Name of Student _____________ Date of Report ________________
Date of Tantrum _____________ Time of Tantrum ______________
A.B.C. Functional Behavior Analysis
1. Environmental : Change of Physical Environment (new room, new place)
Change of People in the Physical Environment
Please State Details (which people, how many, etc.)
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
2. Possible Sensory Triggers: Sounds Taste Smell Touch Visual Temperature
Please State Details:
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
3. Other Factors to Consider as Possible Causes (did any of these changes occur?)
Insistence on Sameness of Schedules and Routines
Lack of Social Awareness - Does not pick up on Social Cues
Unable to Communicate Illness or Injury
Frustration at a Task or Following a Rule
Please State Details:
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
4. This Tantrum occurred “out of the blue” with no clearly identifiable rhyme or reason.
Please State Details:
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
Part II . State the Behavior
1. Approximate DURATION of Tantrum (in minutes)
0 .... 5 ....10 ....15 .... 20 .... 25 .... 30 .... 35 ....40 .... 45 .... 50 .... 55 .... 60 +
2. Exact Behavior of the Tantrum (circle all which apply)
PASSIVE
Pouting Sulking ....“Go Limp”.... Crying/Sobbing....Clinging to
Objects
Other (please state) _____________________________________________________
AGGRESSIVE
Yelling.... Shouting.... Screaming.... Cursing.... Hair Pulling
....Hitting.... Biting.... Kicking Throwing Objects (large? small?)
Other (please state) _______________________________________________________
Body Position: Laid in the Floor.... In Chair/At Desk.... Ran Around the Room.... Under a table or desk.... Ran Toward a Person.... Stood in Middle of Room
Other:(please state)__________________________________________________
3. Degree of SEVERITY of the Behaviors
Degree of “Viciousness” of Aggressive Behaviors
1.... 2.... 3.... 4.... 5.... 6.... 7.... 8.... 9.... 10
Did not Leave a mark-- Bruised Skin -- Drew Blood
Hair Pulling Degree of “Viciousness”
1.... 2.... 3.... 4.... 5.... 6.... 7.... 8.... 9.... 10
Touched Hair -- Tugged Hair -- Ripped Hair from Scalp
NO physical confrontation to report.
Part III. Consequenses
Now this part does not mean what punishment did the student receive for this “acting out” behavior. Consequences here just mean what did the adult do immediately following the temper tantrum?
For example: ignored the tantrum, removed the student to a renewal area, used a restraining hold such as a basket hold, etc.
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
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September 27, 1998
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