Student’s name_________________________ Therapists name___________________
Date__________________ Location_________________________
What does the child like to do?
What brings a gleam to his/her eye? Give examples.
What does the child find challenging, disengage from?
Does the child like to be touched? How?
Do you recognize any sensory sensitivities or cravings (sound, visual, touch, movement, tactile, taste, smell)? Explain.
How does the child communicate what he/she wants?
Can the child make decisions in play, use ideas, sequence ideas? Explain
Does the child have motor planning (executing an idea using fine motor, gross motor or communication) strengths or weaknesses?
What do you think about the child’s visual system (sensitivities, perceptual) and visual-spatial abilities?
