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Nd Program Development for Problem Behavior. Pacific Grove, CA: Brooks/Cole Publishing. FUNCTIONAL ASSESSMENT INTERVIEW FORM YOUNG CHILD Child with Problem Behavior(s): Age: Yrs Date of Interview: Mos Interviewer: Sex: M F Respondent(s): A. DESCRIBE THE BEHAVIOR(S) 1. What are the behaviors of concern? For each, define how it is performed, how often it occurs per day, week, or month, how long it lasts when it occurs, and the intensity in which it occurs (low, medium, high). Behavior.

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