Profile SurveyPlease enable JavaScript in your browser to complete this form.Profile - Step 1 of 6We're doing market research to better understand our community. We are dedicated to supporting families with sensory sensitive kids. Gathering information from families like yours will help us ensure we're going in the right direction.NameFirstLastEmailZip Code# of Kids in the FamilyWith Sensory SensitivitiesSelect012345+Without Sensory SensitivitiesSelect012345+What's the maximum distance are you willing to travel for...TherapyTo and From SchoolIn town (<20 min)Surrounding area (<40 min)Pretty far (<hour)Anywhere! (> hour)To and From SchoolTo and From SchoolIn town (<20 min)In town (<20 min)Surrounding area (<40 min)Surrounding area (<40 min)Pretty far (<hour)Pretty far (<hour)Anywhere! (> hour)Anywhere! (> hour)PlaydateTo and From SchoolIn town (<20 min)Surrounding area (<40 min)Pretty far (<hour)Anywhere! (> hour)To and From SchoolTherapy To and From SchoolIn town (<20 min)Therapy In town (<20 min)Surrounding area (<40 min)Therapy Surrounding area (<40 min)Pretty far (<hour)Therapy Pretty far (<hour)Anywhere! (> hour)Therapy Anywhere! (> hour)Social ActivityTo and From SchoolIn town (<20 min)Surrounding area (<40 min)Pretty far (<hour)Anywhere! (> hour)To and From SchoolTherapy To and From SchoolIn town (<20 min)Therapy In town (<20 min)Surrounding area (<40 min)Therapy Surrounding area (<40 min)Pretty far (<hour)Therapy Pretty far (<hour)Anywhere! (> hour)Therapy Anywhere! (> hour)Extracurricular activitiesTo and From SchoolIn town (<20 min)Surrounding area (<40 min)Pretty far (<hour)Anywhere! (> hour)To and From SchoolTherapy To and From SchoolIn town (<20 min)Therapy In town (<20 min)Surrounding area (<40 min)Therapy Surrounding area (<40 min)Pretty far (<hour)Therapy Pretty far (<hour)Anywhere! (> hour)Therapy Anywhere! (> hour)Activity with sensory interventions in placeTo and From SchoolIn town (<20 min)Surrounding area (<40 min)Pretty far (<hour)Anywhere! (> hour)To and From SchoolTherapy To and From SchoolIn town (<20 min)Therapy In town (<20 min)Surrounding area (<40 min)Therapy Surrounding area (<40 min)Pretty far (<hour)Therapy Pretty far (<hour)Anywhere! (> hour)Therapy Anywhere! (> hour)NextFor the rest of this survey, please tell us about one of your children.You can fill out this survey again with another child in mind.Child's School LevelSelect OneInfant/ToddlerPreschoolEarly Elementary (K-2)Elementary (3-6)Junior High (7-8)High School (9-10)Transitions ProgramAdultWhen did you first notice sensory sensitivity in your child?InfantToddlerPreschoolKindergartenElementaryJunior HighHigh SchoolWhat were the first clues of sensory sensitivity? (Select all that apply.)Didn't like to be dirtyVery little to no awareness of being messyTrouble riding in the car (motion sickness, crying, etc.)Constantly looking to spin or swingConstantly seeking tactile input (fidgeting, pulling hair, biting nails, etc.)Very little to no awareness of tactile input (barely notices touching things, etc.)Didn't like tactile input (doesn't like the feel of grass, carpet, tags, certain types of clothing)Constantly bumping into things, trippingAfraid of things that test your awareness of body in space (going down the stairs, playground equipment, etc.)Seaking pressure in unusual ways (being squished, pressing body against objects, etc.)Avoiding food that smells or looks funnyTook a long time to potty train (seemed to be unable to tell when they had to go potty, over or under sensitive to dirty diapers)OtherTell us about your child's sensory needs. (Select the most common response per system.)Visual (sights)Sensory SeekingSensory AvoidingDepends on the situationUnaffectedUnsureSensory SeekingSensory SeekingSensory AvoidingSensory AvoidingDepends on the situationDepends on the situationUnaffectedUnaffectedUnsureUnsureAuditory (sounds)Sensory SeekingSensory AvoidingDepends on the situationUnaffectedUnsureSensory SeekingInteroception (internal) Sensory SeekingSensory AvoidingInteroception (internal) Sensory AvoidingDepends on the situationInteroception (internal) Depends on the situationUnaffectedInteroception (internal) UnaffectedUnsureInteroception (internal) UnsureOlfactory (smell)Sensory SeekingSensory AvoidingDepends on the situationUnaffectedUnsureSensory SeekingInteroception (internal) Sensory SeekingSensory AvoidingInteroception (internal) Sensory AvoidingDepends on the situationInteroception (internal) Depends on the situationUnaffectedInteroception (internal) UnaffectedUnsureInteroception (internal) Unsure Gustatory (taste)Sensory SeekingSensory AvoidingDepends on the situationUnaffectedUnsureSensory SeekingInteroception (internal) Sensory SeekingSensory AvoidingInteroception (internal) Sensory AvoidingDepends on the situationInteroception (internal) Depends on the situationUnaffectedInteroception (internal) UnaffectedUnsureInteroception (internal) UnsureTactile (touch)Sensory SeekingSensory AvoidingDepends on the situationUnaffectedUnsureSensory SeekingInteroception (internal) Sensory SeekingSensory AvoidingInteroception (internal) Sensory AvoidingDepends on the situationInteroception (internal) Depends on the situationUnaffectedInteroception (internal) UnaffectedUnsureInteroception (internal) UnsureVestibular (body in space)Sensory SeekingSensory AvoidingDepends on the situationUnaffectedUnsureSensory SeekingInteroception (internal) Sensory SeekingSensory AvoidingInteroception (internal) Sensory AvoidingDepends on the situationInteroception (internal) Depends on the situationUnaffectedInteroception (internal) UnaffectedUnsureInteroception (internal) UnsureProprioceptive (pressure on joints)Sensory SeekingSensory AvoidingDepends on the situationUnaffectedUnsureSensory SeekingInteroception (internal) Sensory SeekingSensory AvoidingInteroception (internal) Sensory AvoidingDepends on the situationInteroception (internal) Depends on the situationUnaffectedInteroception (internal) UnaffectedUnsureInteroception (internal) UnsureInteroception (internal)Sensory SeekingSensory AvoidingDepends on the situationUnaffectedUnsureSensory SeekingInteroception (internal) Sensory SeekingSensory AvoidingInteroception (internal) Sensory AvoidingDepends on the situationInteroception (internal) Depends on the situationUnaffectedInteroception (internal) UnaffectedUnsureInteroception (internal) UnsurePreviousNextDoes your child participate in any enrichment programs? (Select all that apply.)SportsNoAt SchoolOutside of School - Special Needs FocusedOutside of School - With SupportsOutside of School - With No SupportsNoNoAt SchoolAt SchoolOutside of School - Special Needs FocusedOutside of School - Special Needs FocusedOutside of School - With SupportsOutside of School - With SupportsOutside of School - With No SupportsOutside of School - With No SupportsScoutsNoAt SchoolOutside of School - Special Needs FocusedOutside of School - With SupportsOutside of School - With No SupportsNoSports NoAt SchoolSports At SchoolOutside of School - Special Needs FocusedSports Outside of School - Special Needs FocusedOutside of School - With SupportsSports Outside of School - With SupportsOutside of School - With No SupportsSports Outside of School - With No SupportsArtNoAt SchoolOutside of School - Special Needs FocusedOutside of School - With SupportsOutside of School - With No SupportsNoSports NoAt SchoolSports At SchoolOutside of School - Special Needs FocusedSports Outside of School - Special Needs FocusedOutside of School - With SupportsSports Outside of School - With SupportsOutside of School - With No SupportsSports Outside of School - With No SupportsMusicNoAt SchoolOutside of School - Special Needs FocusedOutside of School - With SupportsOutside of School - With No SupportsNoSports NoAt SchoolSports At SchoolOutside of School - Special Needs FocusedSports Outside of School - Special Needs FocusedOutside of School - With SupportsSports Outside of School - With SupportsOutside of School - With No SupportsSports Outside of School - With No SupportsDanceNoAt SchoolOutside of School - Special Needs FocusedOutside of School - With SupportsOutside of School - With No SupportsNoSports NoAt SchoolSports At SchoolOutside of School - Special Needs FocusedSports Outside of School - Special Needs FocusedOutside of School - With SupportsSports Outside of School - With SupportsOutside of School - With No SupportsSports Outside of School - With No SupportsSocial ProgramsNoAt SchoolOutside of School - Special Needs FocusedOutside of School - With SupportsOutside of School - With No SupportsNoSports NoAt SchoolSports At SchoolOutside of School - Special Needs FocusedSports Outside of School - Special Needs FocusedOutside of School - With SupportsSports Outside of School - With SupportsOutside of School - With No SupportsSports Outside of School - With No SupportsOtherNoAt SchoolOutside of School - Special Needs FocusedOutside of School - With SupportsOutside of School - With No SupportsNoSports NoAt SchoolSports At SchoolOutside of School - Special Needs FocusedSports Outside of School - Special Needs FocusedOutside of School - With SupportsSports Outside of School - With SupportsOutside of School - With No SupportsSports Outside of School - With No SupportsIn general, how successful is your child in participating in enrichment programs?At SchoolVery successfulFairly successfulIt's a struggleNot at allNot applicableVery successfulVery successfulFairly successfulFairly successfulIt's a struggleIt's a struggleNot at allNot at allNot applicableNot applicableOutside of School - Special Needs FocusedVery successfulFairly successfulIt's a struggleNot at allNot applicableVery successfulOutside of School - With No Supports Very successfulFairly successfulOutside of School - With No Supports Fairly successfulIt's a struggleOutside of School - With No Supports It's a struggleNot at allOutside of School - With No Supports Not at allNot applicableOutside of School - With No Supports Not applicableOutside of School - With SupportsVery successfulFairly successfulIt's a struggleNot at allNot applicableVery successfulOutside of School - With No Supports Very successfulFairly successfulOutside of School - With No Supports Fairly successfulIt's a struggleOutside of School - With No Supports It's a struggleNot at allOutside of School - With No Supports Not at allNot applicableOutside of School - With No Supports Not applicableOutside of School - With No SupportsVery successfulFairly successfulIt's a struggleNot at allNot applicableVery successfulOutside of School - With No Supports Very successfulFairly successfulOutside of School - With No Supports Fairly successfulIt's a struggleOutside of School - With No Supports It's a struggleNot at allOutside of School - With No Supports Not at allNot applicableOutside of School - With No Supports Not applicablePreviousNextTell us about a social or enrichment experience where your child was successful. What was the experience? What do you think helped make it successful?Which of the following is most helpful in creating a successful outing for your child? Select only one response in each category.Sensory InputsThe environment is built around sensory sensitivitiesCaregiver provides sensory interventionsNot ApplicableIntegration ModelChild participates with other sensory sensitive kidsChild is integrated with all kinds of kidsNot a factor in successOrganization ModelActivity is grouped by age-levelActivity is grouped by skill or comprehension levelNot a factor in successAdult LeaderIs a good temperament match with your childHas been professionally trainedNot a factor in successDo you think the things that help your child be successful are unique to him/her? Yes, my child has a unique set of challengesNo, other children with sensory sensitivities would also benefitNo, all children could benefitPreviousNextTell us about a social or enrichment experience that was unsuccessful. What was the experience? What went wrong? How did your child react?What does it look like when your child is unsuccessful in a social or enrichment activity? (Select all that apply.)He/she is deregulated during the activityHe/she is deregulated for some period of time after the activityHe/she tries to participate, but is unable to successfullyHe/she wants to participate but is left outHe/she refuses to participateAdult guidance is lackingThe adult in charge lacks knowledge of how to successfully helpThe adult in charge is not a good match with my childDo you think the things that impede your child from being fully successful in an enrichment experience are unique to them?Yes, my child has a unique set of challengesNo, other children with sensory sensitivities would also be tripped upNo, all children are affected by these factors to some degreeWhat could be done to improve a situation that is not going well? (Select all that apply.)Making sensory interventions availableAssign him/her a buddyCreate lower adult to child ratiosCreate more purposeful integrationsMake a quiet space availableFinding the same activity somewhere else more conducive to our needsA different adult leading the activityPreviousNextHow did you hear about this survey?Select OneWord of MouthFlyerAdvertisementSocial MediaGoogle SearchOtherLet us know if you are interested in staying in touch for...Taking additional surveysParticipating in a focus groupParticipating in one-one interviewsHearing about our progressComing to special eventsYou name it, I want to hear about it!By filling out this survey, I agree to the Privacy Policy and Terms of Use.MessageSubmit Share Share Tweet Pinterest Email
