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ADOLESCENT / ADULT SENSORY PROCESSING DISORDER CHECKLIST

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CHECKLIST

SENSORY MODULATION:

  • bothered by clothes; certain materials, tags, seams, pantyhose, ties, belts, turtlenecks, have to wear shorts, skirts, or pants exclusively, etc.

bothered by “light touch”; someone lightly touching/rubbing your hand, face, leg or back

  • excessively ticklish
  • distressed by others touching you; would rather be the “toucher” than the   “touchee”, difficulty “snuggling” with your partner
  • have to fidget and “fiddle” with things all the time; change in your pocket, your keys, a pen/pencil, paper clip, rubber band, ANYTHING within reach
  •  often touching and twisting your own hair
  • very sensitive to pain, especially as compared to others
  • don’t seem to notice pain; get shots/cuts/bruises and hardly feel a thing
  • dislike the feeling of showers or getting splashed
  •  difficulty going to the beach; the sand blowing on your skin or getting on your body
  • avoid touching anything “messy”; if you do, you have to go wash your hands right away and/or only touch it with your fingertips
  • can not wear new or “stiff” clothes that have not been washed or soaked in fabric softener
  •  hate to be barefoot or hate to wear shoes and/or socks
  • frequently get car sick, air sick, motion sick
  •  a thrill seeker; loves fast and/or dangerous rides, leisure activities, and sports
  • difficulty riding on elevators, escalators, or moving sidewalks
  • avoid amusement park rides that spin or go upside down
  •  seek out fast, spinning, and/or upside down carnival rides
  • will often rock or sway body back and forth while seated or standing still
  • frequently tips chair on back two legs
  • restless when sitting through a lecture, presentation, or movie
  •  constantly chews on ends of pens and pencils
  •  smokes cigarettes
  •  difficulty eating foods with mixed textures, or one particular texture
  • prefer foods with very strong tastes and flavors
  • prefer very bland foods, dislike anything spicy
  •  has a diagnosed eating disorder or has major eating “sensitivities”
  •  constantly biting nails or fingers
  • bites lips or inside of cheeks
  •  frequently shake your leg while sitting or falling asleep
  •  love to sleep with multiple or heavy blankets on top of you
  •  seek out crashing and “squishing” activities
  •  cracks knuckles often
  • loves crunchy foods (popcorn, carrots, chips, nuts, pretzels, etc.)
  •  frequently have gum or hard candy in your mouth
  • has an “endless” supply of air fresheners, scented candles, odor masking sprays, etc.
  • becomes nauseated or gags from certain cooking, cleaning, perfume, public restroom, or bodily odors
  •  identifies objects by smell, have to smell everything, judge whether you like something or someone by smell
  • becomes overstimulated / overaroused when people come to the house or in crowded places
  • very high or very low energy level
  • avoids crowds and plans errands at times when there will be fewer people
  • overly exited/aroused in group settings
  • hides or disappears when guests come over
  • substance abuse
  • drinks excessive amounts of coffee or caffeinated beverages
  •  notice and bothered by noises other people do not seem bothered by… clocks, refrigerators, fans, people talking, outdoor construction, etc.
  •  sensitive to loud sounds or commotion
  • easily distracted by auditory or visual stimuli
  •  can not attend certain public events or places due to excessive noise

    SENSORY DISCRIMINATION:

    __ __ can’t identify objects by feel if your eyes are closed

__ __ difficulty finding things in your purse or pocket without looking

__ __ don’t seem to notice if your hands or face are dirty

__ __ bothered by hands or face being dirty

__ __ loves to touch and be touched, has to touch everything

__ __ have a hard time feeling where a bug has bitten you or whether you are being bitten

__ __ difficulty heating food to the correct temperature, feeling if it is too hot or too cold

__ __ difficulty locating items in a cupboard, drawer, in your closet, or on a grocery shelf

__ __ difficulty with recognizing/interpreting/following traffic signs

__ __ difficulty judging distances about where your car is in relation to other cars, in parking spaces, or near a curb (fail miserably at parallel parking!!)

__ __ difficulty merging into oncoming traffic on road, rotary, or highway

__ __ get disoriented and/or lost easily in stores, buildings, hiking, etc.

__ __ can’t sleep if room isn’t completely dark

__ __ fearful of heights

__ __ difficulty concentrating on or watching a movie/tv show when there is background noise or distractions

__ __ difficulty remembering or understanding what is said to you

__ __ difficulty following directions if given two or three at one time

__ __ can not complete concentrated tasks if noises present

__ __ sensitive, or over reacts, to sirens, dogs barking, vaccuum cleaners, blenders, or other sudden/loud sounds

__ __ talks too loud or too soft

__ __ lethargic, hard to get going, appears “lazy” and unmotivated

__ __ become engrossed in one single activity for a long time and seems to tune out the rest of their environment

__ __ spend hours at a time on fantasy or video games and activities

__ __ great difficulty settling body down for sleep or waking up in the morning (did you even hear the alarm that has been going off for 15 minutes?)

__ __ has difficulty licking an ice cream cone neatly

__ __ difficulty with speech and annunciation

__ __ bumps into things frequently

__ __ often pushes too hard on objects, accidentally breaking them

__ __ difficulty judging how much pressure to apply when doing tasks or picking something up

__ __ difficulty identifying which key on your ring belongs to what

__ __ numbers and letters often reversed or backwards

__ __ difficulty telling time on an analogue clock

__ __ difficulty reading and understanding a map, bus schedule, directions

__ __ difficulty organizing and grouping things by categories, similarities, and/or differences

__ __ can’t seem to find words in word search puzzles

__ __ unable to identify foods that have gone bad by smell

__ __ difficulty being able to smell dangerous smells, i.e., smoke, noxious/hazardous solvents

__ __ difficulty being able to smell when something is burning on the stove or in the oven

__ __ difficulty distinguishing different tastes and/or flavors of food and/or drink items

SENSORY-BASED MOTOR SKILLS:

__ __ difficulty learning to ride a bike or other “moving” equipment

__ __ clumsy, uncoordinated, and accident prone

__ __ difficulty walking on uneven surfaces

__ __ difficulty with fine motor tasks such as buttoning, zipping, tying, knitting, sewing, playing games with small parts, closing zip loc bags

__ __ confuses right and left sides

__ __ prefers sedentary tasks, avoiding sports or physical activities

__ __ difficulty with handwriting; hard to read, takes a long time to write

__ __ frequently bumps into people and things

__ __ easily fatigued with physical tasks

__ __ frequently misses when putting objects on a table

__ __ messy eater, difficulty with eating utensils, spills and drops food

__ __ knocks drinks or other things over when reaching for them

__ __ frequently drops items

__ __ has to talk self through tasks

__ __ hums or vocalizes while concentrating on a task

__ __ significant difficulty learning to tie a tie

__ __ difficulty with motor tasks requiring several steps

__ __ difficulty lining up numbers correctly for math problems and/or balancing a checkbook

__ __ difficulty learning new motor tasks…a new dance, sport or exercise activity, how to drive

__ __ lose balance frequently

__ __ significant difficulty learning to type the “proper” way

SOCIAL / EMOTIONAL:

__ __ dislikes changes in plans or routines, needs structure

__ __ may be described as “stubborn”, “defiant”, or “uncooperative”

__ __ cries easily, over things others usually don’t, very “emotional” and “sensitive”

__ __ can’t seem to finish anything

__ __ difficulty making decisions

__ __ rigid and controlling

__ __ prefers solitary activities, avoids groups

__ __ impatient and/or impulsive

__ __ difficulty with social cues and non verbal language

__ __ difficulty with authority figures

__ __ trouble relating to and socializing with peers and colleagues

__ __ a “sore loser”

__ __ strong feelings of anger or rage

__ __ easily frustrated

__ __ needs sameness and routines; needs to know what to expect

__ __ have panic or anxiety attacks

__ __ plagued by fears and/or phobias

__ __ OCD-type qualities; can’t let foods touch each other on your plate, have to wear clothes a certain way, will only do ____, repetitively does ____, can not do _____ without doing _____, has to have ____ like ____

__ __ distractible and unorganized

__ __ hates surprises

__ __ difficulty seeking out and maintaining relationships

__ __ avoids eye contact

Internal Regulation:

__ __ difficulty falling asleep or getting on a sleep schedule

__ __ heart rate speeds up, and won’t slow down when at rest, or won’t speed up for tasks that require a higher heart rate

__ __ respiration too fast or slow for the appropriate state of arousal

__ __ over or under sensitivity to bowel and bladder sensations

__ __ over or under sensitivity to the sensation of hunger/appetite

__ __ irregular, inconsistent bowel, bladder and appetite sensations

__ __ difficulty with temperature regulation of body

 

 

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CLINIC FOR CHILDREN

Yudhasmara Foundation

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

http://childrenclinic.wordpress.com/

 

 

 

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

email : judarwanto@gmail.com

 

 

 

 

 

 

 

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