Name
Completed by
Date
How to use the scale
For each system, mark where this child usually sits:
- OVER = too much gets through (avoids, covers ears, distressed by things others don't notice)
- OK = no particular difficulty
- UNDER = not enough gets through (doesn't notice, misses signals)
- SEEKS = actively looks for this input
A child can be OVER in one system and SEEKS in another. That's normal.
| Sense | Over | OK | Under | Seeks | Notes — specifics matter more than the box |
|---|---|---|---|---|---|
| Hearing | |||||
| Sight | |||||
| Touch | |||||
| Smell | |||||
| Taste / food | |||||
| Movement / balance | |||||
| Body awareness | |||||
| Internal signals |
Specific triggers
Sounds
- Hand dryers
- Bells
- Canteen
- Corridors
- Chairs scraping
- Fans / lights humming
- Assembly
- Sudden noise
- Fire alarm
Other
Light and visual
- Overhead fluorescents
- Flicker
- Whiteboard glare
- Sunlight
- Busy displays
- Screens
Other
Touch and clothing
- Labels
- Seams
- Specific fabrics
- Uniform item: ______________________
- Unexpected touch
- Queuing close to others
- Messy play
Other
Smell
- Cleaning products
- Canteen
- Toilets
- Perfume / deodorant
- Art materials
- Science
Other
Food
Textures avoided
Accepted foods
Places that are consistently hard
- Canteen
- Hall
- Corridors
- Changing rooms
- Toilets
- Playground
- Minibus
Internal signals (interoception)
Does this child reliably notice:
| Yes | Sometimes | No | |
|---|---|---|---|
| Hunger | |||
| Thirst | |||
| Needing the toilet | |||
| Too hot / too cold | |||
| Pain or injury | |||
| Feeling ill | |||
| Emotions building |
If several are "No", schedule drinks, food and toilet breaks rather than waiting for the child to ask.
What regulates this child
- Movement / running
- Heavy work (carrying, pushing, climbing)
- Deep pressure
- Quiet space
- Dark space
- Music
- Chewing
- Fidget item
- Water
- Being outside
- Their interest
- Being alone
- Being near a trusted adult
Other
Stims used (leave alone unless causing injury)
Early warning signs of overload
Write here
Time of day this usually happens
Adjustments in place
- Ear defenders / earplugs
- Reduced lighting
- Seating change
- Leaves lesson 2 min early
- Alternative to canteen
- Movement breaks
- Heavy work before demanding tasks
- Fidget permitted
- Exit card
- Named safe space
- Scheduled drink / toilet breaks
- Advance warning of alarms
Other
What has been tried and did NOT work
Review date
Not a clinical assessment. For a full sensory assessment, ask about referral to occupational therapy via your GP or SENCO.