9.1 Indirect Assessment Methods and Review of Records

The Foundations and Core Purposes of Behavioral Assessment

In applied behavior analysis (ABA), behavioral assessment is not a static, one-time pre-treatment administrative requirement. Rather, it is a dynamic, multi-phase scientific process designed to identify, define, and measure socially significant behaviors, uncover the environmental variables that reliably evoke and maintain those behaviors, and guide the selection of individualized, function-based behavior-change interventions (Cooper, Heron, & Heward, 2020; Hawkins, 1979).

Hawkins (1979) conceptualized behavioral assessment as a funnel-shaped continuum that progresses systematically from broad, exploratory evaluations to narrow, highly focused empirical investigations. The comprehensive assessment continuum encompasses five fundamental clinical purposes:

1. Screening and General Disposition: Determining whether an individual requires behavioral services, identifying whether referral concerns fall within the scope of practice of applied behavior analysis, and ruling out immediate medical or psychiatric crises that mandate urgent referral to other disciplines.
2. Defining and Quantifying Target Behaviors: Delineating ambiguous referral complaints (e.g., "aggressive", "hyperactive", "noncompliant") into objective, measurable, and observable operational definitions, while establishing baseline parameters (frequency, rate, duration, latency, interresponse time, or intensity).
3. Uncovering Functional Relations and Pinpointing Environmental Variables: Isolating the motivating operations (MOs), discriminative stimuli ($S^D$s), and maintaining reinforcement contingencies (positive, negative, or automatic) that govern the occurrence of target responses.
4. Guiding Intervention Selection and Design: Providing empirical data necessary to engineer proactive antecedent modifications, establish functionally equivalent replacement behaviors (FERBs), and eliminate maintaining reinforcement contingencies for problem behavior (extinction).
5. Continuous Progress Monitoring and Outcome Evaluation: Establishing baseline benchmarks against which treatment fidelity, intervention efficacy, maintenance, generalization, and social validity are systematically and repeatedly judged over time.

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Comprehensive Review of Records and Biological Setting Events

A thorough record review is a mandatory initial step in any comprehensive behavioral assessment. Behavior analysts must never conceptualize a client's behavior in an environmental vacuum; biological, physiological, and historical variables substantially interact with current operant contingencies.

Educational and Developmental Records

Reviewing past educational records—such as Individualized Education Programs (IEPs), Section 504 plans, psychoeducational evaluation reports, and multi-tiered systems of support (MTSS) tracking logs—provides vital information regarding:

• Prior standardized cognitive, linguistic, and academic achievement benchmarks.
• Previously attempted academic accommodations and instructional modifications.
• Historical response-to-intervention data across various pedagogical arrangements.
• Current individualized educational goals, ensuring that behavior-analytic programming complements and reinforces academic curricula rather than duplicating or conflicting with school-based mandates.

Medical, Physiological, and Psychiatric Histories

Physiological events frequently operate as powerful motivating operations (MOs) or biological setting events that alter the reinforcing or punishing effectiveness of environmental consequences and momentarily alter the frequency of behavior reinforced by those consequences. A behavior analyst must meticulously review medical records, nursing logs, physical examination summaries, and specialized diagnostic evaluations (e.g., sleep studies, gastrointestinal panels, allergy screenings, neurological consults).

Key biological variables that require systematic screening include:

• Gastrointestinal (GI) Distress: Chronic constipation, gastroesophageal reflux disease (GERD), and irritable bowel syndrome are prevalent among individuals with autism spectrum disorder and severe developmental disabilities. Acute visceral pain acts as an unconditioned establishing operation (EO) that increases the value of escape from demands or evokes severe self-injurious behavior (SIB) maintained by automatic pain attenuation.
• Dental Pathologies: Undetected caries, impacted wisdom teeth, or abscesses can evoke intense head banging, jaw punching, or aggression during eating routines.
• Otitis Media (Ear Infections): Middle ear inflammation and pressure evoke head hitting, ear pulling, and severe irritability, often mistakenly diagnosed as "sensory seeking" or escape from academic instruction.
• Sleep Disruptions: Chronic sleep deprivation, sleep apnea, or irregular sleep-wake cycles lower frustration tolerance, functioning as an omnibus establishing operation that magnifies the aversive properties of everyday task demands.
• Allergies and Dermatological Conditions: Eczema, hives, or environmental allergies can evoke severe scratching, skin picking, and agitation.
• Neurological Conditions and Seizure Disorders: Subclinical seizure activity, post-ictal states, or medication-related neurological side effects can produce abrupt, unexplained behavioural shifts, disorientation, or drop attacks.

When severe problem behavior (such as explosive aggression or acute self-injury) exhibits a sudden, dramatic onset without an obvious environmental change, the behavior analyst has an ethical obligation under the BACB Ethics Code to recommend a comprehensive medical examination before initiating behavioral interventions.

Pharmacological Documentation

Psychotropic medications (e.g., atypical antipsychotics, stimulants, selective serotonin reuptake inhibitors, mood stabilizers, alpha-2 adrenergic agonists) produce complex behavioral and physiological effects. The assistant behavior analyst must document:

• Exact medication names, daily dosages, dosing schedules, and recent dose titrations.
• Documented side-effect profiles (e.g., akathisia, tardive dyskinesia, sedation, ataxia, xerostomia/dry mouth, extreme polydipsia/thirst, changes in appetite).
• Potential drug-behavior interactions: For instance, a medication causing extreme drowsiness alters the motivating operation for task engagement, while a medication causing increased appetite significantly magnifies food-based motivating operations.

Historical Behavioral Programming

Scrutinizing previous Behavior Support Plans (BSPs), functional assessments, and crisis management protocols prevents the reinvention of failed strategies and illuminates potential pitfalls. Behavior analysts evaluate:

• Interventions that previously demonstrated robust behavioral reduction or skill acquisition.
• Documented treatment integrity failures that caused prior interventions to falter.
• Histories of intensive punishment procedures, which may have produced conditioned emotional responses, escape/avoidance repertoires, or countercontrol against clinical staff.

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Indirect Functional Behavioral Assessment Methodologies

Indirect functional assessment methods gather retrospective information about the target behavior, antecedent events, and maintaining consequences from informants who know the individual well (e.g., parents, teachers, paraprofessionals, residential staff) without directly observing or experimentally manipulating the behavior itself.

Structured Informant Interviews

• Functional Assessment Interview (FAI): Developed by O'Neill et al. (1997), the FAI is an exhaustive, semi-structured clinical interview protocol consisting of 11 open-ended sections. It systematically assesses target behaviors, setting events (ecological, physical, and physiological factors), immediate antecedents, perceived communicative functions, maintaining consequences, skill proficiencies, reinforcer effectiveness, and historical intervention attempts.
• Clinical Intake and Diagnostic Interviews: Semi-structured intake interviews conducted with family members and educators to delineate the client's developmental milestones, family dynamics, cultural background, daily routines, and primary caregiver priorities.

Standardized Checklists and Rating Scales

Standardized indirect instruments utilize structured, closed-ended Likert scales or dichotomous questions to quantify informant impressions of behavioral function:

• Motivation Assessment Scale (MAS): Developed by Durand and Crimmins (1988), the MAS consists of 16 Likert-scale items (rated from 0 = "Never" to 6 = "Always") designed to evaluate the likelihood of target behavior occurring under specific environmental circumstances. It categorizes maintaining contingencies into four distinct functional domains: Sensory (automatic positive reinforcement), Escape (social negative reinforcement), Attention (social positive reinforcement), and Tangible (social positive reinforcement via access to items/activities).
• Questions About Behavioral Function (QABF): Developed by Paclawskyj, Matson, Rush, Smalls, and Vollmer (2000), the QABF consists of 25 items rated on a 4-point scale (0 = "Never", 1 = "Rarely", 2 = "Some", 3 = "Often"). It evaluates five distinct behavioral functions: Attention, Escape, Non-social (automatic reinforcement), Physical (pain or internal biological discomfort), and Tangible.
• Functional Analysis Screening Tool (FAST): Developed by Iwata, DeLeon, and Roscoe (2013), the FAST comprises 16 dichotomous (Yes / No) questions organized into four functional categories: Social Positive (attention and preferred items), Social Negative (escape from instructional tasks or activities), Automatic Positive (sensory stimulation), and Automatic Negative (pain attenuation or alleviation of discomfort).

Psychometric Strengths and Critical Inherent Limitations

While indirect assessments are ubiquitous in applied settings, assistant behavior analysts must maintain a rigorous scientific understanding of their psychometric profile:

• Clinical Strengths:
  • High Administrative Efficiency: Rating scales and checklists can be administered in 10 to 20 minutes, requiring minimal clinician time.
  • Zero Direct Evocation of Dangerous Behavior: Because indirect tools do not place the client in analog test conditions, they present zero risk of physical injury, making them safe for preliminary screening of lethal behaviors.
  • Broader Ecological Context: Informants observe the individual across weeks, months, or years across diverse natural settings (home, bus, community) that a behavior analyst cannot observe directly.
  • Useful for Generating Preliminary Hypotheses: Indirect data help clinicians construct initial operational definitions, identify potential motivating operations, and select conditions for subsequent direct observation.
• Inherent Scientific Limitations:
  • Subjectivity and Informant Bias: Responses depend entirely on retrospective human memory, which is vulnerable to recency effects, confirmation bias, emotional fatigue, and caregiver burnout.
  • Poor Inter-Rater and Test-Retest Reliability: Empirical investigations (e.g., Sigafoos et al., 1994; Zarcone et al., 1991; Alter et al., 2008) have repeatedly demonstrated that different informants completing the MAS or FAST for the same client often produce conflicting functional rankings, with inter-rater agreement coefficients frequently falling below $0.50$ Kappa.
  • Limited Validity: When indirect results are compared with experimental functional analyses, agreement is modest and inconsistent across studies, so a rating-scale profile cannot confirm function.
  • Best-Practice Rule: Indirect functional assessment instruments should never serve as the sole basis for developing a behavior intervention plan, selecting an extinction procedure, or asserting a functional relation.

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Operationalizing Target Behaviors and Establishing Priorities

A target behavior cannot be reliably assessed, observed, or modified until it has been explicitly operationalized. An operational definition translates ambiguous clinical descriptions into precise, objective criteria.

Hawkins and Dobes (1977) Criteria for Behavioral Definitions

A high-quality behavioral definition must satisfy three core standards:

1. Objective: Refers exclusively to observable characteristics of the behavior and immediate environmental events. It avoids internal mentalistic constructs (e.g., "anger", "frustration", "defiance", "anxiety").
2. Clear: Unambiguous and easily readable such that an unfamiliar observer or novel technician could read the definition and accurately record instances without prior training.
3. Complete: Delineates the explicit boundaries of what constitutes an instance (inclusions) and what does not constitute an instance (exclusions), leaving zero room for subjective observer interpretation.

Function-Based vs. Topography-Based Definitions

• Function-Based Definitions: Define the target behavior strictly by its common effect on the environment (the functional response class), regardless of physical form. For example: "Elopement is defined as any instance in which the client moves greater than 5 feet away from the supervising adult without permission, resulting in adult pursuit or escape from a scheduled task." Function-based definitions are preferred because they capture all functionally equivalent topographies and focus directly on the operant mechanism.
• Topography-Based Definitions: Define the behavior strictly by its physical form, shape, or motor execution. Indicated when the behavior analyst does not yet know the function, or when multiple distinct topographies produce different environmental impacts (e.g., "Head hitting is defined as any contact between an open or closed hand and any portion of the skull from above the neck, audible from 3 feet away").

Setting Behavioral Priorities

When a client presents with multiple challenging behaviors, the behavior analyst must prioritize targets using socially valid, ethical criteria:

1. Danger to Self or Others: Behaviors threatening physical safety (severe SIB, violent aggression, elopement into traffic) receive immediate, primary priority.
2. Frequency, Duration, and Chronicity: Pervasive, chronic behaviors that disrupt extensive portions of daily living.
3. Habilitation and Access to Reinforcing Environments: Behaviors that, if reduced, unlock access to least restrictive environments (LRE), inclusive classrooms, community participation, and natural reinforcers.
4. Prerequisite Competencies for Future Skill Acquisition: Behaviors that interfere with attending, instructional control, or basic communication repertoires.
5. Reduction of Negative Attention and Stigmatization: Behaviors that provoke social rejection, caregiver isolation, or restrictive physical interventions.

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Comparative Matrix of Indirect Assessment Instruments

The following table compares the structural characteristics, informant formats, target functions, psychometric properties, and clinical limitations of primary indirect assessment instruments:

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Clinical Troubleshooting and Common Assessment Pitfalls

• Pitfall 1: Relying Exclusively on Indirect Assessments to Author a Behavior Support Plan: Implementing an extinction protocol based solely on a high score on the MAS Attention subscale is a major clinical and ethical violation. If the behavior is actually maintained by automatic reinforcement or escape, attention extinction will fail and may cause severe harm.
• Pitfall 2: Overlooking Medical Etiologies in Sudden Behavioral Bursts: Assuming that a sudden escalation of aggression during circle time is purely "escape from instruction" without screening for ear infections, tooth abscesses, or gastrointestinal impactions can result in medical neglect.
• Pitfall 3: Formulating Mentalistic Operational Definitions: Defining noncompliance as "when the student chooses to be defiant or demonstrates an obstinate attitude" violates the criterion of objectivity. It must be defined as "failure to initiate the teacher's vocal instruction within 5 seconds of presentation."