Sensorimotor Questionnaire

QUESTIONS  

1.  Is your child particularly sensitive to touch? 

2.  Does your child particularly enjoy fast –moving or spinning activities at the playground or at home, perhaps with little or no dizziness?

3.  Does your child show particular caution in approaching activities involving fast movement or movement of the body?

4.     Does your child have unusual sensitivities to smell?

5.  Is your child particularly sensitive to noise, e.g. putting hands over ears when others are not bothered by sounds?

6.  Have you ever had concerns about your child’s hearing either in general or in conjunction with ear infections?

7.  Have you ever had concerns about your child’s vision?

8.  Do you think your child has a more “loose” or “floppy” body build than others?

9.  Does your child have difficulty orientating her body effectively for dressing activities, such as putting arms in sleeves, putting fingers in mittens, or putting toes in socks?

Questions 10.  Do you feel that your child has not yet established a definite hand preference when using a spoon, crayon, marker, pencil, etc.?

11.  Does your child avoid active physical games involving running, jumping, and use of large play equipment?

12.  Does your child avoid manipulation of small objects?

13.  Does your child avoid activities involving the use of “tools” such as crayons, pencils, markers, and scissors?

14.   Do you feel that your child has a short attention span, even for things that she enjoys?

15.  Do you feel that your child tends to be restless or “fidgety” during times when quiet concentration is required?

YES   

NO