Stimulation Questionaire
Touch
Does your child avoid touching or being touched by objects and people?
Does she react with a fight or flight response to getting dirty to certain textures of clothing and food and to another persons unexpected light touch? Paw through toys with an extreme purpose (line up toys or excessively) |
Is your child unaware of pain?
- Temperature? - How objects feel? Does your child wallow in the mud? Paw through toys purposelessly? Chew on inedible objects like shirt cuffs? Toys? Etc? Does your child rub up against furniture? Walls? Or people? |
Movement
Does your child avoid moving?
Does she avoid running? Climbing? Sliding? Swinging? Does she feel seasick in cars or elevators? |
Does your child crave movement?
Fast spinning environments? Such as swinging, rocking, twirling, and riding merry go rounds? Does she move constantly? Does she enjoy getting into upside down positions? |
Body Position
Does your child seem rigid, tense, stiff, or uncoordinated?
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Does your child slump or slouch?
Does your child’s actions seem clumsy or inaccurate? Does she bump into objects? Stamp her feet? Twiddle her fingers? |
Sight
Does your child get overexcited when there is too much to look at? Words, toys, other children, etc.?
Does she often cover her eyes or have poor eye contact? Is she inattentive when drawing or doing desk work? Does she overreact to bright light? |
Does your child touch everything in order to learn about it? Do you feel your child misses important visual cues such as another person’s facial expressions and gestures? |
Sound
Does your child cover her ears to close out sounds or voices?
Does she complain about noises such as a vacuum cleaner or blender that do not bother others? |
Does your child ignore voices?
Does your child have difficulty following directions? Does your child not listen well to herself? Does your child speak in a booming voice? Does your child want the TV and radio to be loud? |
Smells
Does your child object to odors such as ripe banana that other children do not notice?
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Does your child ignore unpleasant odors like a dirty diaper?
Does your child sniff food, people, and objects? |
Taste
Does your child strongly object to certain textures and temperatures of foods?
Does your child gag when she eats? |
Does your child lick or taste inedible objects like playdough or toys?
Does she prefer spicy or very hot foods? |