Short Sensory Profile
Hr,g..
ieiEl Child's Name: Birth Date: _ Daio:
5fnSOny DnOftLf comp,eted by; Relationship to Child:
Winnie Dunn,
Ph,D., OTR, FAOTA Service Provider's Name: Discipline:
Please check the box that best describes the Use the following key to mark your respoRses:
frequency with which your child does the fol- When presentod wiih the opportunity, you child always
lowing behaviors, Ploase answer all cf the r€sponds In lhis manner, 100oio of the time.
staiernents. lf you are unable io oomment \Men presented with the opportunity, your child frequently
responds In this manner, about 75orb of the time.
because you have not observed the behavior
When presented with the opportunity, your child occasionally
or believe that it does not apply to your child, responds in this manner, about 50Vooi the time.
please draw an X through ihe number for thal When presented with the opportunity, vour child seldom
item. Ploase do not write in the Section Raw responds in this manner, about 250/o'oi the time,
Score Total row Whon presented with the opportunitv, your child never
responds in this mannor, 0oio of the tim'e.
Expresses distress :lgyg qrooming (for example, fights or cries during haircutting, face washing, flngernail cutting)
Prefers long"sleeved clothing when it is warm or short sleeves when it is cold
barefoot, especially in sand or grass
Reacts enrotionally or
Withdraws from splashing wator
Flas difficulty sianding in line or close to other people
Rubs or scratches out a spot that has been touched
Section Raw Score Total
Avoids cerlain tastes or food smells that are typically part of children's dieto
Will only eat certain tastes (list: _J
't0 Limits self to particular food textLrres/temperatLrres (list;
11 Picky eater, especially regarding {ood textures
Section Raw Score Total
12 Becomes anxious or distressed when feet leave the oroLrnd
13 Fears falling or heights
't4 Dislikes aotivities whore head is upside down (for example, somersaults, roughhousing)
Seetion Raw Score Xotal
15 Enjoys strange noises/seeks io rnake noise for noise's sake
16 Seeks all kinds o{ movement and this interferes with daily routines (for example, can't sit still, fidgotn)
17 Becomes overly excilable during nrovement activity
18 Tcruches people and objects
19 Doesn't seem to notice when face or hancls are tre$sy
20 Jumps from one activity to anoiher so thai it interferes with play
21 Leaves clothing twisted on body
Sectlon Raw $eore Toial
076 1 638(
22 ls distracted or has trouble functionino if there is a lot of rroise around
23 Appears to ttot hear what yott $ay (for example, does not "tune.in" to what you $ay, appear$ to ignore you)
24 Can't work with background nojse (for example, fan, refrigerator)
25 Has trouble completing tasks 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
Seetion Raw Sesrc Total
28 Seems to have weak muscles
29 Tires easily, especially when standing or holding parlicular body position
30 Has a weak grasp
31 Can't lift heavy objects (for example, weak in comparjson to same age children)
32 Props to suppod self (even during activity)
33 Poor endurarrceitires easily
Sectisn Raw Score Total
llesponds negatively to unexpected or loud noises (for example, cries or hides at noise
34
from vacuunr cleaner, dog barking, hair clryer)
35 l-lolds hands over ears to protect ears fronr sound
36 ls bothored by bright lights aftor others have adapted to the light
37 Watches everyone when they nrove around the roor.n
38 Covers eyes or sqLrints to protect eyea frorn light
Seetion Raw Score Total
FOR OFFICE USE ONLY
SCORE KEY
iumnnary
tstructierns: Transfer the score for each soction to the Section Raw $core"Tbtal colunrn. 1 = Always 4, * Seldonr
Plot these toials by marking an X in the appropriaie classification colurrrn 2 = Frecluontly ti * Nr:ver
(lypical Perforr"nance, Probairle Differonce, Definite Differronce)j 3 = Oer:asionolly
Tactile {iensitivity
Taste/Smell Sensitivity
Movemeni $ensitivity
Unden esponsive/Seeks Sensation
Auditory Filtering 1g-'-.--:.. 6
Low Energy/Weak
VisLral/Auditory Sensitivity
Total
llassifications are based on the per{ormance of children without disabilities (n.= 1,037).
Copyright O 1999 by The Psychological Corporation. All rights resoryocl, T'FIF]
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