Support Plan

Module 3a Handout 3a.6: Individualized Intensive Interventions

Adapted from: O'Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997). Functional Assessment and Program Development for Problem Behavior. Pacific Grove, CA: Brooks/Cole Publishing.

FUNCTIONAL ASSESSMENT INTERVIEW FORM-YOUNG CHILD

Child with Challenging Behavior(s):Tim Date of Interview: 1/24 Age: 3 Yrs 6 Mos Sex: M* F I nterviewer: Lisa Respondent(s) : Teacher, Assistant, & Mother

A. DESCRIBE THE BEHAVIOR(S)

1. What are the behaviors of concern? For each, define how it is performed, how often it occurs per day, week, or month, how long it lasts when it occurs, and the intensity in which it occurs (low, medium, high).

How is it performed? How often? How long? Intensity?Behavior 1. Verbal aggression Threatens (“I'm gonna kill you”

while pointing a finger gun “Get away”, growls...)

2-5 x/day 5 sec.-1min. Low-high

2. Physical aggression Hits, pushes, kicks, punches, rams w/toy

2-3 x/wk 5 sec.- 30 sec. High

3. Property destruction Throwing or banging toys 2-5 x/wk 5 sec.- 30 sec. High

4.

2. Which of the behaviors described above occur together (e.g., occur at the same time; occur in a predictable “chain”; occur in response to the same situation)?

Seems unpredictable at this point. At times he will verbally aggress, then do either physical aggression or property destruction, or they happen independent of each other. Other times he will begin with either property destruction and/ or physical aggression and intersperse verbal aggression.

B. IDENTIFY EVENTS THAT MAY AFFECT THE BEHAVIOR(S)

1. What medications does the child take, and how do you believe these may affect his/her behavior?

None

2. What medical complication (if any) does the child experience that may affect his/her behavior (e.g., asthma, allergies, rashes, sinus infections, seizures)?

None

R ev. 2/1 0 The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/c sefel H 3a.6

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Module 3a Handout 3a.6: Individualized Intensive Interventions

3. Describe the sleep cycles of the child and the extent to which these cycles may affect his/her behavior.

His mother reports that now that he is in school a routine is better established and will sleep through the night. Although she also reports that getting him to “go to bed” is very difficult and that he falls asleep on the couch around 9:00 or 9:30 and is carried to his crib. Then, he sleeps very restlessly and is all over the bed. (Did not sleep through the night until he was 2.5 years.)

4. Describe the eating routines and diet of the child and the extent to which these routines may affect his/her behavior.

Eats independently at school for snack. At home, his mother reports that “he is very explicit with getting food cut up,” and that “he sees food as a temporary interruption of play and only eats to live.” He sits in a high chair while she feeds him. Won't sit in restaurants to eat.

5. Briefly list the child's typical daily schedule of activities and how well he/she does within each activity.

Time Activity Child’s Reaction 8:00 AM Wakes, gets dress, eats breakfast Better the last 2 wks - month, in the past, has physically resisted

dressing and eating. 8:30 AM To school Does nicely 8:45 AM Arrives to school Greets by shooting with his finger gun, sometimes cries for hug Until 9:30 AM Playground Verbal and physical aggression, property destruction 9: 30 AM Story Time Sits and attends nicely 9: 45 AM Small Group Sits and attends nicely 10:00 AM Wiggle Time Follows directions and enjoys movement and dancing

10:15 AM Plan/Centers Plans nicely, once in centers: verbal & physical aggression, property destruction

10:30 AM Centers/Snack (cont.) Eats snack and plays computer nicely, other center areas, especially blocks, he will use verbal and physical aggression, property destruction

11:30 AM Circle Sits and attends nicely 11:45 AM Playground Verbal and physical aggression, property destruction 12:30 PM Lunch Eats nicely 1:00 PM Nap Lays on a cot nicely with book

2:15 PM Snack Eats nicely

2:35 PM Good-bye circle Sits, attends

3:00 PM Mother picks up Goes nicely

3:30 PM Then, the schedule is not consistent. (sometimes out shopping or home, Goes to mall or Target or home to play or sometimes the park)

Likes to stay busy

Drives home Goes nicely

5:30 PM Arrives at home, plays on floor Enjoys

6:00 PM Cont. playing Does O.K.

6:30 PM Dad home/Dinner Picky, resistant, in high chair

7:00 PM Play Chooses activities, sometimes rough with toys

9:00 PM Bath Difficult to get out, gets physically aggressive

R ev. 2/1 0 The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/c sefel H 3a.6

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