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Problem Behavior Questionnaire Respondent Information ...

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Problem Behavior Questionnaire Source: Lewis, , Scott, , & Sugai, G. (1994). The Problem Behavior Questionnaire : A teacher-based instrument to develop functional hypotheses of Problem Behavior in general education settings. Diagnostique, 19, 103-115. Reprinted with permission. Respondent Information Student __________________________________ DOB __________ Grade _________ Sex: M F IEP: Y N Teacher ________________________________________ _________ School ______________________________ Telephone_______________________________ _________________ Date ________________________________ Student Behavior : Please briefly describe the Problem Behavior (s) Directions: Keeping in mind a typical episode of the Problem Behavior , circle the frequency with which each of the following statements is true. Percent of the time Never 10% 25% 50% 75% 90% Always 1.

Problem Behavior Questionnaire Profile Directions: Circle the score given for each question from the scale below the corresponding question number (in bold). In interpreting the completed student profile, any item circled at the three (3) or above level represents a

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