.  Real comorbidity involves separate and unrelated conditions that may or may not influence each other (e.g., Mental Retardation and Blindness; Autism Spectrum Disorder and Deafness; Mental Retardation and Epilepsy).  I am somewhat dubious about disorders that really represent the unique profile and neurological development such as ASD + ADHD or OCD, for example.

The following diagnoses are genuinely comorbid if they exist

  • Sensory Disorders such as Blindness; Deafness
  • Chronic Health Conditions not included in any DSM Dx
Other information remarkable in the Diagnosis section
  • Remark if Guides express doubts or disagreement regarding diagnosis.
  • Remark if any diagnosis is currently being reevaluated or challenged.  Remain absolutely neutral in your comments in this section.  Identify the reporter of the information (i.e. “Teacher reports…” “Dr. Jones reports…”).
  • Remark if a Student is being treated by a psychiatrist for attentional/self-regulatory symptoms, anxiety, depression, obsessive/compulsive symptoms, psychotic symptoms, etc.
  • R/O or Rule Out (e.g., R/O mental retardation) means the diagnosis is being considered, but further evidence is needed to establish a firm diagnosis of that disorder.

Note: Autism is always listed as Autism Spectrum Disorder.  Give the entire diagnostic label.

Eligibility (for school Individual Educational Program services)

A Student’s special education eligibility qualifies him or her for services as per the IEP in school.  They are recommended by School-based Clinicians such as School Psychologists, Occupational Therapists, Physical Therapists, Language/Speech Therapists and School Nurses

Disabilities are classified into five eligibility categories:[2]

Category A — Physical Impairments;

Category B — Emotional Impairments;

Category C — Communication Impairments;

Category D — Learning Impairments;

Category E — Developmental Delay.

The term “educational performance” is used in all of the definitions for eligibility. As used in this guide, “educational performance” is a term referring to how a student functions in the educational setting. It may or may not require academic achievement testing as noted within each category.  Multi – disciplinary assessment should be collected to substantiate an adverse impact on educational performance.

NOTE: When using Categories A thru D, for a preschool child, the IEP Team must address questions regarding “educational performance”. To assist with that discussion, it is recommended that the IEP Team equate the term “educational performance” with “developmental progress” since in most cases there was no formal education provided.

Category A – Physical Impairment

Definitions: “Students whose educational performance is adversely affected by a physical impairment that requires environmental and / or academic modifications including, but not limited to, the following: visually impaired, hearing impaired, orthopedically impaired, other health impaired.”

  • Autism A developmental disability significantly affecting verbal and non – verbal communication and social interaction, generally evident before age 3, that adversely affects educational performance. The term does not include students with characteristics of the disability serious emotional disturbance.
  • Deaf A hearing loss or deficit so severe that the student is impaired in processing linguistic information through hearing, with or without amplification, to the extent that his / her educational performance is adversely affected.
  • Deaf – Blindness Concomitant hearing and visual impairments. This disability causes such severe communication, developmental, and educational problems that they cannot be accommodated in special education programs solely for students with deafness or students with blindness.
  • Hearing Impairment An impairment in hearing, whether permanent or fluctuating that adversely affects a student’s educational performance.
  • Other Health Impairment Limited strength, vitality, or alertness due to chronic or acute health problems that adversely affect a student’s educational performance, including heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia or diabetes.
  • Orthopedic Impairment A severe physical impairment that adversely affects a student’s educational performance. The term includes congenital impairments, impairments caused by disease (i.e., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes such as cerebral palsy, amputations, and fractures or burns causing contractures.
  • Traumatic Brain Injury An acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a student’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as: cognition, language, memory, attention, reasoning, abstract thinking, judgement, or problem – solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma.
  • Visual Impairment, including Blindness An impairment in vision that, even with correction, adversely affects a student’s educational performance. The term includes both partial sight and blindness.
Category B – Emotional Impairment

Definitions: An emotional condition that has been confirmed by clinical evaluation and diagnosis and that, over a long period of time and to a marked degree, adversely affects educational performance and that exhibits one or more of the following characteristics:

1.   An inability to learn that cannot be explained by intellectual, sensory, or health factors.

2.   An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

3.   Inappropriate types of behavior under normal circumstances.

4.   A tendency to develop physical symptoms or fears associated with personal or School problems.

5.   A general pervasive mood of unhappiness or depression.

This includes students who are schizophrenic, but does not include students who are socially maladjusted, unless it is determined that they are seriously emotionally disturbed.

The term does not usually include:

a.   intellectual deficit;

b.   sensory or physical impairments;

c.   attention deficit disorder;

d.   anti – social behavior;

e.   parent – child problems;

f.    conduct disorders;

g.   interpersonal problems;

h.   other problems which are not the result of a severe mental disorder.

Category C – Communication Impairment

Category C – Communication Impairment includes two disabilities: Speech disorders and Language disorders.

Definition: Students whose educational performance is adversely affected by a developmental or acquired communication disorder to include voice, fluency, articulation, receptive and / or expressive language.

  • Language Disorders: Language disorders are characterized by an impairment/delay in receptive and/or expressive language including semantics, morphology/syntax, phonology and/or pragmatics. This impairment does not include students whose language problems are due to English as a second language or dialect difference.
  • Speech Disorders
    • Articulation disorder is characterized by substitutions, distortions, and/or omissions of phonemes which are not commensurate with expected developmental age norms, which may cause unintelligible conversational speech and are not the result of limited English proficiency or dialect.
    • Fluency disorder is characterized by atypical rate, rhythm, repetitions, and/or secondary behavior(s) which interferes with communication or is inconsistent with age/development.
    • Voice disorder is characterized by abnormal pitch, intensity, resonance, duration, and/or quality which is inappropriate for chronological age or gender.
Category D – Learning Impairment

Category D – Learning Impairment includes two disabilities: information processing and intellectual deficit.

Definitions: Information Processing Deficit: Information processing deficit is a disorder in a student’s ability to effectively use one or more of the cognitive processes (i.e., discrimination, association, retention, reasoning) in the educational environment. The term does not apply to student’s who have learning problems that are primarily the result of visual, hearing or motor disabilities, of mental retardation or emotional disturbance or of environmental, cultural, or economic disadvantage.
NOTE: Students who function within the “slow learner” range do NOT meet the criteria for an information processing deficit.  These are students whose measured intelligence is within normal intelligence limits, although at the low end (e.g. 70-90-IQ).  These students generally demonstrate a “flat profile on individual measures of intelligence and academic achievement.

  • Intellectual Deficit: Intellectual deficit is significantly sub-average intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely affects a student’s educational performance.
Category E – Developmental Delay

Definitions: Category E – Developmental Delay is a category specific to children ages birth through 5 only. The term developmental delay refers to a condition which represents a significant delay in the process of development. It does not refer to a condition in which a child is slightly or momentarily lagging in development. The presence of a developmental delay is an indication that the developmental processes are significantly impacted and that, without special intervention, it is likely that the educational performance will be affected when the child reaches school age.

There are five developmental areas of concern in the definition of developmental delay. They are:

1.   Physical Development – fine / gross motor skills used for coordinated use of muscles and body control in actions such as balance, standing, walking, climbing, object manipulation, cutting, and pre – writing activities;

2.   Communication Development – ability to understand and use language and the phonological processes;

3.   Cognitive Development – ability to receive information, process relationships, and apply knowledge;

4.   Social / Emotional Development – ability to develop and maintain functional interpersonal relationships and to exhibit social and emotional behaviors appropriate to the setting; and

5.   Adaptive / Self – Help Development – ability to deal with environmental expectations and use functional daily living skills.

Diagnoses are based on a “Medical Model,” that supposedly tell the Clinician what to expect in terms of symptomology, the course of the illness, and treatment options.  In fact, those diagnosed with developmental and emotional/psychiatric disorders form very heterogeneous groups, and individuals within the groups can have very different needs and learning styles.

It is a huge mistake to attribute behavior to diagnosis or to select treatments or interventions based solely on diagnosis.

While Eligibility Categories are based more on Student needs, these too are too broad and cannot explain the Student’s behavior or determine what treatments or interventions are indicated.