Screening Tool : Sensory Processing Problems : eMentalHealth.ca

1.

Was unusually fussy, difficult to console, or easily startled as an infant?

	Yes
	No

2.

Has difficulty regulating sleep/wake cycles --settling for sleep, staying asleep, and waking without irritability

	Yes
	No

3.

Is over-sensitive to stimulation--over-reacts to touch, taste, sounds, or odors

	Yes
	No

4.

Strongly dislikes baths, haircuts, or nail cutting (i.e. touch sensitivity)

	Yes
	No

5.

Uses an inappropriate amount of force when handling objects, coloring, writing, or interacting with siblings or pets (i.e. poor registration)

	Yes
	No

6.

Has poor muscle tone, fatigues easily, leans on people, or slumps in a chair

	Yes
	No

7.

Was slow to roll over, creep, sit, stand, or walk, or to achieve other motor milestones

	Yes
	No

8.

Is clumsy, falls frequently, bumps into furniture or people, and has trouble judging position of body in relation to surrounding space

	Yes
	No

9.

Has difficulty learning new motor tasks; experiences frustration when attempting to follow instructions or sequence steps for an activity

	Yes
	No

10.

Avoids playground activities, physical education class, and/or sports

	Yes
	No

11.

Does not enjoy age-appropriate motor activities such as jumping, swinging, climbing, drawing, cutting, assembling puzzles, or writing

	Yes
	No

12.

Finds it difficult to make friends with peers; prefers to play with adults or younger children

	Yes
	No

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Screening Tool: Sensory Processing Problems