Short Sensory Profile (SSP) Form

Please fill this Short Sensory Profile (SSP) form before your appointment for better understanding of your condition, which help us prepare best for you.

Short Sensory Profile

Winnie Dunn, Ph. D., OTR, FAOTA

Child's Name

Completed By

Relationship to Child

Specialist

Specialist Name

Child Date of Birth

Assessment Date

Instructions

Please check the box that best describes the frequency with which your child does the following behaviors. Please answer all of the statements. If you are unable to comment because you have not observed the behavior or believe that it does not apply to your child, please draw an X through the number for that item. Total each column and record it in the Section Raw Score Total row.

Use the following to mark your responses:

ALWAYS - When presented with the opportunity, your child always responds in this manner, 100% of the time.

FREQUENTLY - When presented with the opportunity, your child frequently responds in this manner, 75% of the time.

OCCASIONALLY - When presented with the opportunity, your child occasionally responds in this manner, 50% of the time.

SELDOM - When presented with the opportunity, your child seldom responds in this manner, 25% of the time.

NEVER - When presented with the opportunity, your child never responds in this manner, 0% of the time.

Tactile Sensitivity

1. Express distress during grooming (for example, fights or cries during haircutting, face washing, fingernail cutting)

Always

Frequently

Occasionally

Seldom

Never

Tactile Sensation Raw Score

Taste/Smell Sensitivity

List the tastes

List food textures/temperatures

Taste/Smell Raw Score

Movement Sensitivity

Movement Sensitivity Raw Score

Underresponsive/Seeks Sensation

16. Seeks all kinds of movement and this interferes with daily routines (for example, can’t sit still, fidgets)

Always

Frequently

Occasionally

Seldom

Never

Underresponsive Sensitivity Raw Score

Auditory filtering

23. Appears to not hear what you say (for example, does not “tune-in” to what you say, appears to ignore you)

Always

Frequently

Occasionally

Seldom

Never

Auditory Filtering Raw Score

Low Energy/Weak

Low Energy/Weak Raw Score

Visual/Auditory Sensitivity

34. Responds negatively to unexpected or loud noises (for example, cries or hides at noise from vacuum cleaner, dog barking, hair dryer)

Always

Frequently

Occasionally

Seldom

Never

Visual/Auditory Sensitivity Raw Score

Summary & Results

The results are Plotted with typical classifications:

Performance,
Probable Difference,
Definite Difference

Tactile Sensitivity

Typical Performance: 35-30 | Probable Difference: 29-27 | Definite Difference: 26-7

/35

Taste/Smell Sensitivity

Typical Performance: 20-15 | Probable Difference: 14-12 | Definite Difference: 11-4

/20

Movement Sensitivity

Typical Performance: 15-13 | Probable Difference: 12-11 | Definite Difference: 10-3

/15

Underresponsive/Seeks Sensation

Typical Performance: 35-27 | Probable Difference: 26-24 | Definite Difference: 23-7

/35

Auditory Filtering

Typical Performance: 30-23 | Probable Difference: 22-20 | Definite Difference: 19-6

/30

Low Energy/Weak

Typical Performance: 30-26 | Probable Difference: 25-24 | Definite Difference: 23-6

/30

Visual/Auditory Sensitivity

Typical Performance: 25-19 | Probable Difference: 18-16 | Definite Difference: 15-5

/25

Total

Typical Performance: 190-155 | Probable Difference: 154-142 | Definite Difference: 141-38

/190

Short Sensory Profile (SSP) Form