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Age of a Child
Does your Child Avoid or dislike getting hands messy? OftenSometimesRarely
Become upset when face is washed? OftenSometimesRarely
Become upset when having hair combed or fingernails cut? OftenSometimesRarely
Prefer long sleeved clothing or jackets, even when it is hot? OftenSometimesRarely
Avoid going barefoot, especially in sand or grass? OftenSometimesRarely
Become irritated by tags in clothing? OftenSometimesRarely
Seem to crave being held or cuddled? OftenSometimesRarely
Express discomfort when touched in a friendly way by others? OftenSometimesRarely
Seem overly-sensitive to pain, and be bothered by small cuts? OftenSometimesRarely
Mouth objects or clothes often? OftenSometimesRarely
Have difficulty judging how much strength to use, e.g. petting animals with too much force? OftenSometimesRarely
Does your Child
Become anxious or distressed when feet leave the ground? OftenSometimesRarely
Avoid climbing or jumping? OftenSometimesRarely
Seem fearful of falling or heights? OftenSometimesRarely
Dislike riding in a car? OftenSometimesRarely
Dislike activities where head is upside down (as with hair washing) or when lifted overhead? (as in somersaults)? OftenSometimesRarely
Love to be tipped upside down or lifted overhead? OftenSometimesRarely
Seek out all kinds of movement activities? OftenSometimesRarely
Jump often and for long time on beds or other bouncy surfaces? OftenSometimesRarely
Like to spin herself/himself? OftenSometimesRarely
Rock his/her body or head? OftenSometimesRarely
Bang head on purpose? OftenSometimesRarely
Throw him/ herself against floor, wall, or other people for fun? OftenSometimesRarely
Become easily distracted by visual stimulation? OftenSometimesRarely
Express discomfort at bright lights? OftenSometimesRarely
Avoid or have difficulty with direct eye contact? OftenSometimesRarely
Have a hard time picking out a single object from many, such as finding a specific toy in a toy box? OftenSometimesRarely
Become distracted or have a problem when surrounded by a lot of noise? OftenSometimesRarely
Respond negatively to unexpected or loud noises? OftenSometimesRarely
Like to make loud noises? OftenSometimesRarely
Explore objects by smelling them? OftenSometimesRarely
Seem bothered by smells that most other people do not notice? OftenSometimesRarely
Chew or lick non-food items? OftenSometimesRarely
Tend to be especially active and always on the go? OftenSometimesRarely
Tend to fidget excessively in a chair when eating or working? OftenSometimesRarely
Tend to lack carefulness and to be impulsive? OftenSometimesRarely
Seem aggressive in play? OftenSometimesRarely
Need assistance to feed himself/herself? OftenSometimesRarely
Tend to eat in a sloppy manner? OftenSometimesRarely
Frequently spill liquids? OftenSometimesRarely
Drool? OftenSometimesRarely
Have trouble chewing? OftenSometimesRarely
Have trouble swallowing? OftenSometimesRarely
Have difficulty or dislike eating foods with lumps, such as chunky soups? OftenSometimesRarely
Stuff or put too much food in his/her mouth at once? OftenSometimesRarely
Frequently lose things, such as toys or shoes/coat? OftenSometimesRarely
Get lost easily? OftenSometimesRarely
Have difficulty tolerating changes in plans or expectations? OftenSometimesRarely
Have difficulty changing from one activity to another? OftenSometimesRarely
Need extra assistance to get started with a task or activity? OftenSometimesRarely
Become easily distracted while working or playing? OftenSometimesRarely
Have irregular sleep patterns? OftenSometimesRarely
Wake frequently during the night? OftenSometimesRarely
Have a difficult time falling asleep? OftenSometimesRarely
Require less sleep than other children? OftenSometimesRarely
Have a set routine before bedtime? OftenSometimesRarely
Tend to be uncooperative or stubborn? OftenSometimesRarely
Have temper tantrums or outbursts of anger? OftenSometimesRarely
Seem to need more protection from life than other children? OftenSometimesRarely
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