Sensory Profile

Student’s Name:
A. Auditory Almost Always Frequently Occasionally Seldom Almost Never
1 Misses oral directions in class more than other students
2 Appears to not hear what you say (e.g., does not tune in to what you say, appears to ignore you)
3 Seems oblivious within an active environment (i.e., unaware of activity)
4 Hums, whistles, sings, or makes other noises throughout the day
5 Is distracted or has trouble functioning if there is a lot of noise in the area
6 Tells others to be quiet
7 Becomes distressed during assemblies, lunch, or other large gatherings
8 Is overly bothered by loud or unexpected noises (e.g., fire alarm, books slamming to the floor, doors slamming, announcements, bells)
9 Has difficulty participating in group activities where there is a lot of talking
10 Holds hands over ears to protect them from sound
B. Visual Almost Always Frequently Occasionally Seldom Almost Never
11 Misses written or demonstrated directions more than other students
12 Has trouble keeping materials and supplies organized for use during the day
13 Leaves items blank on a busy worksheet even when he or she knows the answers
14 Doesn’t watch during instruction, but follows through with activities
15 Adds more details to drawing and coloring than other students
16 Watches other students when they move around the room
17 Notices even small changes in the room or desk organization
18 Comments on small details in objects or pictures that others haven’t noticed
19 Looks away from tasks to notice all other activity in the room
20 Startles at unexpected movements near desk or around room (e.g., another student getting up quickly, objects fall off desk)
21 Avoids eye contact
C. Movement Almost Always Frequently Occasionally Seldom Almost Never
22 Is clumsy and awkward in movements (e.g., runs into desks and furniture when moving about)
23 Slouches, slumps, or sprawls in chair
24 Rests head in hands on desk or table during class time and seatwork
25 Runs or bumps into things (e.g., walls, doors, equipment, other people)
26 Seeks all kinds of movement, which interferes with daily routines (e.g., can’t sit still, fidgets)
27 Is “on the go”
28 Fidgets during activities (e.g., moves around, taps on desk)
29 Gets up and moves around more than other students
30 Seems to find excessive reasons for approaching the teacher
31 Stands or sits at the side of the playground during recess
32 Withdraws from activities
33 Is slow to participate in physically active tasks or activities
34 Intentionally withdraws from active environments or situations (e.g., retreats to a quiet area in the classroom)
35 Refuses to participate in team games (e.g., soccer or basketball)
D. Touch Almost Always Frequently Occasionally Seldom Almost Never
36 Does not steady objects when working (e.g., does not hold paper down when writing)
37 Comes too close into other people’s personal space when talking
38 Doesn’t seem to notice when face and hands remain soiled
39 Touches people and objects to the point of irritating them
40 Plays or “fiddles” with objects or school supplies (e.g., pencils, notebooks, folders)
41 Displays unusual need to touch certain toys, surfaces, or textures (i.e., constantly touching objects)
42 Is fidgety or disruptive when standing in line or close to other people (e.g., getting on the bus, sitting in an assembly)
43 Wants to wipe hands quickly or often during messy tasks
44 Is easily upset by minor injuries (e.g., bumps, scrapes, cuts)
45 Uses only fingertips to work on projects that require manipulation
46 Flinches when you get in close proximity or touch his or her body
47 Refuses to participate in activities that are messy (e.g., art projects, using glue or paint)
E. Behavior Almost Always Frequently Occasionally Seldom Almost Never
48 Is inefficient in doing things (e.g., wastes time, moves slowly, makes tasks more complicated)
49 Appears inactive (i.e., seems to lack energy)
50 Shows little emotion regardless of the situation
51 Seems more curious than other students
52 Is bothered by rules being broken
53 Is bossy with classmates or peers
54 Can be described as over-reactive or dramatic when compared to classmates or peers
55 Doesn’t express emotions (i.e., has a flat, unresponsive affect)
56 Doesn’t have a sense of humor
57 Can be described as inflexible when compared to classmates and peers
58 Has difficulty tolerating changes in routines, plans, and expectations
59 Is stubborn or uncooperative
60 Perseverates to the point that he or she cannot move on (i.e., can’t shift gears)
61 Withdraws when there are changes in the environment or routine
62 Is frustrated easily
           
Student’s Name:  

Section Raw Scores/Classifications

Sections Section Raw Score Total Definite Difference Probable Difference Typical Performance Probable Difference Definite Difference
Auditory /50          
Visual /55          
Movement /70          
Touch /60          
Behavior /75          

**There is no Definite Difference/Much Less Than Others score for this section.
*There is no Probable Difference/Less Than Others score for this section.

Section Grid

School Factor Raw Scores/Classifications

Factors Factor Raw Score Total Definite Difference Probable Difference Typical Performance Probable Difference Definite Difference
School Factor 1 /105          
School Factor 2 /65          
School Factor 3 /85          
School Factor 4 /55          

**There is no Definite Difference/Much Less Than Others score for this section.
*There is no Probable Difference/Less Than Others score for this section.

School Factor Grid

Quadrant Raw Scores/Classifications

Quadrants Quadrant Raw Score Total Definite Difference Probable Difference Typical Performance Probable Difference Definite Difference
Registration /85          
Seeking /60          
Sensitivity /80          
Avoiding /85          

**There is no Definite Difference/Much Less Than Others score for this section.
*There is no Probable Difference/Less Than Others score for this section.

Quadrant Grid