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Functional Behavioral Assessment: Part 1 (Description) Date: 3/30/2013 Student Name: Gisela Garcia ID: DOB: 2102005 ase !anager: "aren #ones Page of Data Sources: O$ser%ation Parent Inter%ie& Student Inter%ie& )ating Scales 'eac(er Inter%ie& Normati%e 'esting

Description of Behavior: t&irling and inattention Setting(s) in which behavior occurs: Small grou* reading and &(ole grou* mat( instruction

Frequency: '&irling occurred nine out of t(e ten da+s o$ser%ed, Inattention occurred si- out of t(e ten da+s o$ser%ed, Intensity . onse/uences of *ro$lem $e(a%ior on student0 *eers0 instructional en%ironment1: Student is failing $ot( reading and mat( at t(is time, 'eac(er sto*s instruction to admonis( student or redirect (er attention, Duration: 1 (our and 25 minutes out of a total of 15 (ours of instructional time &as lost, Describe Previous Interventions : 'eac(er tells student to sto* t&irling0 or to *a+ attention, Student sto*s for a&(ile and t(en returns to $e(a%ior, Educational impact: Student is failing both math and reading.

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Functional Behavioral Assessment: Part

(Function)

Date: 3/30/2013 Student Name: Gisela Garcia ID: DOB: 2102005 ase !anager: "aren #ones Page of Function of Behavior: S*ecif+ (+*ot(esi3ed function for eac( area c(ec4ed $elo&, !!ective "egulation#Emotional "eactivity .Identif+ emotional factors5 an-iet+0 de*ression0 anger0 *oor self6conce*t5 t(at *la+ a role in organi3ing or directing *ro$lem $e(a%ior1: $ognitive Distortion .Identif+ distorted t(oug(ts5 inaccurate attri$utions0 negati%e self6statements0 erroneous inter*retations of e%ents5 t(at *la+ a role in organi3ing or directing *ro$lem $e(a%ior1: Student $elie%es s(e cannot do t(e &or4, "ein!orcement .Identif+ en%ironmental triggers and *a+offs t(at *la+ a role in organi3ing and directing *ro$lem $e(a%ior1:
Antecedents: instruction in reading or mat( Behavior: t&irling and inattention !onse"uences#$einforcement: &or4 dela+ed

%odeling (Identif+ t(e degree to &(ic( t(e $e(a%ior is co*ied0 &(o t(e+ are co*+ing t(e $e(a%ior from and &(+ t(e+ are co*+ing t(e $e(a%ior1:

Family Issues .Identif+ famil+ issues t(at *la+ a *art in organi3ing and directing *ro$lem $e(a%ior1:

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Physiological#$onstitutional .Identif+ *(+siological and/or *ersonalit+ c(aracteristics5 de%elo*mental disa$ilities0 tem*erament5 t(at *la+ a *art in organi3ing and directing *ro$lem $e(a%ior1:

$ommunicate need .Identif+ &(at t(e student is tr+ing to sa+ t(roug( t(e *ro$lem $e(a%ior1: Student does not understand instruction

$urriculum#Instruction .Identif+ (o& instruction0 curriculum0 or educational en%ironment *la+s a *art in organi3ing and directing *ro$lem $e(a%ior1: Student does not *rocess %isual information as &ell as s(e does auditor+ information, Student needs direct instruction &it( (ands on acti%ities to *ractice s4ills,,