ABA and behaviour therapy assessment report format and sample
An ABA and behaviour therapy assessment report format with sample entries, from referral and strengths to next steps.
✓Strengths come before behaviours of concern
✓Sample entry for every findings section
✓Fill in online, download PDF
Free · No sign-up · Saves in your browser · Built into healhab as “Comprehensive Behavioural and Functional Skills Assessment”
What's inside
Reason for Referral and Priorities
Background and Current Supports
Strengths, Interests, and Preferences
Communication and Social Interaction
Adaptive and Daily Living Skills
Learning Readiness and Participation
Emotional Regulation and Coping
Behaviour(s) Requiring Assessment or Support
+ 6 more sections
Preview · 14 sections
Comprehensive Behavioural and Functional Skills Assessment
Patient
Patient ID
Date of birth
Assessment date
Therapy
Therapist
Languages
Referred by
Reason for Referral and Priorities
Reason for referral
Patient caregiver priorities
Background and Current Supports
Relevant background
Current supports and services
Strengths, Interests, and Preferences
Strengths interests preferences
Communication and Social Interaction
Communication social findings
Adaptive and Daily Living Skills
Adaptive skills findings
Learning Readiness and Participation
Learning readiness participation
Emotional Regulation and Coping
Regulation coping findings
Behaviour(s) Requiring Assessment or Support
Behaviour / Skill Concern
Operational Description
Setting
Frequency / Duration / Intensity Source
Functional Impact
Setting-specific Pattern Summary
Setting Event / Situation
Antecedent
Observed Behaviour
Response / Consequence
Evidence Source
Safety and Safeguarding Considerations
Safety considerations
Summary of Strengths and Support Needs
Strengths
Support Needs
Clinical Formulation / Working Hypotheses
Working hypotheses
Recommendations and Next Steps
recommendations
Data collection follow up
Therapist Sign-off
Therapist
Designation
Registration
Date
How to fill it in
1
Reason for Referral and Priorities
Who referred, what they asked, and what the family wants to change.
More guidance
Write who referred, the question they asked, and what the family wants to change, in their own words where you can. If the referrer's concern differs from the family's priority, record both, because the plan will need to serve both. Keep this factual: who noticed what, where, and since when.
2
Background and Current Supports
Reported history, current services, who does the daily care, and every language used.
More guidance
Record history only as the family or documents report it: health, sleep, feeding, schooling, earlier therapy, and current services with their frequency. Note who lives at home and who does most of the daily care. In joint families a grandparent may manage most routines and needs to be part of the plan. List every language used at home and at school.
3
Strengths, Interests, and Preferences
Preferred activities, people and objects, and how you learned about each one.
More guidance
Give this section real effort. Interests and strengths are the raw material for motivation and teaching, and families notice when a report opens with what their child does well. Record preferred activities, objects, people, foods, songs and sensory experiences, and how you learned about each: direct observation, caregiver report, or a preference check.
4
Communication and Social Interaction
How the person communicates now, in every mode, with real examples.
More guidance
Describe how the person communicates now, across every mode: speech, signs, gestures, pictures, a device, or leading an adult by the hand. Give examples of what they request, refuse, comment on or ask, and with whom. Note how they join others in play or work. Record differences as information and build on what already works for this person.
5
Adaptive and Daily Living Skills
How much help each home routine needs, described as it happens at home.
More guidance
Cover the routines that matter in this household: eating, toileting, dressing, bathing, sleep, and staying safe at home and outside. For each, say how much help is needed and of what kind, such as full physical help, a gesture or a reminder. Describe the skill as it happens at home, including eating with hands or using a jet spray, so goals fit the family's real routine.
6
Learning Readiness and Participation
The conditions under which the person learns best, written precisely.
More guidance
Record the conditions under which the person learns best: seating, group size, length of activity, type of instruction, and what helps them wait, take turns and switch tasks. Note the longest engagement you observed and in which activity. These details decide how sessions are set up, so write them precisely.
7
Emotional Regulation and Coping
What distress looks like, what sets it off, and what helps recovery.
More guidance
Describe what distress looks like for this person, what tends to set it off, and what helps them recover, including strategies they already use. Rocking, humming or hand-flapping may be how someone stays regulated; record these as information and do not list them as behaviours to reduce unless they cause harm. Note how long recovery took and what the adult did that helped.
8
Behaviour(s) Requiring Assessment or Support
Observable definitions of behaviours of concern, with the source of every figure.
More guidance
List only behaviours that cause harm, block learning or participation, or matter to the person and family. Write each one so two observers would agree it happened: describe what the body does, not what you think it means. In the frequency, duration and intensity column, name the source of the figure (ABC sheets, caregiver estimate, your observation) and leave gaps as gaps.
9
Setting-specific Pattern Summary
What was recorded before, during and after, per setting, with evidence sources.
More guidance
Use the table to record what your data show in each setting: what was going on beforehand, what the person did, and how others responded. Cite the evidence source in every row. Keep this to what was recorded. Interpretation belongs in the formulation section, where the clinician who signs the report owns it.
10
Safety and Safeguarding Considerations
Any risk or safeguarding concern, the steps taken, and who was informed.
More guidance
Record any risk to the person or others, any safeguarding concern, and the steps already taken, following your clinic's safety, safeguarding and escalation policy. Name who was informed and when. If restrictive practices are being used at home or school, document them factually and follow the clinic's policy on next steps. Do not write a new safety procedure into the assessment itself.
11
Summary of Strengths and Support Needs
Strengths paired with support needs, each drawn from earlier findings.
More guidance
Pair strengths with needs in two short columns so families can read the main message at a glance. Draw each item from findings earlier in the report. Word needs as the support the person requires, such as support to ask for a break, so the column reads as a plan rather than a list of deficits.
12
Clinical Formulation / Working Hypotheses
The clinician's reviewed reasoning, tied to evidence. Leave it blank rather than guess.
More guidance
This is the treating clinician's reasoning, reviewed by an authorised clinician before the report is shared. Tie every hypothesis to evidence recorded above, state how confident the team is, and name the information still missing. Leave it blank in a draft rather than guess, because a hypothesis written too early tends to shape the data collected afterwards.
13
Recommendations and Next Steps
Numbered next steps: services, further assessment, data to collect, and who does what.
More guidance
List what should happen next: services suggested and how often, whether a functional behaviour assessment is needed for a specific behaviour, further data to collect, and who will do each step by when. Number the items so the treatment plan can refer back to them. Keep recommendations within your own service and record onward referrals separately.
ABA and behaviour therapy assessment report format and sample: filled sample
Fictional entries, initials only, showing the level of detail to aim for. Impression and summary sections are left for the treating clinician.
Reason for Referral and Priorities
Referred by A.'s class teacher for difficulty staying with group activities. Parents' priority: A. asks for food and the toilet without becoming distressed.
Background and Current Supports
Lives with parents, paternal grandmother and an older sister. Grandmother manages mornings and after-school time. Home languages Tamil and English; school instruction in English. Attends speech therapy twice a week.
Strengths, Interests, and Preferences
Seeks out number puzzles and completes 24-piece puzzles without help. Laughs and reaches toward his sister to restart tickle games (caregiver report). Chose the drum over five other toys in a free-choice check.
Communication and Social Interaction
Requests snacks by bringing the packet to an adult. Uses about ten single words in Hindi at home (parent report); said “open” and “more” in session. Watched peers at the sand tray and joined when offered a spade.
Adaptive and Daily Living Skills
Eats rice and dal with his right hand once the plate is set in front of him; an adult mixes the food. Uses the toilet when taken every two hours; does not yet signal the need.
Learning Readiness and Participation
Stayed at the table for about six minutes with a shape sorter and an adult beside her. Left when the activity changed without warning; came back when shown a picture of the next activity.
Emotional Regulation and Coping
When the room became noisy, S. covered her ears and moved to the corner. She settled within two minutes once given her headphones and left alone with an adult nearby.
Behaviour(s) Requiring Assessment or Support
Biting: closes teeth on another person's arm or hand with enough pressure to leave a mark. Caregiver estimates three to four times a week at home; observed once in a 45-minute session.
Behaviour therapy assessment report vs FBA
Assessment report
Functional behaviour assessment (FBA)
Question it answers
What can this person do, and where do they need support across daily life?
Why does this particular behaviour happen, and what could serve the same purpose?
Scope
Communication, adaptive skills, learning readiness, regulation and behaviours of concern
One to three clearly defined target behaviours
Main evidence
Interviews, observation across activities, earlier reports
ABC records, baseline counts or durations, structured interviews
What it leads to
An ABA treatment plan with goals across several domains
A behaviour intervention plan (BIP)
When to write it
At intake and at planned re-assessments
When a specific behaviour affects safety, learning or family life
Tips and mistakes to avoid
Do
Observe in at least two settings, such as the clinic and home, before you write.
Record every language used with the person and the one you assessed in.
Write short, concrete sentences that both the family and the next therapist can use.
For schools, prepare a short teacher note from this report with the family's consent.
In healhab's Template Studio, a clinic can adapt this starter and keep one version for every therapist.
Avoid
Listing harmless self-regulation, such as rocking or humming, as a behaviour to reduce.
Writing labels such as “aggressive” or “non-compliant” in place of what the person did.
Entering estimated frequencies without marking them as estimates and naming the source.
Letting conclusions creep into the findings sections instead of the reviewed formulation.
About this assessment report
An ABA or behaviour therapy assessment report records why someone was referred, what they already do well, how they communicate, manage daily routines and cope with stress, and which behaviours need a closer look. This template gives you those sections in order, with tables for behaviour descriptions and setting patterns, and contains no test items.
A new referral covering communication, daily living and behaviour
A planned re-assessment before rewriting the treatment plan
A move into centre sessions or a new school
A second opinion alongside earlier reports
Read more
This is the broad, first-look report in behaviour therapy, written after intake interviews, observation in a natural setting and a review of earlier reports. It describes the whole person first and behaviours of concern second.
It suits any qualified behaviour therapist under the clinic's supervision arrangements. US clinics call it a behavioral assessment report. For one behaviour and why it happens, use the narrower FBA template.
Questions
What should an ABA assessment report include?+
The referral reason and family priorities, background, strengths, communication, adaptive skills, learning readiness, regulation, defined behaviours of concern with their evidence, safety, a reviewed formulation and numbered recommendations. This template follows that order so the treatment plan can pick up each finding.
Is there a filled sample of this assessment report?+
Each section guide shows a fictional sample entry, using initials only, so you can see the level of detail to aim for. The formulation and summary sections have guidance only, because the treating clinician writes them from their own findings.
Can I add results from a curriculum assessment or standardised test?+
Yes. If your clinic uses a licensed tool, record its name, the date given, and the results exactly as the manual reports them in the relevant section. The template itself contains no test items and does not interpret any instrument.
Who writes a behaviour therapy assessment in India?+
It depends on the clinic and the team's qualifications. Many centres have the treating behaviour therapist write it and a senior clinician or behaviour analyst review it. Add each person's qualification and any registration number, such as RCI where applicable, in the sign-off.
How long should the report be?+
Long enough to answer the referral question with evidence, and no longer. If a section has nothing new, write one line saying so. Move detailed data, such as completed ABC sheets, to an appendix and refer to them by date.
Should I send the full report to the school?+
Only with the family's consent, and usually as a shorter version. Teachers need strengths, what helps in class and the strategies to use. Sensitive family and health details can stay in the clinic copy.
Can I fill this in online and download it?+
Yes. Open the template in the browser editor, complete each section and download a PDF. You do not need an account, and the draft stays in your browser until you clear it.
