Sensory Integration Screening Questionnare

Imagine a small child unable to sit still in school because the tag on the inside of his shirt is bothering him. The teacher sends a look to the child who is desperately trying to behave, yet the urge to wiggle and move about is overwhelming almost to the point of being painful.

Imagine it’s nearing the end of the school year and as a special treat the school is having a field day outside in the warm sun. All of the children are eagerly running about, happy to be outside. They swing on the swings, play in the sandbox and jump from the monkey bars. One child is hesitates to leave the classroom and then sits quietly, alone on the sidelines while the other children play. He can’t even bear to look at them. When it is time for an organized relay race, he reluctantly gets to the back of the line and then falls three times as he runs the field in terror. When it comes time to catch the ball he sticks his tongue out and turns his head in fear and the other children laugh at him.

Imagine a child who:

  • Misjudges the distance between other people an objects
  • Has a hard time with transitions from one activity to another
  • Has difficulty calming down
  • Has an unusually high or low activity level
  • Fatigues easily
  • Has difficulty chewing or speaking
  • Becomes emotional and quickly frustrated when things aren’t just right (Kranowitz, Carol Stock, M.A. The Out of Sync Child Has Fun: Activities for Kids with Sensory Processing Disorder. New York: Penguin Group, 2003.)

Sensory issues can appear in any one or combination of the seven sensory systems: tactile, vestibular, proprioceptive, visual, auditory, olfactory, or gustatory.

The following questionnaire can help determine the areas of difficulty for the sensory child.

Tactile System

Does the child:

  • Mouth objects
  • Dislike or avoid messy play
  • Avoid touch or contact
  • Dislike hair brushing or wearing a hat
  • Have difficulty tolerating touch by a washcloth or towel
  • Dislike crowds or groups of people/children for fear of physical contact
  • Have difficult showing tactile affection, such as giving/receiving hugs, kisses or pats on the back
  • Avoid using the whole hand during functional activities and uses only the fingertips
  • Have poor gross motor control

Vestibular System

Does the child:

  • Avoid playground activities
  • Dislikes or constantly seeks being upside down
  • Become fearful when his/her feet leave the ground
  • Crave or avoid movement
  • Appears to be a daredevil or thrill-seeker
  • Needs to be constantly moving
  • Turn their entire body to look at you
  • Constantly change positions in sitting
  • Dislike automotive transportation (e.g., car, bus, train)
  • Need to take frequent movement breaks and sit still for a while
  • Have difficulty with visual tracking and therefore easily loses his/her place when reading or unable to catch a ball or has difficult with other activities that require hand/eye coordination

Proprioceptive System

Does the child:

  • Enjoy rough and tumble type of play
  • Relaxes with deep pressure (e.g., bear hug, firm massage, heavy object)
  • Exert too much or little pressure with objects
  • Displays a weak grasp
  • Lock joints to maintain posture
  • Seem accident prone
  • Prefer gross motor toys to fine motor manipulation toys
  • Chew on toys to increase attention and/or postural stability
  • Display difficulty with appropriate chewing of foods
  • Appear clumsy by crashing, bumping or crashing into things easily

Visual System

Does your child:

  • Get easily distracted by visual input
  • Hang head close to food when eating to block out extra visual input
  • Squints to improve visual input
  • Frequently lose his/her place when reading
  • Hesitate to ascend/descent stairs
  • Have trouble matching and sorting objects
  • Display more calm, grounded behavior in the darkness or lower lighting
  • Look intensely at objects or people
  • Frequently stare off into space
  • Complains of seeing double
  • Has difficulty shirting gaze from one object to another
  • Has difficulty tracking moving objects
  • Omits words/numbers when reading
  • Misjudges spatial relationships
  • Displays poor sense of direction/orientation

Auditory System

Does the child:

  • Become upset with loud or unexpected noises
  • Hum or sing to screen out unwanted sounds
  • Become easily distracted by sounds or noises
  • Cover his/her ears to screen out loud noises
  • Appear not to hear, even when being directly called
  • Stop playing in the presence of unfamiliar sounds
  • Dislike crowds or noisy places
  • Display sensitivity to sounds from an outside source
  • Looks to others before responding
  • Displays difficulty reading out loud or speaking intelligibly
  • Has weak vocabulary, grammar or syntax

Olfactory System

Does the child:

  • Display extreme sensitivity to smells
  • Dislike certain clothing (e.g., new, wool, particular fabrics) because of the smell
  • Smell toys prior to playing with them
  • Overreact to new people and new scents
  • Appear to have no sense of smell at all
  • Appear to be a picky eater

Gustatory System

Does the child:

  • Have difficulty tolerating toothpaste
  • Hesitate to try new foods
  • Display strong preferences for certain foods and/or wants to eat the same foods at every meal
  • Exhibit chewing and/or eating of non-edible items
  • Tastes toys prior to playing with them
  • Gags during self-care activities

The Sensory Profile, Short Sensory Profile, and/or Sensory Processing Measure are screenings scales often administered to parents, teachers, and others.  These are not complete assessments; rather they only a screening tool used to indicate whether or not a formal evaluation is required.

If your child has five or more YES responses (in the appropriate section, then you child may have sensory-integration difficulties. You should have your child evaluated by an Occupational Therapist who is certified in Sensory Integration.