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spm-p Sensory Processing Measure-Preschool HOUSE

Cheryl Ecker, M.A., OTR/
L and L. Diane Parham, Ph.D., OTR/L, FAOTA

Father/Mother/Guardian Information
Form Score
Name/ Identification No: Instructions

Your relationship with the child: Data: Please answer the questions on this form based on your child's typical
behavior over the past month. Use the following rating scale:
child information

Name/ Identification No: Never: The behavior never or almost never happens.
Occasionally: The behavior occurs sometimes.
Gender: ÿ M ÿ F Age: Years months
Often: The behavior occurs most of the time.
Always: The child always or almost always responds in this way.
Race/Ethnicity:
Circle one of the answers that best describes how often the behavior
ÿ American Indian/Alaska Native ÿ Asian ÿ Black/African American
happens. Do your best to answer all questions. Several questions ask
ÿ Hispanic/Latino ÿ Native Hawaiian/Pacific Islands ÿ White ÿ Other whether the child is uncomfortable in certain situations.
Being
uncomfortable can include verbal expressions (mumbling, crying,
Comments on the child's behavior and functioning: screaming or non-verbal expressions (walking away, gesturing, pushing
something away, running away, cringing, dropping/throwing objects). You
can use the space on the left to add any comment on your child's behavior
or functioning.

PLEASE CIRCLE YOUR ANSWERS.

NEVER CHANCE. FREQUENTLY ALWAYS SOCIAL PARTICIPATION this child…

N ………. O ………… F ………… S ………… 1. Play with friends cooperatively..

N ………. O ………… F ………… S ………… 2. Share things when asked.

N ………. O ………… F ………… S ………… 3. Participate in group games without interrupting the activity.

N ………. O ………… F ………… S ………… 4. Participates and interacts appropriately at meal times.

N ………. O ………… F ………… S ………… 5. Appropriately participates in family outings, such as dining out or going to a museum or mall.

N ………. O ………… F ………… S ………… 6. Properly participates in family gatherings such as holidays, weddings, and birthdays.

Participates appropriately in activities with friends, such as parties and games and playground toys.
N ………. O ………… F ………… S ………… 7.

N ………. O ………… F ………… S ………… 8. Helps with family activities like carrying shopping bags and picking up siblings from school.

NEVER CHANCE. FREQUENTLY ALWAYS VISION this child...

Seems uncomfortable with light, especially bright lights (blinks, squints, cries, closes eyes, etc.).
N ………. O ………… F ………… S ………… 9.

N ………. O ………… F ………… S ………… 10. Has difficulty finding an object when it is with other things.

Has difficulty recognizing whether objects are similar or different based on their color, shape, or size.
N ………. O ………… F ………… S ………… 11.

He likes to watch objects turning or moving, more than most children his age.
N ………. O ………… F ………… S ………… 12.

N ………. O ………… F ………… S ………… 13. Walk among objects or people as if they were not there.

N ………. O ………… F ………… S ………… 14. Likes to turn light switches on and off repeatedly.

N ………. O ………… F ………… S ………… 15. Likes to look at moving objects out of the corner of his eye.

N ………. O ………… F ………… S ………… 16. Has difficulty paying attention if you are in a place with many things to look at.

It is uncomfortable in places with a lot of visual stimuli, such as a very messy room or a store full of items.
N ………. O ………… F ………… S ………… 17.

N ………. O ………… F ………… S ………… 18. You are easily distracted by looking at things around you when you are walking.

N ………. O ………… F ………… S ………… 19. Has difficulty completing simple tasks when there are too many things to look at.

NEVER CHANCE. FREQUENTLY ALWAYS HEARING this child…

Seems bothered by normal sounds in a house, such as a vacuum cleaner, hairdryer, or flushing noise.
N ………. O ………… F ………… S ………… 20.

N ………. O ………… F ………… S ………… 21. Responds negatively to loud noises, running away, crying, or covering ears with hands.

N ………. O ………… F ………… S ………… 22. It doesn't seem to hear certain sounds.

Is disturbed or extremely interested in sounds that are not normally heard by other people.
N ………. O ………… F ………… S ………… 23.

Seems easily distracted by ambient noises such as a lawn mower outside the house, air conditioner, a refrigerator, etc.
N ………. O ………… F ………… S ………… 24.

N ………. O ………… F ………… S ………… 25. Likes to make certain noises repeatedly, such as flushing the toilet many times.

N ………. O ………… F ………… S ………… 26. Shows distress with shrill sounds such as whistles, party paraphernalia, flutes and trumpets.

Demonstrates discomfort in places with a lot of auditory stimuli, such as at a party or in crowded places.
N ………. O ………… F ………… S ………… 27.

N ………. O ………… F ………… S ………… 28. Easily startled by hearing a loud or unexpected sound.

NEVER CHANCE. FREQUENTLY ALWAYS TATTO this child…

N ………. O ………… F ………… S ………… 29. Moves away when lightly touched.

N ………. O ………… F ………… S ………… 30. He prefers to touch than to be touched.

N ………. O ………… F ………… S ………… 31. Stresses when they cut their nails.
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N ………. O ………… F ………… S ………… 32. You feel uncomfortable when your face is touched.

N ………. O ………… F ………… S ………… 33. Avoid playing with finger paint, sand, clay, clay, glue, or other dirty things.

N ………. O ………… F ………… S ………… 34. It has a high pain tolerance.

N ………. O ………… F ………… S ………… 35. He doesn't like to brush his teeth any more than other kids his age.

N ………. O ………… F ………… S ………… 36. Seems to take pleasure in painful sensations, such as falling to the ground or hitting your own body.

N ………. O ………… F ………… S ………… 37. He doesn't like to comb, brush and fix his hair.

N ………. O ………… F ………… S ………… 38. He doesn't like to cut his hair.

N ………. O ………… F ………… S ………… 39. Avoid foods with certain textures.

N ………. O ………… F ………… S ………… 40. Vomits or feels like vomiting when eating foods with certain textures.

N ………. O ………… F ………… S ………… 41. He doesn't like it when they try to clean or wash his face.

N ………. O ………… F ………… S ………… 42. He drools more than other kids his age.

NEVER CHANCE. FREQUENTLY ALWAYS SMELL AND TASTE this child…

N ………. O ………… F ………… S ………… 43. Likes to ingest non-food products such as glues, paints, etc.

N ………. O ………… F ………… S ………… 44. Seems to ignore or not notice strong odors to which other children would react.

N ………. O ………… F ………… S ………… 45. Prefers flavors of certain foods to the point of refusing to eat other foods offered.

N ………. O ………… F ………… S ………… 46. Refuses to use toothpaste on the toothbrush.

NEVER CHANCE. FREQUENTLY ALWAYS BODY CONSCIOUSNESS this child…

N ………. O ………… F ………… S ………… 47. Holds objects (such as a pencil or spoon) so tightly that the object is difficult to use.

N ………. O ………… F ………… S ………… 48. Seems to seek out activities such as pushing, pulling, dragging, lifting, and jumping.

Is insecure when lifting or lowering the body during movement, such as sitting or stepping over an object.
N ………. O ………… F ………… S ………… 49.

N ………. O ………… F ………… S ………… 50. Holds objects (such as a pencil or spoon) so loosely that the object is difficult to use.

Seems to exert too much pressure on tasks such as walking (walking heavily), slamming doors, or pressing too hard when using pencils or crayons.
N ………. O ………… F ………… S ………… 51.

N ………. O ………… F ………… S ………… 52. Jumps a lot.

N ………. O ………… F ………… S ………… 53. Tends to fondle animals very forcefully.

N ………. O ………… F ………… S ………… 54. Hits or pushes other children.

N ………. O ………… F ………… S ………… 55. Chews toys, clothes or other objects more than other children of the same age.

NEVER CHANCE. FREQUENTLY ALWAYS BALANCE AND MOVEMENT this child…

Shows exaggerated fear of movement, such as going up and down stairs or playing on swings, spins, etc.
N ………. O ………… F ………… S ………… 56.

N ………. O ………… F ………… S ………… 57. Avoid balancing activities, such as riding on brakes and on uneven ground.

N ………. O ………… F ………… S ………… 58. Falls off chair while trying to straighten up.

N ………. O ………… F ………… S ………… 59. Fails to catch hold when falling.

N ………. O ………… F ………… S ………… 60. It doesn't seem to get dizzy when others normally would.

N ………. O ………… F ………… S ………… 61. He tends to play around with his own body more than other children his age.

N ………. O ………… F ………… S ………… 62. Shows desperation when the head is bowed, in a non-vertical position.

N ………. O ………… F ………… S ………… 63. Has poor motor coordination and looks like a clumsy child.

N ………. O ………… F ………… S ………… 64. When trying to get up, leans on people or furniture.

N ………. O ………… F ………… S ………… 65. Rocks your body when you wake up and sit down.

N ………. O ………… F ………… S ………… 66. Seems afraid to go down stairs or hills.

NEVER CHANCE. FREQUENTLY ALWAYS PLANNING AND IDEATING this child…

N ………. O ………… F ………… S ………… 67. Has trouble figuring out how to carry multiple objects at once.

N ………. O ………… F ………… S ………… 68. Seems confused about how to arrange materials and belongings in their correct places.

N ………. O ………… F ………… S ………… 69. Is confused by the proper sequence of routine actions, such as getting dressed or going to bed.

N ………. O ………… F ………… S ………… 70. Cannot complete multi-step tasks.

Has difficulty imitating demonstrated actions, such as movement games or songs with gestures.
N ………. O ………… F ………… S ………… 71.

N ………. O ………… F ………… S ………… 72. Cannot copy another child or adult in building with blocks.

N ………. O ………… F ………… S ………… 73. Has difficulty coming up with new ideas during play activities.

Tends to perform the same activities over and over, rather than switching to new activities when given the opportunity.
N ………. O ………… F ………… S ………… 74.

N ………. O ………… F ………… S ………… 75. Has problems getting into or out of the car seat.