Sensory Processing Measure–Preschool

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Cheryl Ecker, M.A., OTR/L,
and L. Diane Parham, Ph.D., OTR/L, FAOTA AutoScore ™ Form
Directions
Parent/Guardian Information Please answer the questions on this form based on
Your Name/ID#:_____________________________________________________________________________
your child’s typical behavior during the past month.
Use the following rating scale:
Your Relationship to Child: ________________________________________ Today’s Date: _ __________________
Never: the behavior never or almost never happens
Child Information Occasionally: the behavior happens some of the time
Child’s Name/ID#:________________________________________________________________________________ Frequently: the behavior happens much of the time
Always: the behavior always or almost always happens
Child’s Gender: h M h F Child’s Age: _____________ Years _____________ Months
Circle the one answer that best describes how often
Race/Ethnicity: the behavior happens. Try your best to answer all of the
h American Indian/Alaska Native h Asian h Black/African American
questions.
Several questions ask whether your child shows “distress”
h Hispanic/Latino h Native Hawaiian/Pacific Islander h White h Other in certain situations. Showing distress may include verbal
expressions (whining, crying, yelling) or nonverbal expres-
Comments on child’s behavior/functioning: ____________________________________________________ sions (withdrawing, gesturing, pushing something away,
running away, wincing, striking out).
________________________________________________________________________________________
You may use the space provided on the left to add any
________________________________________________________________________________________ comments on your child’s behavior or functioning.

PLEASE PRESS HARD WHEN CIRCLING YOUR RESPONSES.

a lly tl y
r s ion en ay
s
ve ca qu SOCIAL PARTICIPATION
Ne Oc Fre Alw This child…

N.........O......... F......... A.......... 1. Plays with friends cooperatively.
N.........O......... F......... A..........
2. Shares things when asked.

N.........O......... F......... A.......... 3. Joins in play with others without disrupting the ongoing activity.

N.........O......... F......... A.......... 4. Takes part in appropriate mealtime interactions.

N.........O......... F......... A.......... 5. Participates appropriately in family outings, such as dining out or going to a park or museum.

N.........O......... F......... A.......... 6. Participates appropriately in family gatherings, such as holidays, weddings, and birthdays.

N.........O......... F......... A.......... 7. Participates appropriately in activities with friends, such as parties, using playground equipment,
and riding tricycles.

N.........O......... F......... A.......... 8. Cooperates during family errands, such as grocery shopping or picking up siblings from school.
VISION This child…
LE

N.........O......... F......... A.......... 9. Seems bothered by light, especially bright light (blinks, squints, cries, closes eyes, etc.).
10. Has trouble finding an object when it is part of a group of other things.
N.........O......... F......... A..........
11. Has difficulty recognizing how objects are similar or different based on their colors, shapes, or sizes.
N.........O......... F......... A..........
12. Enjoys watching objects spin or move more than most children his or her age.
N.........O......... F......... A..........
13. Walks into objects or people as if they were not there.
N.........O......... F......... A..........
14. Likes to flip light switches on and off repeatedly.
N.........O......... F......... A..........
P

15. Enjoys looking at moving objects out of the corner of his or her eye.
N.........O......... F......... A..........
16. Has trouble paying attention if there are a lot of things to look at.
N.........O......... F......... A..........
17. Becomes bothered by busy visual environments, such as a cluttered room or a store with a lot of items.
N.........O......... F......... A..........
M

18. Becomes easily distracted by looking at things while walking.

N.........O......... F......... A..........
19. Has trouble completing simple tasks when there are many things to look at.
N.........O......... F......... A..........
HEARING This child…
20. Seems bothered by ordinary household sounds, such as the vacuum cleaner, hair dryer, or toilet flushing.
N.........O......... F......... A..........
A

21. Responds negatively to loud noises by running away, crying, or holding hands over ears.
N.........O......... F......... A..........
22. Appears not to hear certain sounds.
N.........O......... F......... A..........
23. Seems disturbed by or intensely interested in sounds not usually noticed by other people.
N.........O......... F......... A..........
S

24. Seems easily distracted by background noises, such as a lawn

N.........O......... F......... A..........
mower outside, an air conditioner, a refrigerator, or fluorescent lights.
25. Likes to cause certain sounds to happen over and over again, such as by repeatedly flushing the toilet.
N.........O......... F......... A..........
26. Shows distress at shrill or brassy sounds, such as whistles, party noisemakers, flutes, and trumpets.
N.........O......... F......... A..........
27. Becomes distressed by busy sounds, such as a party or a crowded room.
N.........O......... F......... A..........
28. Startles easily when hearing a loud or unexpected sound.
N.........O......... F......... A..........
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