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Parent Check List - Sensory Assessment
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Bystander Seeker Misses sensory input Looks for sensory input High threshold & passive self-regulation High threshold & active self-regulation Needs high levels of sensory input but does not actively seek it Needs high levels of sensory input and actively seeks it Avoider Moves away from sensory input Low threshold & active self-regulation Needs low levels of sensory input and actively seeks it Dunn's Sensory Processing Framework Jessie GinSENSORY PROCESSING Usseggineref, Se CHILD NAME ace Date Possive ‘Wandering Moving Slowly Staring Low Energy 00000 Active In Constant Motion Moving Quickly Fleeting Gaze High Energy 00000 Engaged Regulated Attentive Communicating Alert 00000 Child's Baseline Level of Arousal Olow Ohigh optimal — Mixed Jessie Gingee SENSORY PROCESSING Upseggner, CHILD NAME ace DATE AUDITORY PROCESSING | Sensation Patterns Seeker Enjoys funny noises Likes to make noises Enjoys musical toys or games with sound Avoider 1D Has negative reactions to unexpected sounds or loud noises © Covers ears 1D Has strong reactions to everyday sounds Sensor O Notices subtle environmental sounds © Has difficuty focusing in a noisy environment © sdistracted by subtle sounds in the room Bystander © Does not seem affected in environments with competing sounds © Needs name to be called loudly or repetitively in order to respond (Does not seem to be bothered by loud noises Moavied trom Dunn's Sensory Poti Notes Notes Notes Notes essie Ginghurgee SENSORY PROCESSING Upseggner, VISUAL PROCESSING | Sensa Seeker Enjoys bright colors and lights D0 _ Likes to look at details on toys or objects 1D Watches people or moving objects in the environment Avoider Bothered by bright lights and colors Prefers dark rooms or rooms with dim lighting Escapes from rooms that are busy with people and objects Sensor 2 Distracted in busy environments with lots of clutter or people DD Notices toys or objects in the room 1D Trouble focusing in rooms with lots of colors and bright lights Bystander 2 Doesn't seem to notice people in the room © Doesn't seem to notice objects or toys in the environment 1D Hos trouble finding objects in the room Moavied trom Dunn's Sensory Poti in Patterns Notes Notes Notes Notes essie GinghurgSENSORY PROCESSING Upseggner, Seeker Constantly touches people or objects © Enjoys touch and textures Looks for different touch experiences Avoider Q Moves away from light touch © Bothered by different textures 'sdistressed or has negative reactions to ‘touch experiences not under their control Sensor Has strong reactions to everyday touch experiences © Distracted when touched or bumped Notices when they are touched, even lightly Bystander Seems to have a high pain tolerance © Does not notice when hands are messy Does not seem to notice when touched or bumped Moavied trom Dunn's Sensory Poti Notes Notes Notes Notes essie GinghurgSENSORY PROCESSING Upseggner, VESTIBULAR PROCESSING | Sensation Patterns Seeker © Seems to bein constant motion © often rocks, spins, or bounces: OO Enjoys movement activities Avoider © Dislikes movement activities 1D) Seems anxious when feet are off the ground 1 Does not participate in activities with movement Sensor Does not seem to move frequently O Seems affected (eg, dizzy) after movement activities G Frefers to be in upright body positions Bystander O Seems unaffected by intense movements D Tolerates lots of strong movements like spinning and swinging O Never seems to "get enough" movement Moavied trom Dunn's Sensory Profile Notes Notes Notes Notes essie GinghurgSENSORY PROCESSING Upseggner, PROPRIOCEPTIVE PROCESSING | Sensation Patterns Seeker Notes D squeezes self behind furniture G Pushes or pulls objects, toys, or people 1D Enjoys climbing and hanging from playground equipment or furniture Avoider Notes Does not enjoy pushing or pulling objects Does not lft or carry heavy objects 1D Does not climb or hang Sensor Notes O sits or stands upright without leaning on people or walls for support 1D Not clumsy O seems very aware of own body in space Bystander Notes © Leans on walls or other people © Seems to have a heavy or tired body i Bumps into objects or trips easily Meaitied from Ounn's Sensory Profile Jessie Ginsburg,SENSORY PROCESSING Usseggnere, ceo Name ace ate Which Does the Child Prefer? Neutral Both © Loud music O Soft Music o oO Lots of singing OD Minimal singing o a © Many Funny Noises CG _ No Funny Noises oO a © Vocaiizes Loudly O Vocalizes Softly o a D Talks Aloud Frequently © Talks Aloud infrequently a oO © Loud sounds © Soft Sounds a Q © Musical Toys& Games Quiet Toys & Games o a Notes Which Does the Child Prefer? Neutral Both © Bright Lights Dark spaces Oo oO © Bright Colors & Patterns (J Muted Colors & Patterns =) oO © Spinning objects stil objects o o O Looking at Details OQ Not Looking Closely a Oo © Watching People Avoids Busy Spaces Oo Oo Notes Josie GinghurgSENSORY PROCESSING Usseggnere, MSS Which Does the Child Prefer? Neutral Both © Touching Objects or People (Avoids Touching o oO O Feeling Various Textures) Withdraws from Textures «= a © Rubbing objects on Face (Not Being Touched oO a © water Play Staying Dry & clean o a Notes Which Does the Child Prefer? Neutral Both Q Running O walking Qo o O Jumping Q Feet on the Ground Qa QO D Spinning walking in Straight Lines a Oo © Rocking Remaining in One Place a oO Being Upside Down staying Upright Oo Oo Moving Around O Sitting Down a QO Notes essie GinghurgSENSORY PROCESSING Usseggnere, ree Which Does the Child Prefer? Neutral Both 1D Giving Big Hugs QO Avoids Giving Big Hugs Oo Q D Climbing O Remaining on the Floor Oo oO © Hanging Feet on the Ground a Oo © Squeezing © Touching Lightly a oO © Pulling O Not Exerting Energy a a D Pushing O Not Using Force a ia) O Chewing O Not Chewing on Objects a oO Notes essie Ginghurg
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