Sensory Symptoms Checklist
Sensory Symptoms Checklist
Sensory Symptoms Checklist
The following checklist is not a diagnostic tool. Rather, it is an indicator of sensory over‐
or under‐responsiveness. The purpose of this tool is to assist in developing an
appropriate treatment plan, and/or sensory diet, for an individual with sensory
modulation difficulties.
Remember that it is normal for all people to be sensitive to certain sensations. Sensory
modulation becomes a disorder only when it is negatively impacting a person’s life (i.e.
ability to pay attention, learn, socialize, relax).
* Indicates Sensory‐Seeking behavior. Sensory‐Seeking is a form of under‐
responsiveness but these individuals seek intense sensation to make up for the under‐
responsiveness of their nervous systems. The general under‐responders tend to be
more passive and sedentary than the sensory‐seekers, but still share many symptoms.
TACTILE (TOUCH)
Symptoms of Over‐Responsiveness: Symptoms of Under‐Responsiveness:
_____ avoids affectionate touch _____ always touching others*
_____ bothered by seams in clothing, _____ as a young child, may prefer to
tags, waistbands, etc. be without clothes and barefoot
_____ avoids messy play including _____ doesn’t seem to notice messy
finger‐painting and play‐doh hands or face
_____ dislikes nail‐trimming/hair‐cutting _____ touches everything, brings objects
hair‐brushing/tooth‐brushing and toys to mouth frequently*
_____ limited food preferences, _____ may stuff too much food in mouth
sensitive to food textures _____ seems unaware of light touch
_____ excessively ticklish _____ doesn’t seem to notice cuts and
_____ avoids standing close to others scrapes, doesn’t mind shots
_____ startles easily when touched _____ drools, doesn’t wipe runny nose
unexpectedly _____ unintentionally rough on pets or
_____overreacts to minor injuries or other kids
mosquito bites _____ craves intense flavors – salty, sweet,
sour, spicy*
_____ difficulty with fine motor tasks
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PROPRIOCEPTIVE (PRESSURE ON MUSCLES AND JOINTS)
Since proprioceptive input is always Symptoms of Under‐Responsiveness:
helpful to the nervous system, we do _____ loves jumping, climbing, wrestling,
not see over‐responsivity in this and crashing activities*
category. _____ walks on toes*, or walks heavily
_____ difficulty with fine motor tasks
_____ prefers crunchy and chewy foods*
_____ sucks thumb or fingers, chews on
clothes and toys
_____ grinds teeth, cracks knuckles*
_____ loves tight hugs and “squishing”
activities or positions*
_____ chooses thick or heavy blankets
_____ self‐abusive behaviors – pinching,
biting, head‐banging*
_____ prefers tight‐fitting clothes or may
wear a snug jacket constantly*
Other symptoms of proprioceptive dysfunction that are not classified as either over‐ or
under‐responsiveness include (circle all that apply): accidentally breaks objects
frequently, presses too hard or too light when coloring or writing, uses inappropriate
force on objects (i.e. may squeeze juice boxes too tightly), uses too much force for
things like opening/closing doors, plays roughly with animals and other kids.
VESTIBULAR (MOVEMENT)
Symptoms of Over‐Responsiveness: Symptoms of Under‐Responsiveness:
_____ as a baby, dislikes being held _____ as a baby, needs to be rocked a lot, is
away from adult’s body or tossed happiest in stroller, swing, bouncer*
in air, may be “clingy” _____ dislikes sedentary tasks*
_____ avoids swings, slides, anything _____ is in constant motion, loves spinning,
that requires feet to be off the swinging, being upside down*
ground _____ may have low muscle tone (muscles
_____ fearful of escalators, elevators, and joints seem too soft and floppy)
and all heights _____ “W” sitting on floor, slumps, leans in
_____ gets motion sick easily chair
_____ dislikes leaning back for hair‐ _____ loves spinning, loves amusement
washing or floating on back park rides, is a “thrill‐seeker”*
in pool _____ rocks self or moves head back and
forth while sitting*
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AUDITORY (SOUND)
Symptoms of Over‐Responsiveness: Symptoms of Under‐Responsiveness:
_____ as a baby, startles easily, cries with _____ may not consistently respond to
vacuum, hair‐dryers, toilet flushing name (rule out hearing loss)
_____ dislikes noisy places _____ prefers t.v. and music to be loud*
_____ easily distracted and bothered _____ often doesn’t notice background
by background noises noises
_____ cries, covers ears with loud or _____ makes own sounds frequently,
unexpected sounds enjoys silly sounds of others*
_____ asks others to be quiet _____ says “What?” frequently even though
hearing is intact
_____ may appear oblivious to some
sounds, has difficulty locating sound
_____ may use self‐talk to get through a
task
VISUAL
Symptoms of Over‐Responsiveness: Symptoms of Under‐Responsiveness:
_____ bothered by bright lights, sun _____ loves shiny, spinning or moving
_____ dislikes visually busy places objects*
(stores, playgrounds, cluttered _____ difficulty with eye‐hand coordination
rooms) tasks (catching a ball, stringing
_____ avoids eye contact (beads, tracing and writing)
_____ prefers dim lighting, shade _____ loves action‐packed, colorful
_____ rubs eyes a lot, may get t.v. shows and electronic games*
headaches from reading _____ difficulty distinguishing between
similar letters and shapes
_____ difficulty with visual‐tracking, may
lose place frequently while reading
GUSTATORY AND OLFACTORY (TASTE AND SMELL)
Symptoms of Over‐Responsiveness: Symptoms of Under‐Responsiveness:
_____ talks about smell a lot, notices _____ smells and licks inedible objects
odors others don’t notice such as toys and play‐doh*
_____ plugs nose, avoids places with _____ likes strong odors such as perfume,
strong smells (some restaurants) cleaning products, and gasoline*
_____ dislikes new foods, may have very _____ prefers strongly flavored foods ‐
limited food preferences spicy, salty, bitter, sour, sweet*
*Indicates sensory‐seeking behavior. See note at top of form.
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