Fba Spu 328
Fba Spu 328
Fba Spu 328
Adapted from Dr. Brian Iwatas work (1996 & 1998) at The Florida Center on Self-Injury
Behavior Problem(s): __Begging during dinner by placing head on table or licking the side of
plates.
Date(s): 9/9/2013 11/2/2013
Informant: Bruno
Interviewer: Marissa Weidner
To the Interviewer: The FAST is designed to identify a number of factors that may influence the
occurrence of behavior problems. It should be used only as an initial screening tool and as part
of a comprehensive functional analysis of the behavior problem. The FAST should be
administered to several individuals who interact with the client frequently. Results should then
be used as the basis for conducting direct observations in several different contexts to verify
likely behavioral functions, clarify ambiguous functions, and identify other relevant factors that
may not have been included in this instrument.
To the Informant: After completing the section on Informant-Client Relationship, read each of
the numbered items carefully. If a statement accurately describes the students target behavior
problem, circle Yes. If not, circle No.
INFORMANT-CLIENT RELATIONSHIP
Indicate your relationship to the student:
Parent
Teacher/Instructor
Therapist
Residential Staff
How long have you known the student?
__6___Years
_____ Months
Do you interact with the student on a daily basis? Yes about 8 hrs
No
If Yes, how many hours per day? If No, how many hours per week?
In what situations do you typically observe the student? (Mark all that apply)
Self-care routines
Academic skills training
Meals
When the student has nothing to do
Leisure activities
Work or vocational training
Evenings
Other:
Part I. Problem Behavior Identification:
List behavior problems of concern. Describe each in clear and objective terms.
1__Begging during dinner.
2._Placing head on table when everyone is eating.
3._Licking the side of the plate while someone is eating.
SEVERITY
Mild/Moderate/Severe
Mild/Moderate/Severe
Mild/Moderate/Severe
Mild/Moderate/Severe
Complete Part V if you answered Yes to items 1, 2, or 3. Skip Part V if you answered
No to all three items in Part I.
Part V. Social Reinforcement 4. The behavior often occurs when the student has not received
much attention.
Yes
No
5. When the behavior occurs, you or others usually respond by interacting with the student in
some way (e.g., comforting statements, verbal correction or reprimand, response blocking,
redirection).
Yes
No
6. The student often engages in other annoying behaviors that produce attention.
Yes
No
. The student frequently approaches you (or others) and/or initiates social interaction.
Yes
No
8. The behavior rarely occurs when you give the student lots of attention.
Yes
No
9. The behavior often occurs when you take a particular item away from the student or when you
terminate a preferred leisure activity.
Yes
No
(If yes, identify: _________________________________)
10. The behavior often occurs when you inform the student that (s)he cannot have a certain item
cannot engage in a particular activity.
Yes
No
(If yes, identify: _________________________________)
11. When the behavior occurs, you often respond by giving the student a specific item, such as a
favorite toy, food, or some other item.
Yes
No
(If yes, identify: _________________________________)
12. The student often engages in other annoying behaviors that produce access to preferred
items or activities.
Yes
No
. The behavior rarely occurs when you give the student free access to his or her favorite items or
activities.
Yes
No
14. The behavior often occurs during training activities or when you place other types of
demands on the student.
Yes
No
(If Yes, identify the activities: __ self-care __ academic __work
__ other)
15. The student often is noncompliant during training activities or when asked to complete tasks.
Yes
No
16. The behavior often occurs when the immediate environment is very noisy or crowded
Yes
No
17. When the behavior occurs, you often respond by giving the student a brief break from an
ongoing task.
Yes
No
18 The behavior rarely occurs when you place few demands on the student or when you leave the
student alone.
Yes
No
20 The behavior occurs at relatively high rates regardless of what is going on in the students
immediate surrounding environment.
Yes
No
21. The student seems to have few known reinforcers or rarely engages in appropriate object
manipulation or play behavior.
Yes
No
22. The student is generally unresponsive to social stimulation.
Yes
No
23. The student often engages in repetitive, stereotyped behaviors such as body rocking, hand or
finger waving, object twirling, or mouthing, etc.
Yes
No
24. When the student engages in the behavior, you and others usually respond by doing nothing
(i.e., you never or rarely attend to the behavior).
Yes
No
25. The behavior seems to occur in cycles. During a high cycle, the behavior occurs frequently
and is extremely difficult to interrupt. During a low cycle, the behavior rarely occurs.
Yes
No
26. The behavior seems to occur more often when the student is ill.
Yes
No
27. The student has a history of recurrent illness (e.g., ear or sinus infections, allergies,
dermatitis).
Yes
No
SCORING SUMMARY
Circle the items answered Yes. If you completed only Part II, also circle Items 1, 2, and 3.
Likely Maintaining Variable:
12345678
Replacements
1. Head on Table
Laying Down
3. Food, snacks an drink_He will eat anything and only drink water.
X. Previous Interventions: Provide a summary of any previous interventions and their effects
upon the problem behavior. Include descriptions of procedures, dates and summary of behavioral
data if available.
There have not been any previous interventions.