Quick ABC Data Form with Duration Date: ________________Student: _______________ Observer: ________________________

Time Location (circle) Transition (hallway) Classroom Resource Room Outside Computer lab Lunch Room Bathroom Other: Transition (hallway) Classroom Resource Room Recess Lunch Room Bathroom Other: Transition (hallway) Classroom Resource Room Recess Lunch Room Bathroom Other: Transition (hallway) Classroom Resource Room Recess Lunch Room Bathroom Other: Activity at Onset
Independent work Exercise Special: _________ Deskwork ________ Speech Computer Lunch Recess Hygiene Independent work Exercise Special: _________ Deskwork ________ Speech Computer Lunch Recess Hygiene Independent work Exercise Special: _________ Deskwork ________ Speech Computer Lunch Recess Hygiene Independent work Exercise Special: _________ Deskwork ________ Speech Computer Lunch Recess Hygiene

Trigger / Antecedent
Interruption Task demand Transition to low preference Transition from high preference Adult Demand Request denied Other: Interruption Task demand Transition to low preference Transition from high preference Adult Demand Request denied Other: Interruption Task demand Transition to low preference Transition from high preference Adult Demand Request denied Other:

Behavior
Refusal Drop to floor Out of bounds Threats/ Name calling Property destruction Crying/yelling Other:

Consequence
Ignore Verbal Redirect Adult attention Escape area Avoid/delay activity Other:

Duration
0-1 min 1-5 min 5-10 min 10-15 min 15+ min

Comments

Refusal Drop to floor Out of bounds Threats/ Name calling Property destruction Crying/yelling Other:

Ignore Verbal Redirect Adult attention Escape area Avoid/delay activity Other

0-1 min 1-5 min 5-10 min 10-15 min 15+ min

Refusal Drop to floor Out of bounds Threats/ Name calling Property destruction Crying/yelling Other:

Ignore Verbal Redirect Adult attention Escape area Avoid/delay activity Other

0-1 min 1-5 min 5-10 min 10-15 min 15+ min

Interruption Task demand Transition to low preference Transition from high preference Adult Demand Request denied Other:

Refusal Drop to floor Out of bounds Threats/ Name calling Property destruction Crying/yelling Other:

Ignore Verbal Redirect Adult attention Escape area Avoid/delay activity Other

0-1 min 1-5 min 5-10 min 10-15 min 15+ min

Cash-ins 1 Time # Tokens Reward

Adapted from Linda Mulley, Practical Autism Resources

10

11

12

13

14

15