Sensory Assessment and Planning Report

Student’s Full Name: NYC ID:

Birth Date: Student’s Age:
Service Provider Name:
Service Provider Profession:
Date of Report:

BACKGROUND INFORMATION
Present Conditions/Diagnosis:
Current Services:

The purpose of this report is to

SENSORY TESTING
Sensory processing is the brains ability to orient, regulate, and use multi-sensory information to successfully
complete activities and make the appropriate adjustments to assure ongoing success across environments.
The Sensory Profile 2 is a standardized assessment tool for measuring a student’s sensory processing abilities
and its effect on the student’s functional performance in the classroom/school, home, and community
environments. The information provided by this tool will inform on the student’s way of responding to
sensory experiences in everyday life and demonstrates how significant the observed differences are in
relation to the rest of the population. This information will be used to inform the process of determining how
those responses affect the student’s participation to provide adequate support for success.
The Sensory Profile is intended to be used as part of a comprehensive performance assessment of students,
when combined with other evaluations, observations, and reports.

Rater Information:
Rater 1 (R1): Classroom Staff/Techer Rater 2 (R2): Caregiver
Short Sensory Profile Completed By: Child Sensory Profile 2 Completed by:
Relationship to Child: Teacher Relationship to Child: Mother
Administration Date: *Administration Date:
Child Age at Administration: Child Age at Administration:

*Examiner unsure of exact date completed. Date range based on when SP2 was sent home and returned to therapist.

SCORE PROFILE
The following results were obtained by using the Sensory Profile 2 School Companion Questionnaire by rater
1 and the Sensory Profile 2 Caregiver Questionnaire form by rater 2 respectively.

R1: SENSORY PROFILE 2 SCHOOL COMPANION

Raw Much less Less than Just like More than Much Explained
 the
than more than
Score others majority others
others others
of others
Quadrant
STUDENT is just as interested in
Seeking/Seeker
sensory experiences as others
Avoiding/Avoider STUDENT reacts to sensory
experiences just like the
majority of others
STUDENT detects sensory cues
Sensitivity/Sensor
just like the majority of others
STUDENT notices sensory cues
Registration/Bystander
just like the majority of others

Just like
Much less Much
Raw Less than the More than
than more than
Score others majority others
others others
of others
Sensory Section
STUDENT responds more to
Auditory
sounds than others
STUDENT responds to
Visual vision/sight just like the majority
of others
STUDENT responds to touch just
Touch
like the majority of others
STUDENT responds to
Movement movement just like the majority
of others
STUDENT responds to body
Body Position position just like the majority of
others
STUDENT responds just like the
Oral majority of others to items in or
around the mouth
Behavioral Section
STUDENT exhibits this aspect of
Conduct conduct just like the majority of
others
STUDENT exhibits social
Social Emotional emotional responses just like
the majority of others
STUDENT pays attention to cues
Attentional around him just like the majority
of others
 Typical Performance – scores in this range indicate the child has typical sensory processing abilities. Scares
range from 1 standard deviation below the mean to 1 standard deviation above the mean.
Probable Difference – scores in this range indicate that the child has questionable areas of sensory
processing abilities. Scores deviate more than 1 to 2 standard deviations from the mean.
Definite Difference – scores falling in this category indicate definite sensory processing problems. These are
scores that are more than 2 standard deviations above or below the mean.
STUDENT responds …

R2: CAREGIVER QUESTIONNAIRE

Just like
Much less Much
Raw Less than the More than
than more than
Score others majority others
others others
of others
Quadrant
STUDENT is just as interested in
Seeking/Seeker
sensory experiences as others
STUDENT reacts to sensory
Avoiding/Avoider experiences just like the
majority of others
STUDENT detects sensory cues
Sensitivity/Sensor
just like the majority of others
STUDENT notices sensory cues
Registration/Bystander
just like the majority of others

Quadrant Summary:
STUDENT scored just like the majority of others in all quadrant categories, representing typical performance
for neurologic thresholds in these areas.

Quadrant 1: Registration measures the student’s awareness of sensation. STUDENT scored like the majority
of others.
Quadrant 2: Seeking measures the student’s interest in and pleasure with all types of sensation. STUDENT
scored like the majority of others.
Quadrant 3: Sensitivity measures the student’s ability to notice all types of sensation. STUDENT scored like
the majority of others.
Quadrant 4: Avoiding measures the student’s need for controlling the amount and type of sensation at any
time. STUDENT scored just like the majority of others.

Just like
Much less Much
Raw Less than the More than
than more than
Score others majority others
others others
of others
Sensory Section
 STUDENT responds more to
Auditory
sounds than others
STUDENT responds to
Visual vision/sight just like the majority
of others
STUDENT responds to touch just
Touch
like the majority of others
STUDENT responds to
Movement movement just like the majority
of others
STUDENT responds to body
Body Position position just like the majority of
others
STUDENT responds just like the
Oral majority of others to items in or
around the mouth
Behavioral Section
STUDENT exhibits this aspect of
Conduct conduct just like the majority of
others
STUDENT exhibits social
Social Emotional emotional responses just like
the majority of others
STUDENT pays attention to cues
Attentional around him just like the majority
of others

Sensory and Behavioral Summary:

Auditory is the measurement of the student’s response to things heard. STUDENT scored more than others in
this area.
Visual is the measurement of the student’s response to things seen. STUDENT scored just like the majority of
others.
Touch is the measurement of the student’s responses to stimuli through the skin. STUDENT scored just like
the majority of others.
Movement is the measurement of the student’s responses to the sensations for movement (e.g. – slumps in
chair; gets up and moves around more than others). STUDENT scored just like the majority of others.
Body Position is the measurement of student’s awareness of their body’s position, location, and orientation
in space. STUDENT scored just like the majority of others.
Oral STUDENT scored just like the majority of others.
The Behavior Sections measures the student’s response to a group of items associated with sensory
responses (e.g. – easily frustrated; inefficient in doing things). STUDENT scored just like the majority of
others.

INTERPRETATION OF THE SENSORY PROFILE 2

Interpret the results of above and give recommendations/give a sensory diet.
The Sensory Profile shows STUDENT has
Recommendations

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Clinician signature and credentials