Profile Survey

We'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.

Name

First

Last

Zip Code

# of Kids in the Family

With Sensory Sensitivities

Without Sensory Sensitivities

What's the maximum distance are you willing to travel for...

For 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 Level

When did you first notice sensory sensitivity in your child?

Infant
Toddler
Preschool
Kindergarten
Elementary
Junior High
High School

What were the first clues of sensory sensitivity? (Select all that apply.)

Didn't like to be dirty
Very little to no awareness of being messy
Trouble riding in the car (motion sickness, crying, etc.)
Constantly looking to spin or swing
Constantly 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, tripping
Afraid 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 funny
Took 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)
Other

Tell us about your child's sensory needs. (Select the most common response per system.)

Does your child participate in any enrichment programs? (Select all that apply.)

In general, how successful is your child in participating in enrichment programs?

Tell 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 Inputs

The environment is built around sensory sensitivities
Caregiver provides sensory interventions
Not Applicable

Integration Model

Child participates with other sensory sensitive kids
Child is integrated with all kinds of kids
Not a factor in success

Organization Model

Activity is grouped by age-level
Activity is grouped by skill or comprehension level
Not a factor in success

Adult Leader

Is a good temperament match with your child
Has been professionally trained
Not a factor in success

Do you think the things that help your child be successful are unique to him/her?

Yes, my child has a unique set of challenges
No, other children with sensory sensitivities would also benefit
No, all children could benefit

Tell 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 activity
He/she is deregulated for some period of time after the activity
He/she tries to participate, but is unable to successfully
He/she wants to participate but is left out
He/she refuses to participate
Adult guidance is lacking
The adult in charge lacks knowledge of how to successfully help
The adult in charge is not a good match with my child

Do 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 challenges
No, other children with sensory sensitivities would also be tripped up
No, all children are affected by these factors to some degree

What could be done to improve a situation that is not going well? (Select all that apply.)

Making sensory interventions available
Assign him/her a buddy
Create lower adult to child ratios
Create more purposeful integrations
Make a quiet space available
Finding the same activity somewhere else more conducive to our needs
A different adult leading the activity

How did you hear about this survey?

Let us know if you are interested in staying in touch for...

Taking additional surveys
Participating in a focus group
Participating in one-one interviews
Hearing about our progress
Coming to special events
You name it, I want to hear about it!

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