Short Sensory Profile

Child's Name
Birh Date

MonthDayYear
Date
INSTRUCTONS

Please check the box that best describes the frequency with which your child does the following behaviors. Please answer all of the statements. If you are unable to comment because you have not observed the behavior or believe that it does not apply to your child, please draw an X through the number for that item. Please do not write in the section Taw Score Total row.

Use the following key to mark your responses:

ALWAYS	When presented with the opportunity, your child always responds in this manner, 100% of the time.
FREQUENTLY	When presented with the opportunity, your child always responds in this manner, 75% of the time.
OCCASIONALLY	When presented with the opportunity, your child always responds in this manner, 50% of the time.
SELDOM	When presented with the opportunity, your child always responds in this manner, 25% of the time.
NEVER	When presented with the opportunity, your child always responds in this manner, 0% of the time.

Tactile Sensitivity

	ALWAYS	FREQUENTLY	OCCASIONALLY	SELDOM	NEVER
1. Expresses distress during grooming (for example: fights or cries during haircutting, face washing, fingernail cutting)
2. Prefers long-sleeved clothing when it is warm or short sleeved when it is cold
3. Avoids going barefoot, especially in sand or grass
4.Reacts emotionally or aggressively to touch
5.Withdraws from splashing water
6. Has difficulty standing in line or close to other people
7. Rubs or scratches out a spot that has been touched

Taste/Smell Sensitivity

	ALWAYS	FREQUENTLY	OCCASIONALLY	SELDOM	NEVER
8. Avoids certain tastes or food smells that are typically part of children's diets
9. Will only eat certain tastes
10. Limits self to particular food textures/temperatures
11. Picky eater, especially regarding food textures

Movement Sensitivity

	ALWAYS	FREQUENTLY	OCCASIONALLY	SELDOM	NEVER
12. Becomes anxious or distressed when feet leave the ground
13. Fears falling or heights
14. Dislikes activities where head is upside down (for example: somersaults, roughhousing)

Under Responsive/Seeks Sensation

	ALWAYS	FREQUENTLY	OCCASIONALLY	SELDOM	NEVER
15. Enjoys strange noise/seeks to make noise for noise's sake
16. Seeks all kinds of movement and this interferes with daily routines (for example: can't sit still, fidgets)
17. Becomes overly excitable during movement activity
18. Touches people and objects
19. Doesn't seem to notice when face or hands are messy
20. Jumps from one activity to another so that in interferes with play
21. Leaves clothing twisted on body

Auditory Filtering

	ALWAYS	FREQUENTLY	OCCASIONALLY	SELDOM	NEVER
22. Is distracted or has trouble functioning if there is a lot of noise around
23. Appears to not hear what you say (for example: does not "tune-in" to what you say, appears to ignore you)
24. Can't work with background noise (for example: fan, refrigerator)
25. Has trouble completing task when the radio is on
26. Doesn't respond when name is called but you know the child's hearing is OK
27. Has difficulty paying attention

Low Energy/Weak

	ALWAYS	FREQUENTLY	OCCASIONALLY	SELDOM	NEVER
28. Seems to have weak muscles
29. Tires easily, especially when standing or holding particular body position
30. Has a weak grasp
31. Can't lift heavy objects (for example, weak in comparison to same age children)
32. Props to support (even during activity)
33. Poor endurance/tires easily

Visual/Auditory Sensitivity

	ALWAYS	FREQUENTLY	OCCASIONALLY	SELDOM	NEVER
34. Responds negatively to unexpected or loud noises (for example: cries or hides at noise from vacuum cleaner, dog barking, hair dryer)
35. Holds hands over ears to protect ears from sound
36. Is bothered by bright lights after others have adapted to the light
37. Watches everyone when they move around the room
38. Covers eyes or squints to protect eyes from the light

Should be Empty: