Time Antecedent Behavior Outcome/Consequence Large group activity Directed to work on tasks adult(s) respond (look at or talk Small group activity requiring specific academic to student) Independent skills peer(s) respond (look at, laugh activity Directed to complete or talk to student) Transition nonacademic tasks got specific activity/object Unstructured correction got specific sensory input activity Working/playing w Peers adult attention removed Alone (no interaction) peer attention removed Specify: Engaged in self-selected task specific activity/object removed Directed to stop self-selected specific sensory input removed task Notes: Notes: Large group activity Directed to work on tasks adult(s) respond (look at or talk Small group activity requiring specific academic to student) Independent skills peer(s) respond (look at, laugh activity Directed to complete or talk to student) Transition nonacademic tasks got specific activity/object Unstructured Given correction got specific sensory activity Working/playing w Peers adult attention removed Alone (no interaction) peer attention removed Specify: Engaged in self-selected task specific activity/object removed Directed to stop self-selected specific sensory input removed task Notes: Notes: Large group activity Directed to work on adult(s) respond (look at or talk Small group activity requiring specific academic to student) Independent skills peer(s) respond (look at, laugh activity Directed to complete or talk to student) Transition nonacademic tasks got specific activity/object Unstructured correction got specific sensory input activity Working/playing w Peers adult attention removed Alone (no interaction) peer attention removed Specify: Engaged in self-selected task specific activity/object removed Directed to stop self-selected specific sensory removed task Notes: Summary Statement based on Observation(s) During: When: Student will: Because: Therefore the function is to obtain/avoid (circle one) How confident are you that your Summary Statement accurately explains the problem behavior occurring? Not at all So-so Very confident 1 2 3 4 5 6
Time Antecedent Behavior Outcome/Consequence Large group activity Small group activity Independent activity Transition Unstructured activity Specify: Directed to work on tasks requiring specific academic skills Directed to complete nonacademic tasks correction Working/playing w Peers Alone (no interaction) Engaged in self-selected task Directed to stop self-selected task Notes: adult(s) respond (look at or talk to student) peer(s) respond (look at, laugh or talk to student) got specific activity/object got specific sensory input adult attention removed peer attention removed specific activity/object removed specific sensory input removed Notes: Large group activity Small group activity Independent activity Transition Unstructured activity Specify: Directed to work on tasks requiring specific academic skills Directed to complete nonacademic tasks Given correction Working/playing w Peers Alone (no interaction) Engaged in self-selected task Directed to stop self-selected task Notes: adult(s) respond (look at or talk to student) peer(s) respond (look at, laugh or talk to student) got specific activity/object got specific sensory adult attention removed peer attention removed specific activity/object removed specific sensory input removed Notes: Large group activity Small group activity Independent activity Transition Unstructured activity Specify: Directed to work on requiring specific academic skills Directed to complete nonacademic tasks correction Working/playing w Peers Alone (no interaction) Engaged in self-selected task Directed to stop self-selected task adult(s) respond (look at or talk to student) peer(s) respond (look at, laugh or talk to student) got specific activity/object got specific sensory input adult attention removed peer attention removed specific activity/object removed specific sensory removed Notes: Summary Statement based on Observation(s) During: When: Student will: Because: Therefore the function is to obtain/avoid (circle one) How confident are you that your Summary Statement accurately explains the problem behavior occurring? Not at all So-so Very confident 1 2 3 4 5 6