Written by:
Lisa Tereshko, PhD, BCBA-D
Endicott College

Description:

Autism Treatments SummaryImagine you could not speak and had a condition that suddenly confined you to a chair. It’s dinnertime and a family member brings you your dinner but accidentally leaves it out of reach before leaving the room. You begin banging your head on the back of the hard chair in hopes that someone hears and comes to assist you. They come in the room but instead of pushing your dinner closer to you, they put a pillow behind your head to prevent injury and leave again. You try again but this time they don’t come to help. What if there was a process that could be implemented to help your family understand what led you to bang your head on the chair, wouldn’t you want them to engage in that effort? A functional behavior assessment is just that process.

A functional behavior assessment (FBA) is a process for determining why an individual is engaging in certain behaviors. Oftentimes, autistic individuals engage in various challenging behaviors (e.g., self-injurious behavior and aggression). Sometimes interventions for challenging behaviors are implemented without an FBA which could lead to increased frequency or intensity of the challenging behavior or the emergence of a novel challenging behavior. Conducting an FBA prior to the implementation of an intervention helps to ensure an effective intervention is designed and implemented as it provides a window into the purpose of the challenging behavior for the individual. An FBA aids the clinician in identifying the different reasons an individual is engaging in a behavior (Hanley, 2012). Most often, autistic individuals engage in various challenging behaviors to gain access to a desired item or attention from another person, escape or delay an undesired task, or to access the sensory input they gain by engaging in the behavior. The information gathered through the FBA process is then used to develop a function-based intervention (that typically includes multiple components) that addresses the conditions that were observed to affect the target behavior. The function-based intervention often includes increasing a prosocial behavior that can replace the challenging behavior (e.g., asking for help, signing for a break). The FBA is essential for accurate identification of a replacement behavior that will serve the same purpose as the challenging behavior, as well as proactive strategies that may lessen the need for the individual to engage in the behavior in the first place.

There are multiple components within the process of a functional behavior assessment that can be taken.

    • Indirect Assessments: Indirect assessments involve asking questions to the individual and/or those close to the individual. Questions may include asking about scenarios in which the behavior occurs and what often follows the behavior. Indirect assessments do not require direct observation of the target behavior by the assessor as the information is collected through interviews or questionnaires.
    • Descriptive Assessments: Descriptive assessments do require direct observation of the target behavior by the assessor. During observations, the assessor observes what happens before and after the target behavior occurs to determine the conditions that occur most often before and after the target behavior. These observations do not involve any manipulation of or changes to the conditions in the environment that may influence the behavior.
    • Functional Analyses: A functional analysis is the final component that may be part of the FBA process. A functional analysis involves direct observation of the target behavior by the assessor, but the observation occurs while systematically altering an aspect of the environment. For example, the assessor may remove their attention from the individual, then if the individual engages in the target behavior, they would provide brief attention to the individual. These manipulations allow the assessor to test if different conditions increase the likelihood of the target behavior. The functional analysis is often used to test and confirm hypothesized functions (i.e., reasons for the behavior) of the target behavior gathered from the indirect and descriptive assessments (Hanley, 2012). So, using the example condition described above, if the target behavior occurred more during that situation, the assessor could confirm that the function of (or reason for) the target behavior was to gain attention.

Research Review:

There is a large body of research that supports the use of functional behavior assessments to identify the reasons why individuals with autism engage in various target behaviors. In a review of evidence-based practices for autistic individuals by Hume et al. (2021), they found 21 studies of functional behavior assessments with positive results that targeted a variety of skills such as academic, behavioral, communication, and school readiness.

Two systematic literature reviews also provided further support for the implementation of FBAs to help guide intervention. A literature review of behavioral interventions for children with self-injurious behavior identified, out of the 66 participants, the majority of participants (92.4%) had at least one of the identified components of an FBA completed prior to the implementation of their intervention (Erturk et al., 2017). Indirect assessments (e.g., questionnaires or interviews) were used with 25.6% of the participants and descriptive assessments (i.e., direct observations) were used with 80.3% of the participants. Functional analyses were used with 77% of the participants. When at least one step of the FBA process was implemented with the participants, positive intervention outcomes were observed for 78% of the participants (Erturk et al., 2017). In another review looking at the use of FBAs with adults, Muharib & Gregori (2022) identified 43 articles that implemented FBAs with their participants prior to intervention and found positive results from the intervention in 92.9% of the studies (mixed results were reported in the remaining three studies).

Comparative studies have also examined the effectiveness of FBAs. Jeong et al. (2020) conducted a systematic literature review to examine if interventions implemented following an FBA demonstrated differences compared to those interventions implemented without an FBA. Jeong et al. (2020) reviewed 24 studies and found a higher percentage of reduction of targeted behaviors was observed following an FBA. This review also noted that the included FBAs were used to decrease a variety of target behaviors (e.g., off task behavior, out of seat, verbal and physical aggression, talking out, self-injurious behavior, property destruction, non-contextual facial expressions, tantrums, and food refusal) and increase a variety of target behaviors (e.g., food acceptance, appropriate toy play, on task behavior, academic engagement, and appropriate communication). Call et al. (2023) conducted another comparative study to examine FBAs conducted with autistic children with and without the step of a functional analysis. They evaluated the results of FBAs that did not include functional analyses for 26 participants and FBAs that did include functional analyses for 31 participants. The study found no significant differences between the groups’ outcomes following intervention but did note that the results of other components of the FBA did not always align with the results of the functional analysis. This difference between outcomes of the indirect and descriptive assessments compared to the functional analysis emphasizes the need for a functional analysis to be a part of an FBA to ensure accurate identification of why the target behavior is occurring.

Research has also been conducted to train teachers, parents, and caregivers of individuals with autism to participate in and implement FBAs. Nesselrode et al. (2022) reviewed research on FBAs conducted in public school settings. They found 42 studies that met their criteria with 26% of the participants across the studies being diagnosed with autism. Teachers successfully implemented FBAs in 36.3% of the studies and a combination of teachers, researchers, and teaching assistants successfully implemented or participated in FBAs in 11.4% of the studies. In another review by O’Neill et al. (2025), the researchers found 34 articles assessing parent and caregiver involvement in intervention and found that across all the studies, parents or caregivers participated in 82% of the FBAs. Specifically, 74% of the parents and caregivers participated in indirect assessments, 24% participated in descriptive assessments, and 52% participated in functional analyses.

Recently, functional behavior assessments have also been implemented or trained remotely. Lindgren et al. (2020) implemented a study that remotely trained parents of 41 children with autism to successfully implement a functional analysis followed by a function-based intervention. This study further extended the work done by Lindgren et al. (2016) that compared the training of parents to implement functional analyses delivered via in-home therapy, in clinic-based telehealth, or home-based telehealth and found all three methods resulted in significant behavior reduction. A systematic literature review examining training delivered remotely to staff to increase accurate implementation of FBAs reviewed 8 articles (4 of which were with autistic individuals) and found staff mastered the implementation of FBAs in 87.5% of the studies (Nylen & King, 2024).

Recommendations:

In the research, the application of functional behavior assessments has been very well documented as an effective method to increase the likelihood of an effective intervention being implemented (Call et al., 2023; Erturk et al., 2018; Lindgren et al., 2020; Muharib & Gregori, 2022). The research supporting FBAs cited within this article, the findings within the National Standards Project Phase 2 (2015) that discuss behavioral interventions as an established intervention, and outcomes within systematic reviews of evidence-based practices (e.g., Hume et al., 2021) support the recommendation of the implementation of FBAs prior to intervention for individuals with autism. However, even with the support in the research, it is essential that the determination to implement an FBA be made by an individual’s direct support team.

For providers, when implementing an FBA with an individual, it is important to assess the safety risk for completing and not completing the assessment. For individuals with behaviors that pose a high risk of injury to themselves or others, an experienced clinician should evaluate which type of FBA components should be used to minimize potential harm to those involved. For example, if a functional analysis is used to identify the purpose of self-injury, it may temporarily escalate self-injurious behavior during the analysis which could result in the individual injuring themselves. However, the risk of not completing a functional analysis is that we may not be able to identify the function of self-injury, which may lead to an increase in self-injury if an inappropriate intervention is implemented. An alternative solution might be to use a functional analysis for behaviors that often precede the self-injurious behavior, which may be more appropriate or non-harmful (e.g., yelling), as this could prevent the occurrence of self-injury but still assess its reason for occurring (Hanley, 2012). These are complex decisions and practitioners should always remember to practice within their scope of competence and seek training, supervision, and consultation when needed to develop appropriate assessments and functionally relevant plans.

For parents and caregivers faced with challenging behaviors presented by their child or another individual under their care, the implementation of an FBA by an experienced professional can lead to the development and implementation of effective function-based interventions. To increase the success of this process for their child, parents and caregivers should ask the practitioner which type of FBA will be used to develop the plan (i.e., the use of indirect assessments, descriptive assessments, functional analyses, or a combination). Also, they can inquire about how the results of the FBA will be used to inform the selection of intervention procedures. Finally, parents and caregivers should ask about what communication and coping skills are suggested as replacement behaviors based on the function of the challenging behavior. These questions can help caregivers fully understand the individualized FBA process that will be used and increase their confidence in the rationale for the assessment.

Although research strongly supports the implementation of FBAs to identify why an individual is engaging in a particular behavior, identifying the essential components of an FBA still requires more research. The functional analysis has been identified to be the gold standard for identifying the cause of various behaviors (Call et al., 2023; Lindgren et al., 2016; Sanini et al., 2020) because it has consistently resulted in decreases in target behaviors when interventions are implemented based on functional analysis results. However, research is more mixed when comparing indirect assessments and descriptive assessments (Call et al., 2023). Future research should explore the components of FBAs to ensure accurate assessment application. In the meantime, it is clear that FBAs are an evidence-based practice that increase the likelihood that an effective intervention is selected and implemented for individuals with autism and therefore, it is recommended that FBAs be used when developing interventions for autistic individuals exhibiting challenging behavior.

Selected References:

Systematic Reviews and Task Forces

Erturk, B., Machalicek, W., & Drew, C. (2018). Self-injurious behavior in children with developmental disabilities: A systematic review of behavioral intervention literature. Behavior Modification, 42(4), 498-542. https://doi.org/10.1177/0145445517741474

Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders 51, 4013-4031. https://doi.org/10.1007/s10803-020-04844-2

Jeong, Y., & Copeland, S. R. (2020). Comparing functional behavior assessment-based interventions and non-functional behavior assessment-based interventions: A systematic review of outcomes and methodological quality of studies. Journal of Behavioral Education, 29, 1-41. https://doi.org/10.1007/s10864-019-09355-4

Muharib, R., & Gregori, E. (2022). A systematic and quality review of function-based interventions for adults with intellectual and developmental disabilities. Journal of Developmental and Physical Disabilities, 34, 739-773. https://doi.org/10.1007/s10882-021-09825-6

National Autism Center. (2015). Findings and conclusions: National Standards Project, Phase 2. Author.

Nesselrode, R., Falcomata, T. S., Hills, L., & Erhard, P. (2022). Functional analysis in public school settings: A systematic review of the literature. Behavior Analysis in Practice, 15, 958-970. https://doi.org/10.1007/s40617-022-0067908

Nylen, B., & King, S. (2024). Training practitioners to conduct a functional behavior assessment via telehealth-delivered behavioral skills training: A systematic literature review. Journal of Behavioral Education, 33, 746-768. https://doi.org10.1007/s10864-023-09514-8

O’Neill, P., & Koudys, J. (2025). Scoping review: Caregiver training to reduce challenging behaviors displayed by children on the autism spectrum. Behavior Analysis in Practice, 18, 56-73. https://doi.org/10.1007/s40617-024-00960-y

Sanini, V., Fisher, W. W., Retzlaff, B. J., & Keevy, M. (2020). Efficiency in functional analysis of problem behavior: A quantitative and qualitative review. Journal of Applied Behavior Analysis, 53(1), 44-66. https://doi.org/10.1002/jaba.583

Selected Scientific Studies

Call, N. A., Bernstein, A. M., O’Brien, M. J., Schieltz, K. M., Tsami, L., Lerman, D. C., Berg, W. K., Lindgren, S. D., Connelly, M. A., & Wacher, D. P. (2023). A comparative effectiveness trial of functional based assessment methods. Journal of Applied Behavior Analysis, 57(1), 166-183. https://doi.org/10.1002/jaba.1045

Lindgren, S., Wacker, D., Schieltz, K., Suess, A., Pelzel, K., Kopelman, T., Lee, J., Romani, P., & O’Brien, M. (2020). A randomized controlled trial of functional communication training via telehealth for young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50, 4449-4462. https://doi.org/10.1007/s10803-020-04451-1

Lindgren, S., Wacker, D., Suess, A., Schieltz, K., Pelzel, K., Kopelman, T., Lee, J., Romani, P., & Waldron, D. (2016). Telehealth and autism: Treating challenging behavior at lower cost. Pediatrics, 137(S2), e20152851. https://doi.org/10.1542/peds.2015-28510

Other References

Hanley, G. P. (2012). Functional assessment of problem behavior: Dispelling myths, overcoming implementation obstacles, and developing new lore. Behavior Analysis in Practice, 5(1), 54-72. https://doi.org/10.1007/BF03391818

Reference for this article:

Tereshko, L. (2025). A treatment summary: Functional behavior assessment. Science in Autism Treatment, 22(8).

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