FBA Parent Interview

Date: _____________

Child's Name: ____________________________

Birth date: _____________________

School: __________________________________ Grade: ________________________ Interviewee/Respondent (relationship): ________________________________________ Interviewer: _____________________________________________________________

1.

What does your child do well? What are their greatest attributes?

2.

Parents primary behavioral concerns at home and/or school: Describe behavior in Estimate the frequency & observable terms (looks intensity (per hour/week, like/sounds like) how long) A)

Perceived function(s) (See list at the end)

B)

C)

3.

Are there any warning signs that the child exhibits indicating that the behavior(s) might occur? (e.g., becomes restless, agitated, withdrawn, begins to speak loudly, changes in mood, etc.)

4.

Do the identified behaviors occur in multiple settings? (e.g., home, school, or community settings) If so, where?

5.

Are there good days and bad days? If so, does there seem to be a pattern?

6.

What tends to "set-off" the identified behavior(s)? What is typically happening when the behavior(s) occur?

7.

Are there particular settings in which the behavior(s) are frequently observed? (Some of these may include: large, open rooms vs. small rooms; structured vs. unstructured activities; adult-directed vs. child-directed activities; large vs. small group; close proximity of adult/children vs. far proximity; other)

8.

Are there situational triggers that negatively affect your child's behavior? (Some examples include: lack of social attention; negative social interactions; demands/requests; redirection; task/activity transitions; setting transitions; interruption in routine; embarrassment; when limits are set or consequences are imposed; sleep patterns; eating routines; medications; health issues; life stressors; etc.)

9.

What is the amount of time between the triggering event and the behavior(s)? Is it immediate or delayed? Please explain.

10. Are there any effective strategies or interventions that seem to prevent or diffuse the identified behavior(s)?

11. What is reinforcing and enjoyable for your child? (Tangibles: toys, stickers, prizes; Social: certain people or activities; Activities: play time, outdoors, games, or computer, etc.)

12. What are the consequences that have been implemented and which one have been effective? (Some examples include: warnings; time-outs; ignoring the behavior; los of privileges; behavior contract, etc.)

13. What happens after the behavior occurs in terms of the parent's action and child's reaction?

Functions:

(P/C) Power/Control: Child behaves in order to control events, situations, or people. (E/A) Escape/Avoidance: Child behaves in order to avoid attention, demands/tasks/activities, sensory stimulation, or people. (A) Attention: Child behaves in order to gain attention of peers, teacher, parents, or others. (O) Obtain: Child behaves to obtain sensory stimulation, objects/materials, people, or assistance. (D) Deficit: Skill or performance (A/A) Acceptance/Affiliation: Child behaves to connect/relate with others, or to be accepted. (E) Expression of self: Child behaves to state needs or perceptions, or to demonstrate skills and talents. (G) Gratification: Child behaves in order to be rewarded or pleased. (J/R) Justice/Revenge: Child behaves in order to settle a difference, provide restitution, or settle a score.