Fillable Open-Ended Functional Assessment Interview

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Open-Ended Functional Assessment Interview

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Date of Interview: Child/Client: Interviewer:
Respondent: Respondent’s relation to child/client:
1. His/her date of birth: Age: yrs mo Check one: Male Female
2. Describe his/her language abilities:
3. Describe his/her play skills and preferred toys or leisure activities:
4. What else does he/she prefer?
To develop objective definitions of observable problem behaviors:
5. What are the problem behaviors? What do they look like?
To determine which problem behavior(s) will be targeted in the functional analysis:
6. What is the single-most concerning problem behavior?
7. What are the top 3 most concerning problem behaviors? Are there other behaviors of concern?
Open-Ended Functional Assessment Interview
Developed by Gregory P. Hanley, Ph.D., BCBA-D (Developed August, 2002; Revised: August, 2009)
RELEVANT BACKGROUND INFORMATION
QUESTIONS TO INFORM THE DESIGN OF A FUNCTIONAL ANALYSIS
To determine the precautions required when conducting the functional analysis:
8. Describe the range of intensities of the problem behaviors and the extent to which he/she or others may be
hurt or injured from the problem behavior.
To assist in identifying precursors to dangerous problem behaviors that may be targeted in the functional analysis
instead of more dangerous problem behaviors:
9. Do the different types of problem behavior tend to occur in bursts or clusters and/or does any type of
problem behavior typically precede another type of problem behavior (e.g., yells preceding hits)?
To determine the antecedent conditions that may be incorporated into the functional analysis test conditions:
10. Under what conditions or situations are the problem behaviors most likely to occur?
11. Do the problem behaviors reliably occur during any particular activities?
12. What seems to trigger the problem behavior?
13. Does problem behavior occur when you break routines or interrupt activities? If so, describe.
14. Does the problem behavior occur when it appears that he/she won’t get his/her way? If so, describe the
things that the child often attempts to control.
To determine the test condition(s) that should be conducted and the specific type(s) of consequences that may be
incorporated into the test condition(s):
15. How do you and others react or respond to the problem behavior?
16. What do you and others do to calm him/her down once he/she engaged in the problem behavior?
17. What do you and others do to distract him/her from engaging in the problem behavior?
In addition to the above information, to assist in developing a hunch as to why problem behavior is occurring and to
assist in determining the test condition(s) to be conducted:
18. What do you think he/she is trying to communicate with his/her problem behavior, if anything?
19. Do you think this problem behavior is a form of self stimulation? If so, what gives you that impression?
20. Why do you think he/she is engaging in the problem behavior?
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Open-Ended Functional Assessment Interview

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Completed 29 June 2022

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