Pediatric Sensory Processing Evaluation

Inspection template for documenting a child's sensory responses across environments using the Sensory Profile and structured observation to identify sensory modulation needs for intervention.

Assessment Details

• Child identifier and age recorded
  Document the child's name or internal identifier, age, and grade or developmental level.
• Referral concern and evaluation purpose documented
  Summarize the referral question, participation concerns, and reason for sensory processing evaluation.
• Settings observed included at least two environments
  Select the environments included in the evaluation.
• Standardized sensory profile completed
  Confirm whether a Sensory Profile or equivalent standardized sensory processing measure was completed.
• Observation period and activities documented
  Record the observation duration, tasks, routines, and activities used to elicit sensory responses.
• Caregiver or teacher input obtained
  Confirm whether collateral report from caregiver, teacher, or other informant was included.

Auditory Processing and Sound Sensitivity

• Responds to name and spoken directions within expected time
  Rate responsiveness to verbal input and ability to attend to spoken cues.
• Shows distress or avoidance with sudden or loud sounds
  Document startle, covering ears, crying, fleeing, or other aversive responses to noise.
• Needs repeated verbal prompts in noisy settings
  Note whether increased auditory load reduces attention, comprehension, or task completion.
• Auditory filtering affects participation
  Rate the extent to which background noise interferes with engagement, transitions, or instruction following.
• Comments on auditory triggers and supports
  Describe specific triggers, calming strategies, and environmental supports that improved regulation.

Tactile, Vestibular, and Proprioceptive Responses

• Tolerates routine touch and grooming tasks
  Rate response to touch during dressing, grooming, handwashing, and incidental contact.
• Avoids or seeks movement activities
  Select the predominant vestibular pattern observed during swings, climbing, spinning, transitions, or gross motor play.
• Body awareness and force grading are age-appropriate
  Rate proprioceptive awareness, pressure grading, and ability to modulate force during play and tasks.
• Craves deep pressure or heavy work input
  Document whether the child seeks pushing, pulling, squeezing, crashing, or weighted input to regulate.
• Tactile defensiveness or sensory seeking observed
  Note defensiveness, avoidance, mouthing, rubbing, or excessive touch seeking that affects participation.
• Movement or touch observations
  Describe specific sensory behaviors, triggers, and successful supports used during observation.

Visual, Oral, and Self-Regulation Responses

• Visual distraction interferes with task completion
  Document whether clutter, movement, lighting, or visual complexity reduces attention or participation.
• Seeks visual input or repetitive visual behaviors observed
  Note staring, peripheral viewing, close viewing, or repetitive visual seeking behaviors.
• Oral sensory seeking or aversion observed
  Document mouthing, chewing, food texture sensitivity, gagging, or oral defensiveness if observed or reported.
• Self-regulation after sensory challenge
  Rate the child's ability to recover after sensory overload, transition, or unexpected input.
• Regulation strategies that were effective
  Select supports that improved regulation or participation during the evaluation.

Participation Impact and Intervention Planning

• Sensory patterns affect school or daily participation
  Rate the overall functional impact of sensory processing on learning, play, self-care, or routines.
• Identified sensory modulation needs
  Select the primary sensory modulation needs identified from the evaluation.
• Recommendations documented
  Provide concise recommendations for classroom, home, or therapy supports based on observed sensory needs.
• Follow-up or re-evaluation plan documented
  Document next steps, referral needs, or timing for follow-up evaluation if indicated.
• Clinician interpretation and summary completed
  Summarize the overall sensory processing profile, key patterns, and clinical interpretation.