01234

| Notes / Examples | | --- | --- | --- | --- | | 14 | Squints, rubs eyes, or complains of headaches in bright light. |

| | | 15 | Bothered by fluorescent lights or flickering screens. |

| | | 16 | Loses place when reading or copying from board. |

| | | 17 | Seeks out shiny/spinning objects or stares at lights. |

| | | Section 4 Raw Score Total: | / 16 | |

5

Smell / Taste

(Olfactory / Gustatory)

| # | Behavioral Indicator | Frequency

01234

| Notes / Examples | | --- | --- | --- | --- | | 18 | Notices or complains about smells others ignore (food, markers, cleaners). |

| | | 19 | Refuses certain food textures or temperatures at lunch. |

| | | 20 | Chews on non-food items (shirt, pencil, hair, eraser). |

| | | Section 5 Raw Score Total: | / 12 | |

6

Body Awareness & Motor Planning

(Proprioceptive / Praxis)

| # | Behavioral Indicator | Frequency

01234

| Notes / Examples | | --- | --- | --- | --- | | 21 | Frequently bumps into people or objects (poor spatial awareness). |

| | | 22 | Uses too much or too little force when writing, erasing, or opening doors. |

| | | 23 | Difficulty sequencing multi-step tasks (e.g., organizing materials). |

| | | 24 | Tires quickly during handwriting or desk work. |

| | | 25 | Appears "slumped" or needs frequent position changes. |

| | | Section 6 Raw Score Total: | / 20 | |

7

Regulation & Attention Impact

(Emotional & Cognitive)

| # | Behavioral Indicator | Frequency

01234

| Notes / Examples | | --- | --- | --- | --- | | 26 | Needs frequent movement breaks to stay on task. |

| | | 27 | Appears overly active or lethargic compared to peers. |

| | | 28 | Emotional outbursts or shutdowns triggered by sensory input. |

| | | 29 | Difficulty transitioning between activities or environments. |

| | | 30 | Academic performance fluctuates with classroom conditions (noise, lighting). |

| | | 31 | Avoids work or experiences challenges with task initiation/completion. |

| | | 32 | Acts out or is disruptive / defiant / oppositional. |

| | | Section 7 Raw Score Total: | / 28 | |

Teacher Summary

1. Primary concern(s) for this student, if any:

2. What strategies have already been tried? (e.g., seating, fidgets, headphones)

3. How do these behaviors impact learning or participation?

SECTION 4: VISUAL INPUT

SECTION 5: TASTE & SMELL

Andy's OT Toolkit Resource • Student Self-Discovery Edition

Discovery Results

Mapping your sensory landscape.

Part 1: Your Scores

Add up the numbers you circled for each section and write the total below. Each section has a maximum possible score of 15.

1. TOUCH

____ / 15

2. SOUND

____ / 15

3. MOVEMENT

____ / 15

4. VISUAL

____ / 15

5. TASTE & SMELL

____ / 15

Interpretation Key

3 – 6

Low Sensitivity: You may need more "intensity" (loud music, firm pressure, movement) to feel alert and grounded.

7 – 10

Typical Processing: Most sensory input is processed efficiently. You might have mild preferences, but they rarely disrupt your day.

11 – 15

High Sensitivity: Your brain registers sensory details quickly. You might notice everything, but you can also become easily overwhelmed or "overloaded."

Andy's OT Toolkit Resource • Student Self-Discovery Edition

Personal Reflection

What your profile means for you.

Part 2: Reflection

1. Looking at your highest score, how does this explain some of your behavior or feelings in school?

2. What is ONE strategy you can try this week to help manage your sensory needs? (e.g., noise-canceling headphones, changing where you sit, using a fidget tool)

Andy's OT Toolkit Resource • Student Self-Discovery Edition

SECTION 4: VISUAL INPUT

SECTION 5: TASTE & SMELL

Andy's OT Toolkit Resource • Student Self-Discovery Edition

Discovery Results

Mapping your sensory landscape.

Part 1: Your Scores

1. TOUCH

____ / 15

2. SOUND

____ / 15

3. MOVEMENT

____ / 15

4. VISUAL

____ / 15

5. TASTE & SMELL

____ / 15

Interpretation Key

3 – 6

Low Sensitivity: You may need more "intensity" to feel alert and grounded.

7 – 10

Typical: Most sensory input is processed efficiently.

11 – 15

High Sensitivity: You registers details quickly, but can become easily overloaded.

Part 2: Reflection

1. Looking at your highest score, how does this explain some of your behavior or feelings in school?

2. What is ONE strategy you can try this week to help manage your sensory needs?

Andy's OT Toolkit Resource • Student Self-Discovery Edition

Andy's OT Toolkit Resource • Student Self-Discovery Edition

SECTION 4: VISUAL INPUT

SECTION 5: TASTE & SMELL

Discovery Results

Mapping your sensory landscape.

Part 1: Your Scores

1. TOUCH

____ / 15

2. SOUND

____ / 15

3. MOVEMENT

____ / 15

4. VISUAL

____ / 15

5. TASTE & SMELL

____ / 15

Andy's OT Toolkit Resource • Student Self-Discovery Edition

Interpretation Key

3 – 6

Low Sensitivity: You may need more "intensity" (loud music, firm pressure, movement) to feel alert and grounded.

7 – 10

Typical Processing: Most sensory input is processed efficiently. You might have mild preferences, but they rarely disrupt your day.

11 – 15

High Sensitivity: Your brain registers sensory details quickly. You might notice everything, but you can also become easily overwhelmed or "overloaded."

Part 2: Reflection

1. Looking at your highest score, how does this explain some of your behavior or feelings in school?

2. What is ONE strategy you can try this week to help manage your sensory needs? (e.g., noise-canceling headphones, changing where you sit, using a fidget tool)

Andy's OT Toolkit Resource • Student Self-Discovery Edition

SECTION 4: VISUAL INPUT

SECTION 5: TASTE & SMELL

Discovery Results

Add up the numbers you circled for each section and record your total below.

1. TOUCH TOTAL

____ / 15

2. SOUND TOTAL

____ / 15

3. MOVEMENT TOTAL

____ / 15

4. VISUAL TOTAL

____ / 15

Andy's OT Toolkit Resource • High School Edition • Page 2

5. TASTE & SMELL TOTAL

____ / 10

Interpretation Key

LOW

Score Range: 3 – 5. You may need more "intensity" (firm pressure, more movement, higher contrast) to feel alert and focus.

MODERATE

Score Range: 6 – 10. Your sensory processing is typical. Some things may bother you occasionally, but they don't impact your daily functioning.

HIGH

Score Range: 11 – 15. You have a sensitive system. You likely need specific quiet zones or sensory tools to manage overwhelm in busy environments.

Personal Reflection

1. Looking at your highest score, how does this explain some of your behavior or feelings in school?

2. What is ONE strategy you can try this week to help manage your sensory needs? (e.g., noise-canceling headphones, a specific seating location, or a fidget tool)

Andy's OT Toolkit Resource • High School Edition • Page 3

SECTION 4: VISUAL INPUT

SECTION 5: TASTE & SMELL

Andy's OT Toolkit Resource • High School Sensory Self-Discovery • Page 2

Discovery Results

Add up the numbers you circled for each section and record your total below.

1. TOUCH TOTAL

____ / 15

2. SOUND TOTAL

____ / 15

3. MOVEMENT TOTAL

____ / 15

4. VISUAL TOTAL

____ / 15

5. TASTE & SMELL TOTAL

____ / 15

Interpretation Key

3 – 6

Low Sensitivity: You may need more "intensity" to feel alert.

7 – 10

Moderate: Typical processing. Input occasionally bothers you.

11 – 15

High Sensitivity: Sensitive system. Overwhelmed easily in busy places.

Part 2: Reflection

1. Looking at your highest score, how does this explain your feelings in school?

2. What is ONE strategy you can try this week to help manage your needs?

Andy's OT Toolkit Resource • High School Sensory Self-Discovery • Page 3

____ / 15

Sound Total

____ / 15

Movement Total

____ / 15

Visual Total

____ / 15

Taste & Smell Total

____ / 15

Interpretation Guide

3 – 6

Low Sensitivity

You may need more intense input to feel alert and focused.

7 – 10

Typical Processing

Your system handles most input efficiently with minor preferences.

11 – 15

High Sensitivity

You notice details others miss, but can easily become overloaded.

Part 2: Reflection

Based on your highest scores, how does your sensory profile impact your school day?

What is one specific change you could make to your environment to feel more successful?

Andy's OT Toolkit • Sensory Discovery • Page 3