Checklist of Communicative Functions of Behaviors
Name: _____________________ Evaluator: ________________________ Date/Time: _________________ Environmental Context: _________________
Directions: Mark an “X” or place tally marks in the matrix to show the possible functions of the communicative acts of the person being observed.
Social
Attention
Social
Attention
Social
Object/Activity
AVOID/ESCAPE
NonSocial
Social
Object/Activity
OBTAIN
NonSocial
Activities:
Pain
Hunger
Fear
Social
Interaction
Physical Contact
Assistance
Food
Objects:
Activities:
Tina T. Dyches, Brigham Young University (2008)
Other:
Sign/Manual System
Nod/Shake Head
Gaze Shift/Aversion
Facial Expression
Other:
Touch
Tantrum
NON-VERBAL
Show
Self-Stimulation
Push/Pull
Point
Perseverative Ritual
Hug/Kiss
Give/Take
Aggression to Self
Aggression to Others
Other:
PHYSICAL
Scream/Yell
One-Word
Multi-Word
Laugh/Giggle
Echolalia-Immediate
Echolalia-Delayed
Cry/Whine
POSSIBLE
FUNCTION
Self-Stimulation
Rehearsal
Relaxation
Social
Interaction
Physical Contact
Assistance
Permission
Food
Objects:
Bizarre Verbal/Vocal
VERBAL/VOCAL