ABA Client Motivation Assessment Questionnaire Form
Please complete this ABA Client Motivation Assessment Questionnaire Form to help us understand the client's motivation, engagement, and preferences for effective session planning.
Client First and Last Name
*
First Name
Last Name
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Primary Motivation Concerns
*
Low interest in activities
Difficulty staying engaged
Limited response to reinforcement
Unclear motivators
Other
Current Motivators (select up to 3)
*
Social praise
Tangible items
Edible treats
Breaks
Access to preferred activities
Other
Preferred Reinforcers
*
Engagement Triggers (What increases participation?)
*
Routine and Environment Factors
*
Consistent schedule
Quiet environment
Visual supports
Frequent breaks
Minimal distractions
Other
Preferred Session Activities
*
Communication Preferences
*
Verbal
Gestures
Picture exchange
Assistive technology
Other
Goal Priorities (rate importance)
*
Rows
Not Important
Somewhat Important
Very Important
Increasing engagement
1
2
3
Expanding motivators
4
5
6
Improving communication
7
8
9
Enhancing independence
10
11
12
Additional Notes Relevant to Motivation Planning
Submit Assessment
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