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)
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)
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)
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)
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)
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)
7. What social skills(s) could the child learn in order to reduce the likelihood of the challenging behavior occurring in the future?
Getting attention appropriately Engaging in interactions (staying on topic with peers and adults in a back-and-forth exchange) Accepting positive comments and praise
Sharing - giving a toy Giving a play idea ("You be the mommy") Making positive comments
Sharing - asking for a toy Playing appropriately with toys and materials with peers Giving praise to peers
Taking turns Accepting positive comments and praise Waiting for acknowledgment or reinforcement
Beginning interactions with peers and adults Skills to develop friendships
Other:

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 Getting engaged in an activity
Controlling impulsive behavior Staying engaged in activities
Strategies for calming down Choosing appropriate solutions
Asking for help Making choices from appropriate options
Using visuals to support independent play Following through with choices
Self-management
Playing independently
Playing cooperatively
Following directions
Following schedules and routines
Accepting "no"
Managing emotions
Other:
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
Expressing emotions (e.g., frustration, anger, hurt) appropriately
Saying, "No" or "Stop"
Other:
Additional comments not addressed: