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Functional Behavioral Assessment (FBA)

STUDENT: AM DOB: ##/##/## Page 1 of 8 Functional Behavioral Assessment (FBA) Student: AM DOB: ##/##/## Age: 7-2 Grade: 1 School/District: Sunshine Academy/SFUSD Case Manager: Ms. H Assessor: Dr. L, PsyD, BCBA Date of Report: ##/##/## Background Information AM is a seven-year-old, male, Hispanic student currently receiving Special Education (SPED) support as a student exhibiting characteristics most consistent with the educational eligibility of Autistic-Like Behaviors (AUT). He is currently enrolled in a small, highly-structured, Special Day Class (SDC) setting at Sunshine Academy, a Non-Public School (NPS) program.

Page 2 of 8 Problem Behavior(s) Based upon input from staff currently working with AM and from AM’s mother, the following target behaviors were placed under study: Target Behavior 1 (TBx1) – removing his own shirt during inappropriate times. Target Behavior 2 (TBx 2) – pinching his own skin, with at least moderate force.

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