A Functional Behavior Assessment Process
Manifestation Determination Process
Sample Forms
Rather than a single procedure or test, FBA is a process. The purpose is to determine which behavior(s) are
limiting educational progress; to design interventions that decrease those target behavior(s); and to promote
appropriate behavior(s) through positive behavioral supports.
Who does it?
The IEP team reviews all pertinent information and gathers new data to determine appropriate intervention
strategies to improve a student's ability to make educational progress.
How is it done?
The IEP team identifies and defines the target behavior(s). By looking at the context of what happens before,
during and after the behavior(s), some reasons for the behavior(s) and the function(s) of behavior(s) can be
explored and tested. An intervention plan to prevent specific behavior(s), develop replacement behavior(s) and
define a straegy to discontinue the plan is designed. This process may take place over a period of time and
require more than one IEP team meeting.
For more information: contact the Special Education Office at your local school system, or the Alabama State
Department of Education, Special Education Services, (334) 242-8114
Manifestation Determination Requirements for IDEA students
How?
The IEP team meets to review the incident, the student's file, the IEP and placement. All relevant information is
considered, including: evaluation and diagnostic results, information from the parents, and observation of the
student
What questions does IDEA '97 require the IEP team to answer?
1. In relationship to the behavior, was the student's IEP appropriate?
If yes, proceed. If no, revise the IEP and/or placement.
2. Were behavior intervention strategies provided consistent with with the
IEP and placement?
If yes, proceed. If no, provide the necessary services.
3. Did the disability impair the ability to understand the impact and
consequences of the behavior subject to disciplinary action?
If yes, the behavior is a manifestation of the disability. If no, proceed.
4. Did the disability impair the ability to control the behavior?
If yes, the behavior is a manifestation of the disability. If no, it is not.
For more information: contact the Special Education Office at your local school system, or the Alabama State
Department of Education, Special Education Services, (334) 242-8114
Documentation of Problem Behavior
Is there evidence from any of the following sources that the student displays problem behaviors (behaviors that
impede the student's learning or that of others) that should be addressed in his/her IEP? Check yes and indicate
the source(s) if there is evidence. Perform a functional behavior assessment and develop a behavior intervention
plan. Check no is there is no evidence.
Yes _____
Referral Information ____
Classroom Observation ____
Parent Input ____
Interviews ____
Formal Testing (e.g., Behavior Rating Scale) ____
Informal Assessment ____
Other ____
Indicate the specific problem behavior(s). Prioritize if there is more than one.
1.
2.
3.
No _____
IEP Team Members
Position
Date
FUNCTIONAL ASSESSMENT
FOR SEVERE PROBLEM BEHAVIOR
Part One: Assessing the Behavior
1. Specific Target Behavior (Include topography; include frequency, duration or intensity) _______________
___________________________________________________________________________________
2. Setting(s) In Which Behavior Occurred __________________________________________________
___________________________________________________________________________________
3. Activities During Which The Behavior Occurred ___________________________________________
___________________________________________________________________________________
4. Time of Day Behavior Occurred _______________________________________________________
5. Person(s) Around Whom The Behavior Occurred __________________________________________
___________________________________________________________________________________
6. Factors That Appeared To Set Off Or Proceed The Behavior
Teacher Factors
___ Task Explanation
___ Performance Feedback
___ Lesson Presentation
___ Teacher Reprimand
___ Teacher Praise
___ Individual Attention
___ Lack of Attention
___ Task Demands
___ Teacher Request
___ Consequence Imposed For Negative Behavior
___ Other ________________________________
Peer Factors
___ Peer Attention (Positive)
___ Peer Attention (Negative)
___ Other _________________________________________________________________________
Setting Factors
___ Transition (Task; Routine)
___ Transition (Setting; Routine)
___ Transition (Task; Unexpected)
___ Transition (Setting; Unexpected)
___ Elevated Noise Levels
___ Presence of Unfamiliar Adults
___ Presence of Unfamiliar Peers
___ Other ________________________________
7. Factors That Appeared To Occur When The Behavior Took Place
Student Factors
___ Drowsy/Sleepy Appearance
___ Physical Complaints (e.g., Hunger, Pain)
___ Disturbed Affect (e.g., sad, angry)
___ Excessive Motor Activity
___ Other ________________________________
Setting Factors
___ Independent Seat Work
___ Group Instruction
___ Crowded Setting
___ One to One Instruction
___ Unstructured Setting
___ Unstructured Activity
___ Other ________________________________
8. Factors That Appeared To Follow The Behavior
Teacher Factors
___ Teacher Reprimand
___ Teacher Praise
___ Task Removal
___ Withdrawal Of Attention
___ Teacher Warning
___ Time-Out
___ Response Cost
___ Sent To Office
___ Communication With Parent
___ Predetermined Contingency Imposed
___ In-School Suspension
___ Out-Of-School Suspension
___ Other ________________________________
Peer Factors
___ Peer Attention (Positive)
___ Peer Attention (Negative)
___ Other _________________________________________________________________________
9. Behavioral Intent Or Function(s) That The Behavior Appeared To Serve
___
Power/Control
___ Over Teachers
___ Over Peers
___ Over Parents
___ Other __________________________________________________
___
Escape/Avoidance
___ From an Activity/Task
___ From a Person __________________
___ From the Classroom
___ From the School
___ Other __________________________________________________
___
Attention
___ Teacher
___ Peer
___ Parent
___ Other
___
Expression of Self
___
Gratification (Self-Reward)
___
Acceptance/Affiliation (More Formal Than Immediate Peer Attention)
___
Justice/Revenge
___
Other ______________________________________________________
Part Two: Formulating Hypotheses
Based On Information In Part One:
1. What Appears To Be The Predominant Setting/Activity in Which The Behavior Occurs? __________
_______________________________________________________________________________
2. What Time(s) Of Day Does The Behavior Typically Occur? ________________________________
3. Around What Person(s) Does The Behavior Typically Occur? ______________________________
4. What Seems To Immediately Precede Or Set Off The Behavior? ____________________________
5. What Seems To Be The Immediate Consequence Of The Behavior? _________________________
6. What Function Or Purpose Does The Behavior Seem To Serve? ____________________________
Functional Hypothesis
Consider both (a) the conditions in which the behavior occurs and (b) the function that the behavior serves.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Part Three: Interpreting the Results
A. Modification of Existing Behavioral Intervention Plan
________________________________________________________________________________
________________________________________________________________________________
B. Development of Behavioral Intervention Plan
Prevention Behavior
Based on the available information, list steps that could be taken to prevent the target behavior from occurring
(e.g., avoidance of certain tasks and/or types of instructional delivery, seating arrangement)
________________________________________________________________________________
Replacement Behavior
Based on the available information, what behavior needs to be taught to allow the student to have a successful
adaptation (e.g., requesting assistance to replace tantruming as a means of gathering attention)
________________________________________________________________________________
________________________________________________________________________________
Identification of Reinforcers
List all reinforcers, including preferred activities, appropriate for this student
________________________________________________________________________________
________________________________________________________________________________
Implementation of Behavior Intervention Plan
Goal:
________________________________________________________________________________
Prevention Strategies for Target Behavior
Strategy
Date
Person(s) Responsible
Outcome
________________________________________________________________________________
Intervention Strategies For Replacement Behavior
Strategy
Date
Person(s) Responsible
Outcome
________________________________________________________________________________
Criteria for Program Discontinuation:
________________________________________________________________________________
C. Manifestation Determination
Consider all relevant information including
1. Evaluation and diagnostic results, including information presented by the parents
2. Observations of the student
3. Student's IEP and placement
Summary of Relevant Information
________________________________________________________________________________
________________________________________________________________________________
Determination
1. In relationship to the behavior subject to disciplinary action, was the student's IEP and placement appropriate
(including special education services and supplementary aids and services)?
Yes - Proceed ___
No - Revise IEP and/or placement ___
2. Were behavior intervention strategies provided consistent with the student's IEP and placement?
Yes - Proceed ___
No - Provide necessary services ___
3. Did the student's disability impair the ability to understand the impact and consequences of the behavior subject
to disciplinary action?
Yes - Behavior is a manifestation of the disability ___
No - Proceed ___
4. Did the child's disability impair the ability to control the behavior subject to disciplinary action?
Yes - Behavior is a manifestation of the disability ___
No - Behavior is not a manifestation of the disability ___
IEP Committee
Signatures
Title
Date
Note: This form was developed by:
Dr, Ron Taylor
Exceptional Student Education
Florida Atlantic University
Boca Raton, FL 33431
Portions were adapted from: Maag, J (1999) Behavior Management: From Theoretical Implications to Practical
Applications. San Diego: Singular Publishing Group.
FUNCTIONAL ASSESSMENT
Part One: Assessing the Behavior
1. Specific Target Behavior (Include topography; include frequency, duration or intensity) _______________
___________________________________________________________________________________
2. Setting(s) In Which Behavior Occurred __________________________________________________
___________________________________________________________________________________
3. Activities During Which The Behavior Occurred ___________________________________________
___________________________________________________________________________________
4. Time of Day Behavior Occurred _______________________________________________________
5. Person(s) Around Whom The Behavior Occurred __________________________________________
___________________________________________________________________________________
6. Factors That Appeared To Set Off Or Proceed The Behavior
Teacher Factors
___ Task Explanation
___ Performance Feedback
___ Lesson Presentation
___ Teacher Reprimand
___ Teacher Praise
___ Individual Attention
___ Lack of Attention
___ Task Demands
___ Teacher Request
___ Consequence Imposed For Negative Behavior
___ Other ________________________________
Peer Factors
___ Peer Attention (Positive)
___ Peer Attention (Negative)
___ Other _________________________________________________________________________
Setting Factors
___ Transition (Task; Routine)
___ Transition (Setting; Routine)
___ Transition (Task; Unexpected)
___ Transition (Setting; Unexpected)
___ Elevated Noise Levels
___ Presence of Unfamiliar Adults
___ Presence of Unfamiliar Peers
___ Other ________________________________
7. Factors That Appeared To Occur When The Behavior Took Place
Student Factors
___ Drowsy/Sleepy Appearance
___ Physical Complaints (e.g., Hunger, Pain)
___ Disturbed Affect (e.g., sad, angry)
___ Excessive Motor Activity
___ Other ________________________________
Setting Factors
___ Independent Seat Work
___ Group Instruction
___ Crowded Setting
___ One to One Instruction
___ Unstructured Setting
___ Unstructured Activity
___ Other ________________________________
8. Factors That Appeared To Follow The Behavior
Teacher Factors
___ Teacher Reprimand
___ Teacher Praise
___ Task Removal
___ Withdrawal Of Attention
___ Teacher Warning
___ Time-Out
___ Response Cost
___ Sent To Office
___ Communication With Parent
___ Predetermined Contingency Imposed
___ In-School Suspension
___ Out-Of-School Suspension
___ Other ________________________________
Peer Factors
___ Peer Attention (Positive)
___ Peer Attention (Negative)
___ Other _________________________________________________________________________
9. Behavioral Intent Or Function(s) That The Behavior Appeared To Serve
___
Power/Control
___ Over Teachers
___ Over Peers
___ Over Parents
___ Other __________________________________________________
___
Escape/Avoidance
___ From an Activity/Task
___ From a Person __________________
___ From the Classroom
___ From the School
___ Other __________________________________________________
___
Attention
___ Teacher
___ Peer
___ Parent
___ Other
___
Expression of Self
___
Gratification (Self-Reward)
___
Acceptance/Affiliation (More Formal Than Immediate Peer Attention)
___
Justice/Revenge
___
Other ______________________________________________________
Part Two: Formulating Hypotheses
Based On Information In Part One:
1. What Appears To Be The Predominant Setting/Activity in Which The Behavior Occurs? __________
_______________________________________________________________________________
2. What Time(s) Of Day Does The Behavior Typically Occur? ________________________________
3. Around What Person(s) Does The Behavior Typically Occur? ______________________________
4. What Seems To Immediately Precede Or Set Off The Behavior? ____________________________
5. What Seems To Be The Immediate Consequence Of The Behavior? _________________________
6. What Function Or Purpose Does The Behavior Seem To Serve? ____________________________
Functional Hypothesis
Consider both (a) the conditions in which the behavior occurs and (b) the function that the behavior serves.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Part Three: Development Of Behavior Intervention Plan
Prevention Behavior
Based on the available information, list steps that could be taken to prevent the target behavior from occurring
(e.g., avoidance of certain tasks and/or types of instructional delivery, seating arrangement)
________________________________________________________________________________
Replacement Behavior
Based on the available information, what behavior needs to be taught to allow the student to have a successful
adaptation (e.g., requesting assistance to replace tantruming as a means of gathering attention)
________________________________________________________________________________
________________________________________________________________________________
Identification of Reinforcers
List all reinforcers, including preferred activities, appropriate for this student
________________________________________________________________________________
________________________________________________________________________________
Implementation of Behavior Intervention Plan
Goal:
________________________________________________________________________________
Prevention Strategies for Target Behavior
Strategy
Date
Person(s) Responsible
Outcome
________________________________________________________________________________
Intervention Strategies For Replacement Behavior
Strategy
Date
Person(s) Responsible
Outcome
________________________________________________________________________________
Criteria for Program Discontinuation:
________________________________________________________________________________
Note: This form was developed by:
Dr, Ron Taylor
Exceptional Student Education
Florida Atlantic University
Boca Raton, FL 33431
Portions were adapted from: Maag, J (1999) Behavior Management: From Theoretical Implications to Practical
Applications. San Diego: Singular Publishing Group.