Sensory Profile 2 - Toddler 0.7 to 2.11- Caregiver Questionnaire

Dear Parent/Caregiver,

The questions that follow contain statements that describe how children may act.

Please read each phrase and select the option that best describes how often your child shows these behaviors.

Please mark one option for every statement.

Use these guidelines to mark your responses:

When presented with the opportunity, my child:


Almost Always: responds in this manner Almost Always (90% or more of the time).

Frequently: responds in this manner Frequently (75% ot the time).

Half the Time: responds in this manner Half the Time (50% of the time).

Occasionally: responds in this manner Occasionally (25% of the time).

Almost Never: responds in this manner Almost Never (10% or less of the time).

Does Not Apply: if you are unable to answer because you have not observed the behavior or believe that it does not apply to your child, please check Does Not Apply.


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Email *
Your Name: *
Your Phone Number: *
Your Relationship to child: *
Child's name: *
Gender: *
Date of Birth: *
Please use the name of the month instead of its number for less confusion.
e.g.: March 2nd 2019, or 2 March 2019
Today's Date: *
MM
/
DD
/
YYYY

In what order is your child born in relation to siblings (for example, 1st child, 3rd child, etc.)?

 *

Have there been more than three children between the ages of birth through 18 years living in your household during the past 12 months:

 *
GENERAL Processing

1- My child needs a routine to stay content or calm.

 *

2- My child acts in a way that interferes with family schedules and plans.

 *

3- My child resists playing among other children.

 *

4- My child takes longer than same-aged children to respond to questions or actions.

 *

5- My child withdraws from situations.

 *

6- My child has an unpredictable sleeping pattern.

 *

7- My child has an unpredictable eating pattern.

 *

8- My child is easily awakened.

 *

9- My child misses eye contact with me during everyday interactions

 *

10- My child gets anxious in new situations.

 *
AUDITORY Processing

11- My child only pays attention if I speak loudly.

 *

12- My child only pays attention when I touch my child (and hearing is OK).

 *

13- My child startles easily at sound compared to same-aged children (for example, dog barking, children shouting).

 *

14- My child is distracted in noisy settings.

 *

15- My child ignores sounds, including my voice.

 *

16- My child becomes upset or tries to escape from noisy settings.

 *

17- My child takes a long time to respond to own name.

 *
VISUAL Processing

18- My child enjoys looking at moving or spinning objects (for example, ceiling fans, toys with wheels).

 *

19- My child enjoys looking at shiny objects.

 *

20- My child is attracted to W or computer screens with fast-paced, brightly colored graphics.

 *

21- My child startles at bright or unpredictable light (for example, when moving from inside to outside).

 *

22- My child is bothered by bright lights (for example, hides from sunlight through car window).

 *

23- My child is more bothered by bright lights than other same-aged children.

 *

24- pushes brightly colored toys away.*

 *

25- My child fails to respond to self in the mirror.

 *
TOUCH Processing

26- My child becomes upset when having nails trimmed.

 *

27- My child resists being cuddled.

 *

28- My child is upset when moving among spaces with very different temperatures (for example, colder, warmer).

 *

29- My child withdraws from contact with rough, cold, or sticky surfaces (for example, carpet, counterlops).

 *

30- My child withdraws from contact with rough, cold, or sticky surfaces (for example, carpet, counterlops).

 *

31- My child pulls at clothing or resists getting clothing on.

 *

32- My child enjoys splashing during bath or swim time.*

 *

33- My child becomes upset if own clothing, hands, or face are messy.*

 *

34- My child becomes anxious when walking or crawling on certain sudaces (for example, grass, sand, carpet, tile).*

 *

35- My child withdraws from unexpected touch.*

 *
MOVEMENT Processing

36- My child enjoys physical activity (for example, bouncing, being held up high in the air).

 *

37- My child enjoys rhythmical activities (for example, swinging, rocking, car rides).

 *

38- My child takes movement or climbing risks.

 *

39- My child becomes upset when placed on the back (for example, at changing times).

 *

40- My child seems accident-prone or clumsy.

 *

41- My child fusses when moved around (for example. walking around, when being handed over to another person).*

 *
ORAL SENSORY Processing

42- My child shows a clear dislike for all but a few food choices.

 *

43- My child drools.

 *

44- My child prefers one texture of food (for example, smooth, crunchy).

 *

45- My child uses drinking to calm self.

 *

46- My child gags on foods or drink.

 *

47- My child holds food in cheeks before swallowing.

 *

48- My child has difficulty weaning to chunky foods.

 *
BEHAVIORAL RESPONSES Associated with Sensory Processing

49- My child has temper tantrums.

 *

50- My child is clingy.

 *

51- My child stays calm only when being held.

 *

52- My child is fussy or irritable.

 *

53- My child is bothered by new settings.

 *

54- My child becomes so upset in new settings that it's hard to calm down.

 *
A copy of your responses will be emailed to the address you provided.
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