On the following chart, indicate the behaviors the person uses to achieve the communicative outcomes listed. you leaves Communicative or to Functions movement speech signing head away vocalizing close Expression signs Objects gaze –word Multiple-word Moves Moves One Other Other Grabs/Reaches Gives Complex Echolalia Complex Aggression phrases utterances Single Pointing Leading Shakes Fixed Facial Self-injury (sentences) Increased Request attention Request help Request preferred food/objects/ activities Request break Show you something or some place Indicate physical pain (headache, illness) Indicated confusion or unhappiness Protest or reject situation or activity With regard to the person’s receptive communication, or ability to understand other persons… a. Does the person follow spoken requests or instructions? If so, approximately how many? (List if only a few.) ________________________________________________________________ ________________________________________________________________ Does the person respond to signed or gestural requests or instructions? If so, approximately how many? (List if only a few.) _____________________________________________________________ _____________________________________________________________
On the following chart, indicate the behaviors the person uses to achieve the communicative outcomes listed. Communicative Functions Complex speech (sentences) Multiple-word phrases One –word utterances Echolalia Other vocalizing Complex signing Single signs Pointing Leading Shakes head Grabs/Reaches Gives Objects Increased movement Moves close to you Moves away or leaves Fixed gaze Facial Expression Aggression Self-injury Other Request attention Request help Request preferred food/objects/ activities Request break Show you something or some place Indicate physical pain (headache, illness) Indicated confusion or unhappiness Protest or reject situation or activity With regard to the person’s receptive communication, or ability to understand other persons… a. Does the person follow spoken requests or instructions? If so, approximately how many? (List if only a few.) ________________________________________________________________ ________________________________________________________________ Does the person respond to signed or gestural requests or instructions? If so, approximately how many? (List if only a few.) _____________________________________________________________ _____________________________________________________________
Functional%20Behavior%20Assessment.docx