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Sensory History Questionaire
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Sensory History Questionaire
Pashe, Callie, & Sasha
How do you calm your child?
How does you child behave when s/he is frustrated?
How does your child behave in public or outside of the home?
What activities do you do with your child?
What are some activites that your child likes?
Whata re some activitie that your child dislikes?
Is there a time of day that your child seems calmer or more frustrated? What time and how does your child behave?
Does the child demonstrate a difference in behavior during the school week than weekends?
Does your child appear clumsy? Describe occasions when your child appeared clumsy?
How did your child transition from sitting to standing and crawling to walking?
How does your child react to different touch, including clothing, temperature, toys and surfaces?
How does your child react to different smells?
How does your child react to different lighting?
How does your child react to different sounds?
Did you breastfeed your child? If so, up until what age?
How did your child tolerate being place on his/her stomach while as an infant?
What tastes and smells does your child avoid?
How does your child react to different textures of food?
Describe your child's behavior with other children.
Does your child consistently respond when being addressed? Please explain.
How does your child react to new movement or movements on uneven surfaces?
How does s/he respond to direction or instructions?
How does s/he behave in the classroom?
Does the child have difiiculties moving from one task to the next? If so, how?
How does the child respond to changes in routines?
How does the child's behavior differ after lunch/recess as opposed to before?
How well does the child tolerate activities on the playground that involve running, swinging, sliding, jumping and spinning?
Describe any type of risky behaviors and activities the child engages in the classroom and playground?
Describe how the child appears in different areas of the classroom, at his/her desk, on the floor.
Describe how the child engages in different play activities in the classroom.
What activities does the child take interest in and take time on?
What activities does the child seem disinterested in?
Does the child have any difficulties copying from the board? If so, explain.
Does the child have poor handwriting? Is so, explain.
When the child is in distress what methods do you use to calm him/her down?
How does the child respond to sudden unexpected noise in school such as the bell?
Does the child seem more productive in a group or individually? Explain.
How does the child tolerate quiet time and/or nap time?
What techniques does the child require to fall asleep during nap time?
How does the child react to different materials used during art time?
Describe the way the child dresses himself when getting ready to go outside.
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