| Item | % |
| Auditory Processing |
|
| 1. Responds negatively to unexpected or loud noises (for example, cries or hides at noise from vacuum cleaner, dog barking, hair dryer) | 33.3 |
| 2. Holds hands over ears to protect ears from sound | 16.7 |
| 3. Has trouble completing tasks when the radio is on | 25.0 |
| 4. Is distracted or has trouble functioning if there is a lot of noise around | 50.0 |
| 5. Can’t work with background noise (for example, fan, refrigerator) | 16.7 |
| 6. Appears to not hear what you say (for example, does not “tune-in” to what you say, appears to ignore you) | 25.0 |
| 7. Doesn’t respond when name is called but you know the child’s hearind is OK | 16.7 |
| 8. Enjoys strange noises/seeks to make noise for noise’s sake | 25.0 |
| Vestibular Processing |
|
| 18. Becomes anxious or distressed when feet leave the ground | 8.3 |
| 19. Dislikes activities where head is upside down (for example, somersaults, roughhousing) | 16.7 |
| 20. Avoids playground equipment or moving toys (for example, swing set, merry-go-round) | 8.3 |
| 21. Dislikes riding in a car | 0.0 |
| 22. Holds head upright, even when bending over or leaning (for example, maintains a rigid position/posture during activity) | 0.0 |
| 23. Becomes disoriented after bending over sink or table (for example, falls or gets dizzy) | 0.0 |
| 24. Seeks all kinds of movement and this interferes with daily routines (for example, can’t sit still, fidgets) | 33.3 |
| 25. Seeks out all kinds of movement activities (for example, being whirled by adult, merry-go-rounds, playground equipment) | 25.0 |
| 26. Twirls/spins self frequently throughout the day (for example, likes dizzy feeling) | 8.3 |
| 27. Rocks unconsciously (for example, while watching TV) | 0.0 |
| 28. Rocks in desk/chair/on floor | 0.0 |
| Modulation of Sensory Input Affecting Emotional Responses |
|
| 92. Needs more protection from life than other children (for example, defenseless physically or emotionally) | 41.7 |
| 93. Rigid rituals in personal hygiene | 25.0 |
| 94. Is overly affectionated with others | 41.7 |
| 95. Doesn’t perceive body language or facial expressions (for example, unable to interpret) | 50.0 |
| Emotional/Social Responses |
|
| 100. Seems to have difficulty liking self (for example, low self-esteem) | 16.7 |
| 101. Has trouble “growing up” (for example, reacts immaturely to situations) | 50.0 |
| 102. Is sensitive to criticisms | 50.0 |
| 103. Has definite fears (for example, fears are predictable) | 41.7 |
| 104. Seems anxious | 33.3 |
| 105. Displays excessive emotional outbursts when unsuccessful at a task | 50.0 |
| 106. Expresses feeling like a failure | 16.7 |
| 107. Is stubborn or uncooperative | 33.3 |
| 108. Has temper tantrums | 25.0 |
| 109. Poor frustration tolerance | 33.3 |
| 110. Cries easily | 41.7 |
| 111. Overly serious | 8.3 |
| 112. Has difficulty making friends (for example, does not interact or participate in gropu play) | 33.3 |
| 113. Has nightmares | 0.0 |
| 114. Has fears that interfere with daily routine | 25.0 |
| 115. Doesn’t have a sense of humor | 16.7 |
| 116. Doesn’t express emotions | 0.0 |
| Emotionally Reactive |
|
| 121. Has difficulty tolerating changes in plans and expectations | 16.7 |
| 122. Has difficulty tolerating changes in routines | 25.0 |
| Inattention/Distractibility |
|
| 48. Has difficulty paying attention | 50.0 |
| 49. Looks away from tasks to notice all actions in the room | 58.3 |