Teacher Presenting Case: __________________
Child’s First Name:________________________
Form completed by: ______________________
Behavioral Description from Teacher
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Description of behavior (What is the specific behavior problem? In what situations does it commonly occur? How often does it occur?):
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Description of child (What is the child’s age? How does he/she communicate? What are some things he/she likes to do (e.g. possible rewards):
Influences on Behavior
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Characteristics of Autism/PDDNOS underlying the behavior (e.g. social, communication, sensory, routines/sameness, organization):
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Motivations underlying the behavior (e.g. escape, attention, tangible, stimulatory):
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Situational factors underlying the behavior (e.g. number of children, nature of activity, characteristics of physical setting):
INTERVENTION OPTIONS
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Structured Teaching |
Notes (describe how) |
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___ 1. Physical organization of classroom
___ 2. Visual schedule
___ 3.Positive routines
___ 4. Individual work systems
___ 5. Teaching strategies (e.g., prompts, materials, etc.)
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Communication Training
_____ 1. Choose the functional concept the child needs to use (e.g. help, finished, no, more, etc.)
_____ 2. Choose the form of communication to teach the child (e.g. verbal, signs/gestures, pictures, objects)
_____ 3. Create opportunities for the child to use communication throughout the day
_____ 4. Design structured activities to elicit communication
_____ 5. Reward the child for communicating
Behavior Management
A. Decreasing problematic behavior by addressing motivations
_____ 1. Providing other appropriate ways to satisfy the motivation (e.g. by allowing the child to meet the need appropriately if he/she has the skill, or by teaching him/her another way to meet the need appropriately):
_____ 2. Changing the consequences of the problematic behavior so that it does not satisfy the motivation:
_____ a. If the motivation is escape, require the child to complete a task
_____ b. If the motivation is attention, provide a brief time-out
_____ c. If the motivation is stimulatory, remove the stimulation
_____ d. If the motivation is tangible, do not allow access to the object
B. Increasing appropriate alternative behavior
_____ 1. Define an appropriate alternative behavior
_____ 2. Teach the child this new adaptive alternative behavior by:
_____ a. Physically guiding the child through the new behavior
_____ b. Providing lots of opportunities to practice the new behavior
_____ 3. Reward the child when he/she exhibits the new behavior in a way that is consistent with the motivation of the original inappropriate behavior:
_____ a. If the child uses problematic behaviors to gain escape, reward good behavior with opportunities to escape
_____ b. If the child uses problematic behaviors to gain attention, reward the good behavior with attention
_____ c. If the child uses problematic behaviors to gain stimulation, reward the good behavior with something stimulating
_____ d. If the child uses problematic behaviors to get a tangible object, reward the good behavior with access to the object