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Run: Pediatric Sensory Processing Evaluation

A Pediatric Sensory Processing Evaluation template for documenting how a child responds to sound, touch, movement, visual input, and oral input across settin...

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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.

Note (optional)

Standardized sensory profile completed critical (required)

Confirm whether a Sensory Profile or equivalent standardized sensory processing measure was completed.

Yes No N/A

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.

Yes No N/A

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 critical (required)

Document startle, covering ears, crying, fleeing, or other aversive responses to noise.

Yes No N/A

Needs repeated verbal prompts in noisy settings

Note whether increased auditory load reduces attention, comprehension, or task completion.

Yes No N/A

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.

Yes No N/A

Tactile defensiveness or sensory seeking observed critical (required)

Note defensiveness, avoidance, mouthing, rubbing, or excessive touch seeking that affects participation.

Yes No N/A

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.

Yes No N/A

Seeks visual input or repetitive visual behaviors observed

Note staring, peripheral viewing, close viewing, or repetitive visual seeking behaviors.

Yes No N/A

Oral sensory seeking or aversion observed

Document mouthing, chewing, food texture sensitivity, gagging, or oral defensiveness if observed or reported.

Yes No N/A

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.

Note (optional)

Participation Impact and Intervention Planning

Sensory patterns affect school or daily participation critical (required)

Rate the overall functional impact of sensory processing on learning, play, self-care, or routines.

Identified sensory modulation needs critical (required)

Select the primary sensory modulation needs identified from the evaluation.

Note (optional)

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.

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