Recognizing a sensory integration disorder early depends on careful observation of how a child moves, plays, eats, dresses and reacts to everyday sensations. The checklist below helps parents and teachers organize what they see. It is a screening aid, not a diagnosis: many children show a few of these signs, and only a professional evaluation can say whether they add up to a problem that needs support.
How to Use This Checklist
- Observe for two to four weeks in different settings: home, school, playground, stores, family visits.
- Mark how often each item happens: rarely, sometimes or often.
- Note the impact: does it stop the child from eating, sleeping, learning, playing or joining in?
- Write down examples with date, place, trigger and what helped. Concrete examples are more useful to a doctor than ticks alone.
- Compare with peers: what is typical for a three-year-old is not typical for a nine-year-old.
Fine Motor and Visual-Motor Skills
- Has difficulty cutting with scissors, stringing beads, opening containers or handling small objects.
- Holds a pencil or crayon with an awkward grip, too tightly or too loosely.
- Was slow to develop a hand preference, or switches hands during tasks.
- Struggles to copy shapes and letters, color within the lines or write legibly.
- Takes much longer than classmates to finish written work.
- Has trouble with buttons, zippers and snaps.
Gross Motor Skills and Motor Planning
- Cannot stand on one foot for a few seconds at an age when peers can.
- Has difficulty catching, throwing or kicking a ball.
- Needs help climbing stairs or getting on and off playground equipment.
- Learns new movements and games slowly, such as skipping, pedaling or jumping jacks.
- Appears clumsy, trips and falls often, bumps into furniture and people.
- Seems stiff and rigid, or loose and “floppy,” and slumps when sitting.
- Has trouble following a moving object or a line of print smoothly with the eyes, loses the place when reading or copying from the board.
Self-Care
- Has more difficulty than peers getting dressed, putting on socks or tying shoes.
- Strongly resists tooth brushing, hair washing, haircuts or nail cutting.
- Is an extremely picky eater, gags on textures or eats only a few foods.
- Has trouble using a fork, spoon or cup at the expected age.
- Has toilet accidents beyond the usual age because body signals are noticed too late.
Touch
- Complains about clothing tags, seams, socks or certain fabrics.
- Pulls away from light or unexpected touch, dislikes hugs or being close to others in line.
- Avoids messy play with paint, glue, sand or play dough.
- Or: touches everything and everyone, seems not to notice cuts, bruises or a dirty face.
Sound
- Covers ears or becomes upset at hand dryers, vacuum cleaners, sirens, fire drills or singing.
- Is overwhelmed in the cafeteria, gym or at birthday parties.
- Or: often does not respond when called, although a hearing test is normal.
- Has difficulty following spoken directions when there is background noise.
Sight
- Is bothered by bright light or sunlight, squints often.
- Is distracted by movement or clutter in the room.
- Has trouble finding an object among others, such as a toy in a bin.
Movement and Balance (Vestibular)
- Is afraid of swings, slides, escalators or having the feet off the ground.
- Gets car sick easily, dislikes being tipped back for hair washing.
- Or: spins, rocks or jumps for long periods and rarely seems dizzy.
- Has poor balance, for example on curbs or uneven ground.
Body Awareness (Proprioception)
- Uses too much force: breaks toys and crayons, slams doors, presses so hard the paper tears.
- Plays roughly without meaning to hurt others.
- Seeks deep pressure: crashing into cushions, crawling under heavy blankets, tight hugs.
- Seems unsure where the body is in space, stands too close to others.
Attention, Behavior and Emotions
- Has trouble sitting still or concentrating, especially in busy environments.
- Has frequent meltdowns that seem out of proportion to the trigger.
- Has great difficulty with transitions and changes in routine.
- Avoids group play or prefers to play alone because of the noise and contact.
- Shows low self-confidence, says “I can’t” before trying physical tasks.
- Is exhausted or irritable after school or outings.
A Sample Observation Note
Ticks on a list are easy to forget. A short note for each notable event gives the pediatrician and therapist much more to work with. A useful entry answers six questions in one or two lines:
- When: date and time of day, for example Tuesday, 7:45 a.m., before school.
- Where: the setting, such as the bathroom, the car or the school cafeteria.
- Trigger: what happened just before, for example new socks, the blender or a change of plans.
- Reaction: what the child did: cried, hid, hit, froze, ran around the room.
- Duration: how long it lasted until the child was calm again.
- What helped: a hug, a quiet room, removing the item, heavy work, time.
After two weeks, read the notes in one sitting. Patterns often stand out: hard mornings, trouble when the child is hungry or tired, specific places, or one sense that causes most of the problems. Bring the notes, the checklist and any reports from daycare or school to the appointment.
Typical Development as a Reference Point
Many items on the list depend on age. Children develop at different speeds, but some rough markers help put observations into context. Most children can walk up stairs with one foot per step and pedal a tricycle by about age three. By four or five, most hop on one foot, catch a large ball and use child scissors. By six, most can dress themselves except for tricky fasteners and write their own name. The CDC’s free “Learn the Signs. Act Early.” milestone checklists cover the first five years in more detail. If a child is clearly behind peers in several areas, mention it to the pediatrician even if sensory reactions seem mild.
What to Do With the Results
If many items are marked “often” and they clearly affect daily life, share the checklist and your notes with the pediatrician. The visit should include a developmental screening, a hearing test and a vision exam, because hearing loss or a vision problem can look like a sensory disorder. The pediatrician also checks for related conditions such as autism, ADHD, anxiety or developmental coordination disorder.
The next step is usually an evaluation by a pediatric occupational therapist. Common standardized tools include:
- Sensory Profile 2: caregiver and teacher questionnaires describing how a child responds to sensory events.
- Sensory Processing Measure, Second Edition (SPM-2): rating forms for home and school that compare settings.
- Sensory Integration and Praxis Tests (SIPT) and the newer Evaluation in Ayres Sensory Integration (EASI): hands-on tests of sensory perception, balance and motor planning.
Sensory processing disorder is not a separate diagnosis in the DSM-5, and the American Academy of Pediatrics (AAP) recommends that any therapy be part of a broader plan with time-limited trials and measurable goals.
Free Evaluations Through Public Programs
For children under three, every state offers an early intervention program under Part C of the Individuals with Disabilities Education Act (IDEA). Parents can refer their child directly, and the evaluation is free. From age three, parents can ask the local school district in writing for an evaluation. If the child qualifies, an Individualized Education Program (IEP) can include occupational therapy; a Section 504 plan can provide accommodations such as movement breaks, a quiet workspace or extra time for written work.
Frequently Asked Questions
Can a checklist diagnose sensory integration disorder?
No. A checklist helps you organize observations. Only a pediatrician and an occupational therapist can evaluate the child and rule out other causes.
How many items need to be checked to be concerned?
There is no fixed number. What matters is how often the behaviors occur and how much they interfere with eating, sleeping, learning, play and family life.
Should teachers fill out the checklist too?
Yes. Children often behave differently at home and at school, and teacher observations help the evaluating team see the full picture.
What happens after an occupational therapy evaluation?
The therapist explains the findings and, if needed, proposes a few measurable goals, a therapy schedule and strategies for home and school, with a date to review progress.
