OP-1 Functional Behavior Assessment

District Name

(Optional Form)

Childs Name: Donald

Date of Meeting: 3/20/2015

Student ID:
Date of Implementation:
4/2/2015

Grade: 5th

Directions: A functional behavioral assessment (FBA) must be conducted when the IEP team determines that the students behavior is a
manifestation of the students disability. A FBA may be conducted, as determined appropriate by the students IEP team, if the students behavior results
in disciplinary action that changes the childs placement on the continuum of alternative placement options.
Please fill out a separate copy of this form for each behavior being assessed.

1. Behavior of Concern: Provide a description of the behavior in observable and measurable terms. Include a descrption of the intensity,
frequency and duration of the problem behavior.

Donald does not raise his hand to ask for help when given reading passages that are too difficult for him. He is
permitted to have a reader and a scribe, but when given assignments with reading required he does not seek out
help, he engages in the off task behavior of starring around the room or talking to neighbors instead. This off task
behavior happens frequently throughout the day. Every time a reading demand is placed on Donald he will engage in
his off task behavior to avoid the reading because it is too challenging, this occurs in every class, but mainly in
Language Arts. The duration of Donald's off task behaviors is various because it continues until a teacher makes
her/himself available to him.
2. What Event Triggers the Behavior (Antecedent):

Include a description of environmental factors which may contribute to the

behavior (e.g., medical conditions, sleep, diet, scheduling and social factors.)

Donalds behavior is triggered when when reading demands are placed on him. When assignments are given out that
require reading, across any subject, Donald engages in the off tasks behaviors described above.
3. Setting Where Behavior Most Likely Occurs: Describe the setting in which the behavior occurs (time of day, physical setting,
persons involved). Include a description of any relevant events that preceded the target behavior (antecedents).

The behavior occurs in various classroom settings. Whenever reading demands are placed on Donald the off task
behavior occurs. It is prodominately observable in his Language Arts classroom, however, it can be seen in his other
classes when reading is required.
4. How Often/How Long: Describe the time between the request to stop or change the behavior and the time of the students response to
the request.

When work is assigned, that requires reading, Donald will engage in off task behavior until a teacher approaches him
and asks if he needs assisstance. This takes various lengths of time, but on average it takes about 4 minutes for a
teacher to be available to check on Donald. However, if the teacher reminds Donald to ask for assistance, with
reading, at the beginning of every class, then Donald will raise his hand and ask within two minutes of the
assignments being given.

5. Who is the student most likely to react negatively to when requested to do something and who is the
student least likely to react negatively to when requested to do something?
Donald does not act negatively toward anyone (teachers, aids, students, etc.) when requested to do something.
6. What is the vocal adult response to the students negative behavior?
Adults respond to Donalds off task behavior by confronting him and reminding him that when he needs assistance he
needs to raise his hand and ask for help. Then they will assit him with his reading.
7. Consequences: Include a description of the consequences that resulted from the behavior of concern.
There are many consequences that result from Donalds off task behavior. First and foremost, Donald does not
complete many assignments because he is not asking for help, which pushes him further behind with grades and
understanding concepts. Secondly, Donald distracts other students around him with his off task behavior. Also, by
Donald not asking for assistance he is not learning how to become more independent, which is crucial for him next
year at the middle school.
8. Why (function or purpose of behavior)?

What is the student communicationg through the behavior of concern?

The student communicates, through the behavior of concern, that the material is too challenging for him. Therefore,
Prepared by the Ohio Department of Education for optional use. Not an ODE Required form.

OP-1 Functional Behavior Assessment

District Name

(Optional Form)

he engages in off task behavior until someone approaches him to provide him with assistance.
Functional Behavioral Assessment Additional Information*
Behavior History Interventions Attempted

Previously the teachers have just

used reminders to help Donald
remember he needs to ask for
assistance.

Other Relevant Information (e.g.,

medical)

Primary Mode of Communication

Verbal

N/A

Signatures:

Prepared by the Ohio Department of Education for optional use. Not an ODE Required form.