APPENDIX M: TRIAL-BASED (CLASSROOM) FUNCTIONAL ANALYSIS RECORDING Student's Name: FORM Teacher: Behavior Definition (in specific, observable, measurable terms): Date/Session: Each trial consists of two segments (control, then test). Control: If no PB by the end of the one min, circle "-" and go to test. If PB occurs before one min, circle "+" end segment immediately, and go to test. Test: If no PB by the end of three min, circle "." and end segment. If PB occurs before three min, deliver specified consequence, circle "+", and end segment. Summarize as % of each trial type with PB. Attention: Demand: Ignore: Tangible: Control: Stand near student; deliver noncontingent attention (pleasant conversation, no tasks). Access to tangible is allowed. Test: Stand near student but ignore (no tasks); deliver attention only following PB. Access to tangible is allowed. Control: Observe while no task demands are present. Access to tangible is allowed. Test: Deliver frequent prompts to engage in difficult work; remove work immediately following PB. Access to tangible is allowed. Two consecutive test segments are conducted. Observe when student is not working, and not interacting with others, and no access to tangibles. Control: Student has access to preferred item (tangible). Test: Stand near student but hold tangible; deliver only following PB. Trial Attention Demand Ignore Tangible Control Test Control Test Test 1 Test 2 1 + + + + Control Test + + Trial Attention Demand Ignore Tangible Control Test Control Test Test 1 Test Control 2 Test 2 + + + + '+ + + - + % PB Adapted from The Florida Center on Self-Injury, 2007