Behavior:____________________________ Client:____________________ Observer: _______________ Date : _____
Adapted from © 2007 The Florida Center on Self Injury Form
Trial Based Functional Analysis
Directions: Conduct trials up to over a 7 day period. Each 4 min trial consists of two, 2 min
segments; a control and a test segment. Conclude by summarizing the % of each trial type with PB.
Control: First 2 min segment in the trial. (a) No problem behavior (PB)
occurs by the end of the 2 min segment, circle (-), go to test. (b) PB occurs,
circle (+), end segment, go to test.
Test: Second 2 min segment in the trial. (a) No PB occurs by the end of
the 2 min segment, circle (-), end segment. (b) PB occurs, deliver specified
consequence, circle (+), end segment.
Attention: Control: Stand near client, deliver noncontingent attention (no tasks).
Test: Stand near client but ignore, deliver attention contingent on
occurrence of PB.
Task/Demand: Control: Observe while no task demands are present.
Test: Deliver prompts to engage in difficult work, remove work contingent on
occurrence of PB.
Alone: Test 1 & 2: Two consecutive test segments are conducted. Observe when client is
not working, not interacting with others, and has no access to leisure items.
Tangible: Control: Client has access to preferred leisure items.
Test: Stand near client but hold leisure items, deliver items contingent on occurrence
of PB.
Trial
Attention Task Alone Tangible
Control Test Control Test Test 1 Test 2 Control Test
1 + - + - + - + - + - + - + - + -
2 + - + - + - + - + - + - + - + -
3 + - + - + - + - + - + - + - + -
4 + - + - + - + - + - + - + - + -
5 + - + - + - + - + - + - + - + -
6 + - + - + - + - + - + - + - + -
7 + - + - + - + - + - + - + - + -
8 + - + - + - + - + - + - + - + -
9 + - + - + - + - + - + - + - + -
10 + - + - + - + - + - + - + - + -
11 + - + - + - + - + - + - + - + -
12 + - + - + - + - + - + - + - + -
13 + - + - + - + - + - + - + - + -
14 + - + - + - + - + - + - + - + -
15 + - + - + - + - + - + - + - + -
16 + - + - + - + - + - + - + - + -
17 + - + - + - + - + - + - + - + -
18 + - + - + - + - + - + - + - + -
19 + - + - + - + - + - + - + - + -
20 + - + - + - + - + - + - + - + %
PB
Additional Comments: