Tactile Sensitivity (7 items)
1. Expresses distress during grooming (for example, fights or cries during haircutting, face washing, fingernail cutting)
2. Prefers long-sleeved clothing when it is warm or short sleeves when it is cold
3. Avoids going barefoot, especially in sand or grass
4. Reacts emotionally or aggressively to touch
5. Withdraws from splashing water
6. Has difficulty standing in line or close to other people
7. Rubs or scratches out a spot that has been touched
Taste/Smell Sensitivity (4 items)
8. Avoids certain tastes or food smells
9. Will only eat certain tastes
10. Limits self to particular food textures/temperatures
11. Picky eater, especially regarding food textures
Underresponsive/Seeks Sensation (7 items)
15. Enjoys strange noises/seeks to make noise for noise's sake
16. Seeks all kinds of movement and this interferes with daily routines (for example, can't sit still, fidgets)
17. Becomes overly excitable during movement activity
18. Touches people and objects
19. Doesn't seem to notice when face or hands are messy
20. Jumps from one activity to another so that it interferes with play
21. Leaves clothing twisted on body
Auditory Filtering (6 items)
22. Is distracted or has trouble functioning if there is a lot of noise around
23. Appears to not hear what you say (for example, does not "tune-in" to what you say, appears to ignore you)
24. Can't work with background noise (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 hearing is OK
27. Has difficulty paying attention
Low Energy/Weak (6 items)
28. Seems to have weak muscles
29. Tires easily, especially when standing or holding particular body position
31. Can't lift heavy objects (for example, weak in comparison to same age children)
32. Props to support self (even during activity)
33. Poor endurance/tires easily
Visual/Auditory Sensitivity (5 items)
34. Responds negatively to unexpected noises (for example, cries or hides at noise from vacuum cleaner, dog barking, hair dryer)
35. Holds hands over ears to protect ears from sounds
36. Is bothered by bright lights after others have adapted to the light
37. Watches everyone when they move around the room
38. Covers eyes or squints to protect eyes from light