ABCD Behavior Assessment Questionnaire Form
Complete this questionnaire to describe observed behavior patterns, context, and rating-based assessment details. Keep the title exactly as written throughout the form.
Respondent and Assessment Context
Respondent Name or Identifier
*
Role or Relationship to the Person Being Assessed
*
Parent
Guardian
Teacher
Clinician
Self
Other
Age Group or Developmental Stage
*
Early Childhood
School-Age
Adolescent
Adult
Older Adult
Other
Assessment Context
*
Behavior Assessment Ratings
Behavior Rating Matrix
*
Rows
Never
Rarely
Sometimes
Often
Very Often
Aggression
1
2
3
4
5
Disruptive behavior
6
7
8
9
10
Attention-seeking behavior
11
12
13
14
15
Avoidance or withdrawal
16
17
18
19
20
Overall behavior frequency
*
Never
1
2
3
4
Very Often
5
1 is Never, 5 is Very Often
Overall behavior intensity
*
Mild
1
2
3
4
Severe
5
1 is Mild, 5 is Severe
Overall behavior impact
*
1
2
3
4
5
Patterns, Triggers, and Notes
Common Triggers or Situations
Transitions or schedule changes
Noise or crowded environments
Task demands or difficult activities
Unexpected changes
Peer conflict or social interaction
Adult redirection or limits
Unstructured time
Fatigue or hunger
Other
Typical Time of Occurrence
Morning
Midday
Afternoon
Evening
During transitions
No consistent pattern
Other
Additional Observations
Priority / Severity
1
2
3
4
5
Submit
Should be Empty: