. RELEVANT BACKGROUND INFORMATION 1. His/her date of birth: Age: yrs mo Check one: Male Female 2. Describe his/her language abilities: Large repertoire of words with Sentences typically in Song. no functional speech. Will speak in 3. Describe his/her play skills and preferred toys or leisure activities: Plays with toys functionally. Preferred toys /activities included Cause and effect toys, stacking toys, puzzles, listening to ABC's, writing Acc's (with asistance), and playing with animals. 4. What else does he/she prefer? Swinging on the swing. QUESTIONS TO INFORM THE DESIGN OF A FUNCTIONAL ANALYSIS To develop objective definitions of observable problem behaviors: 5. What are the problem behaviors? What do they look like? Removing Elopement the day removes shoes and Socks Shoes, Throughout will run from designated play area In moments of frustration or overstimulation will reach Grabbing/squeezing, for someones face or body and will squeece tightly- Self stimulation, hands between legs, bouncing on chat or floor To determine which problem behavior(s) will be targeted in the functional analysis: 5. What is the single-most concerning problem behavior? Grabbing/squeezing What are the top 3 most concerning problem behaviors? Are there other behaviors of concern? Grabbing/Squeezing Elopement Self stimulation determine the precautions required when conducting the functional analysis: Describe the range of intensities of the problem behaviors and the extent to which he/she or others may be hurt or injured from the problem behavior. Grabbing/squeezing - Presents minor in its lowest intensity as squeeze P grabbing and squeecing hard to use of nails while Squeezing while reaching for face. o assist in identifying precursors to dangerous problem behaviors that may be targeted in the functional analysis stead of more dangerous problem behaviors: . Do the different types of problem behavior tend to occur in bursts or clusters and/or does any type of problem behavior typically precede another type of problem behavior (e.g., yells preceding hits)? Grabbing squeezing Typically Joined with yelling access To determine the antecedent conditions that may be incorporated into the functional analysis test conditions: 10. Under what conditions or situations are the problem behaviors most likely to occur? Grabbing/squeezing typically occurs when denied access to preferred item 12 over stimulation 11. Do the problem behaviors reliably occur during any particular activities? Self stimulation often occurs during 12. What seems to trigger the problem behavior? Frustration Overstimulation circle time 13. Does problem behavior occur when you break routines or interrupt activities? If so, describe. no 4. Does the problem behavior occur when it appears that he/she won't get his/her way? If so, describe the Yes, when denied Preferred or activity To determine the test condition(s) that should be conducted and the specific type(s) of consequences that may be incorporated into the test condition(s): 15. How do you and others react or respond to the problem behavior? Ignore and redirect 16. What do you and others do to calm him/her down once he/she engaged in the problem behavior? for appropriate mand. prompt 17. What do you and others do to distract him/her from engaging in the problem behavior? Redirect when esculating In addition to the above information, to assist in developing a hunch as to why problem behavior is occurring and to assist in determining the test condition(s) to be conducted: 18. What do you think he/she is trying to communicate with his/her problem behavior, if anything? Something is not goin his way 19. Do you think this problem behavior is a form of self stimulation? If so, what gives you that impression? Yes, it occurs when appears 20. Why do you think he/she is engaging in the problem behavior? Frustration Trying self regulate. INTERVIEWS & ANECTODAL OBSERVATIONS Client: Observer: Date: Anecdotal Log Time Observed (beginning and end) 9:30 AM 932 AM Location & Setting: Sensory Observed Activity: lining up toys. Observed Behavior: Grabbing at techs face Client: Observer: Date: 12/19/23 Time Observed (beginning and end) \\ 31 AM Location & Setting: Gross motor Observed Activity: Puzzle with shapes 11:31 AM Observed Behavior: Grabbed at techs face