Appendix H

Sample Sensory-Based Goals

Sensory with Self Care Tasks:

1. ______________ will tolerate washing hair for ______% of task without a tantrum in 5 out of 7
days for increased participation and functional independence in daily life.

2. ______________ will tolerate oral hygiene for ______% of task without a tantrum in 5 out of 7
days for increased participation and functional independence in daily life.

3. ______________ will go to sleep after 30 minutes of self preparation routine without difficulty
(i.e. tantrums or other similar behaviors) in 5 out of 7 days for increased participation and
functional independence in daily life.

4. ______________ will demonstrate an appropriate level of arousal for _____ minutes in 4 out of
5 treatment sessions for increased participation and functional independence in daily life.

5. ______________ will wearing UB and LB clothing for _______ minutes without a tantrum in 5
out of 7 days for increased participation and functional independence in daily life.

Behavioral:

1. ________________s family will understand his sensory needs and be able to follow through on
home and school activities that will assist him in maintaining an appropriate level of arousal as
measured through verbal recall of information with _______% accuracy.

2. ________________ will attain and maintain an appropriate level of arousal for activities ____
hours out of the day with ___________ rest breaks as measured by teacher and family report.

3. Using sensory strategies, ___________________ will demonstrate appropriate sensory

modulation skills in order to sit and participate in circle time at school without aggression
towards peers in 4 out of 5 days of the week as measured by teacher report.

4. _______________ will demonstrate ability to tolerate sitting close to peers in classroom without
physically striking another student in 4 out of 5 days of the week as measured by teacher report.

5. ______________ will demonstrate knowledge of sensory diet with ___% accuracy as measured
by verbal and visual recall.

6. ______________ will demonstrate ability to implement sensory diet with ____% accuracy as
measured by skill demonstration per teacher report in 4 out of 5 school days.

7. ______________ will tolerate standing in line without tantrums or other poor behaviors in 4 out
of 5 school days as measured by teacher report.