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Student: ______________ Grade: ___ Age: ___ Teacher: ___________________________ School: _______________________
Time A B C
Antecedents Behaviour Consequences
(Describe what happens before the (Describe what the student does) (Describe what happens after the
behaviour) behaviour)
Transition from desktop computer to another Run away Time out (escape)
activity Throw himself on floor Physical or verbal redirection (attention)
Change of routine and/or familiar adults Aggression (kicking, screaming, biting, Adults talk to him about behaviour
Peers interfering with toys/play scratching, screaming, crying) (attention)
11:30 –12:15 (with new routine) Hitting self Keep hands busy (sensory)
Other: __________________________ Touching genitals Other: _____________________________
Transition from desktop computer to another Run away Time out (escape)
activity Throw himself on floor Physical or verbal redirection (attention)
Change of routine and/or familiar adults Aggression (kicking, screaming, biting, Adults talk to him about behaviour
Peers interfering with toys/play scratching, screaming, crying) (attention)
11:30 –12:15 (with new routine) Hitting self Keep hands busy (sensory)
Other: __________________________ Touching genitals Other: _____________________________
Transition from desktop computer to another Run away Time out (escape)
activity Throw himself on floor Physical or verbal redirection (attention)
Change of routine and/or familiar adults Aggression (kicking, screaming, biting, Adults talk to him about behaviour
Peers interfering with toys/play scratching, screaming, crying) (attention)
11:30 –12:15 (with new routine) Hitting self Keep hands busy (sensory)
Other: __________________________ Touching genitals Other: _____________________________
Transition from desktop computer to another Run away Time out (escape)
activity Throw himself on floor Physical or verbal redirection (attention)
Change of routine and/or familiar adults Aggression (kicking, screaming, biting, Adults talk to him about behaviour
Peers interfering with toys/play scratching, screaming, crying) (attention)
11:30 –12:15 (with new routine) Hitting self Keep hands busy (sensory)
Other: __________________________ Touching genitals Other: _____________________________