Sensory Motor Preference Checklist for Adults

(TherapyWorks, 1992)

This checklist was developed to help adults recognize what strategies their own nervous
systems employ to attain an appropriate state of alertness. Mark the items below that you use
to increase (i) or decrease (d) your state of alertness. You might mark both (i,d) on some items.
Others you might not use at all.

Put something in your mouth (oral motor input)

o Drink a milkshake
o Chew gum
o Suck on hard candy
o Crunch on nuts/pretzels/chips
o Crunch or suck on ice pieces
o Bite on nails/cuticle
o Tongue in cheek movements
o Eat popcorn/cut up vegetables
o Chew on pencil/pen
o Eat chips and a spicy dip
o Chew on coffee swizzle sticks
o Smoke cigarettes
o Take slow deep breaths
o Chew on buttons, sweatshirt strings or collars
o Suck, lick, bite on your lips or the inside of your cheeks
o Whistle while you work
o Drink carbonated drinks
o Drink coffee/tea caffeinated
o Drink hot cocoa or warm milk
o Eat a cold popsicle
o Eat a pickle
o Other:
 Move (Vestibular/Proprioceptive Input)
o Rock in a rocking chair
o Sit with crossed legs and bounce one slightly
o Shift or squirm in chair
o Run/jog
o Push chair back on two legs
o Ride bike
o Aerobic exercise
o Tap toe, heel, or foot
o Isometrics/lift weights
o Dance
o Rock own body slightly
o Tap pencil/pen
o Scrub kitchen floor
o Yard work
o Roll neck and head slowly
o Stretch/shake body parts
o Other:

Touch (Tactile Input):

o Twist own hair
o Move keys or coins in pocket with your hand
o Cool shower
o Warm bath
o Receive a massage
o Pet a dog or cat
o Drum fingers or pencil on table
o Rub gently on skin/clothes
Fidget with the following:
o A straw
o Paper clips
o Cuticle/nails
o Pencil/pen
o Earring or necklace
o Phone cord while talking
o Put fingers near mouth, eye, or nose
o Other:
 Look (Visual Input):
o Open window shades after a boring movie in a classroom
o Watch a fireplace
o Watch fish tank
o Watch sunrise/sunset
o Watch oil and water toys
How do you react to:
o Dim lighting
o Fluorescent lighting
o Sunlight through bedroom window when sleeping
o Rose colored room
o A cluttered desk when needing to concentrate

Listen (Auditory Input):

o Listen to classical music
o Listen to hard rock
o Listen to others hum
o Work in quiet room
o Work in noisy room
o Sing or talk to self
How do you react to:
o Scratch on a chalkboard
o Squeak of a mechanical pencil
o Fire siren
o Waking to an unusual noise
o Dog barking constantly

Are your items clustered in a certain category of sensory input?