PTRYC Teach Form Sample.pdf

PTR-YC Functional Behavioral Assessment Checklist: Teach

Challenging behavior: ____ Person responding: ____ Child: ____

Question Yes No
1. Does the challenging behavior seem to be exhibited in order to gain attention from other children? Yes(specify peers) No
2. Does the challenging behavior seem to be exhibited in order to gain attention from adults? If so, are there particular adults whose attention is solicited? Yes(specify adults) No
3. Does the challenging behavior seem to be exhibited in order to obtain objects (e.g., toys, games, materials, food) from other children or adults? Yes(specify objects) No
4. Does the challenging behavior seem to be exhibited in order to delay a transition from a preferred activity to a nonpreferred activity? Yes(specify transitions) No
5. Does the challenging behavior seem to be exhibited in order to terminate or delay a nonpreferred (e.g., difficult, boring, repetitive) task or activity? Yes(specify nonpreferred tasks or activities) No
6. Does the challenging behavior seem to be exhibited in order to get away from a nonpreferred child or adult? Yes(specify peers or adults) No
7. What social skill(s) could the child learn in order to reduce the likelihood of the challenging behavior occurring in the future? Getting attention appropriately, Sharing-giving a toy, Sharing-asking for a toy, Taking turns, Beginning interactions with peers and adults, Responding or answering peers and adults, Engaging in interactions (staying on topic with peers and adults in a back-and-forth exchange), Giving a play idea ("You be the mommy"), Playing appropriately with toys and materials with peers, Accepting positive comments and praise, Making positive comments, Giving praise to peers, Waiting for acknowledgment or reinforcement, Skills to develop friendships Other:

Fo rm 6 PTR-YC Functional Behavioral Assessment Checklist: Teach (continued)

Question Yes No
8. What problem-solving skill(s) could the child learn in order to reduce the likelihood of the challenging behavior occurring in the future? Controlling anger, Controlling impulsive behavior, Strategies for calming down, Asking for help, Using visuals to support independent play Self-management, Playing independently, Playing cooperatively, Following directions, Following schedules and routines, Accepting "no", Managing emotions, Getting engaged in an activity, Staying engaged in activities, Choosing appropriate solutions, Making choices from appropriate options, Following through with choices
9. What communication skill(s) could the child learn in order to reduce the likelihood of the challenging behavior occurring in the future? Asking for a break, Asking for help, Responding to others, Requesting wants and needs Communicating effectively with words, Communicating effectively with pictures, Communicating effectively with sign language
Additional comments not addressed: