Sense and Self-Regulation Checklist (SSC)

Abstract

The Sense and Self-Regulation Checklist (SSC) is a specialized parent or caregiver measure designed to quantify comorbid symptoms frequently observed in young children diagnosed with autism spectrum disorder (ASD). Recognizing that comorbid symptoms—such as abnormal sensory responses, sleep disruption, and behavioral issues—are associated with increased autism severity, the SSC provides a structured method for their identification and monitoring.

Developed through extensive parental interviews, the SSC assesses sensory processing and self-regulatory difficulties across six distinct sensory subdomains, alongside associated self-regulation behaviors (e.g., orientation, attention, sleep, behavior, and digestion). The instrument is specifically validated for use with children under 6 years of age and serves as a valuable tool for measuring treatment outcomes in clinical and research settings.

Keywords

Sense and Self-Regulation Checklist, SSC, Autism Spectrum Disorder, Sensory Processing, Self-Regulation, Comorbid symptoms, Caregiver Report, Developmental Disabilities, Pediatric Assessment.

Authors

Silva, L. M. T., Schalock, M.

Purpose

The primary purpose of the Sense and Self-Regulation Checklist (SSC) is to serve as a comprehensive screening and measurement instrument, completed by parents or caregivers, to identify and quantify the prevalence and severity of comorbid symptoms linked to autism spectrum disorder (ASD).

The scale is designed not only for initial identification but also for longitudinal tracking. Clinically, it is recommended that these comorbid symptoms—including self-injurious behaviors, aggression, gastrointestinal problems, and sensory abnormalities—be identified and addressed immediately following an autism diagnosis. Furthermore, the SSC functions effectively as a treatment outcome measure, allowing practitioners to gauge the efficacy of interventions aimed at improving sensory and self-regulatory functioning in young children.

Construct

The SSC measures the psychological construct of sensory processing atypicalities and associated self-regulatory functioning, particularly how a child responds to ordinary, daily-life situations. The instrument is grounded in the understanding that difficulties in these areas significantly contribute to the overall severity of ASD symptoms.

The scale is structured around six core sensory subdomains: Touch/Pain, Auditory, Visual, Taste/Smell, Hyperreactive to non-injurious stimuli, and Hyporeactive to injurious stimuli. These sensory domain items are integrated with items assessing various facets of self-regulation, including Orientation/Attention/Self-soothing/Sleep, Behavior (Irritability, Aggression, Self-injurious), Toilet Training, and Digestion. The total score reflects the cumulative burden of these comorbid difficulties.

Validity

Initial psychometric studies have established the validity of the Sense and Self-Regulation Checklist (SSC). The instrument has been demonstrated to be a valid measure for assessing sensory and self-regulatory difficulties specifically in children under 6 years of age.

The development process, which involved extensive interviews with parents of children with autism, supports the content validity of the scale, ensuring that the items accurately reflect real-world challenges faced by this population. Its utility extends beyond ASD, as it can also be used to identify patterns of sensory and self-regulatory difficulties in young children presenting with other developmental disabilities.

Reliability

The reliability of the SSC has been investigated through standard psychometric evidence procedures. Acceptable levels of internal consistency have been demonstrated, indicating that the items within the scale measure the underlying construct cohesively. Furthermore, acceptable test-retest reliability has been established, suggesting that the scores obtained from the SSC remain stable over time, assuming no significant clinical changes in the child’s condition (Silva & Schalock, 2012).

Factor Analysis

While the source content does not provide specific details regarding a formal confirmatory or exploratory factor analysis, the structure of the SSC is explicitly organized into six sensory subdomains (touch-pain, auditory, visual, taste-smell, hyperreactive to non-injurious stimuli, and hyporeactive to injurious stimuli). This organizational structure suggests an underlying multi-factor model consistent with established theories of sensory integration and self-regulation. Domain scores are derived by summing individual items corresponding to these predefined categories.

Instrument

Test Type: Caregiver/Parent Report Checklist

Format: Items are rated on a 4-point Likert scale: 0 (Never), 1 (Rarely), 2 (Sometimes), or 3 (Often). Domain scores are calculated by summing the individual item ratings within that domain.

Language Available: English, Spanish, and Chinese.

Population Group: Children diagnosed with autism spectrum disorder (ASD) or other developmental disabilities.

Age Group: Children under 6 years of age.

Population Details: The caregiver report format is designed to be suitable for use by caregivers who possess at least an elementary school level of education.

Test Methodology: The methodology involves the caregiver circling the most accurate response for each item, followed by a manual summation of the numerical scores to achieve a total score and subsequent domain scores.

Keywords

Sensory Modulation, Behavioral Problems, Aggression, Sleep Disruption, Gastrointestinal Issues, Occupational Therapy, Early Intervention, Developmental Assessment, Psychometric evidence.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Qigong Sensory Training Institute, www.qsti.org

Permissions & Fee and Test Year

The Sense and Self-Regulation Checklist (SSC) was developed by L. M. T. Silva and M. Schalock, with the key psychometric reference published in 2012. The instrument is protected by copyright (© LMTSilva Nov. 2011) and may not be altered or sold.

However, permission is explicitly granted for duplication free of charge. The work is licensed under the Creative Commons license: http://creativecommons.org/licenses/by-nc-nd/3.0.

Reference’s

Silva, L. M. T., & Schalock, M. (2012). Sense and self-regulation checklist, a measure of comorbid autism symptoms: Initial psychometric evidence. The American Journal of Occupational Therapy, 66, 177-186.

Items of the Sense and Self-Regulation Checklist (SSC)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Please circle the response for each item that most accurately describes your child.

• Often 3
• Sometimes 2
• Rarely 1
• Never 0

1. TOUCH/PAIN

• Does not cry tears when hurt
• Doesn’t notice if the diaper is wet or dirty
• Face washing is difficult
• Haircuts are difficult
• Refuses to wear a hat
• Prefers to wear a hat
• Cutting fingernails is difficult
• Prefers to wear one or two gloves
• Avoids wearing gloves
• Cutting toenails is difficult
• Will only wear certain footwear (e.g. loose shoes, no socks)
• Prefers to wear the same clothes day after day
• Will only wear certain clothes (e.g. no elastic, not tight, no tags,
• Cries tears when falls, scrapes skin, or gets hurt  (scale is reversed on purpose)
•  Head bangs on a hard surface
• Head bangs on a soft surface

Self-regulation – Orientation/Attention/Self-soothing/Sleep

• Has to be prompted to make eye contact when spoken to
• Seems not to notice when spoken to in a normal voice
• Does not respond to his/her name
• Does not notice or react when tapped on the back
• Does not roll over onto the back when asked
• Stares off into space
• Seems unaware when others are hurt
• Has difficulty calming him/herself when upset
• Gets upset or tantrums when asked to make a transition
• Has difficulty falling asleep at bedtime
• Has difficulty falling back asleep when awakens during the night
• Awakens very early and stays awake
• Has difficulty awakening in morning
• Makes little jokes. (Answer only if your child has language.) (scale is reversed on purpose)

2. VISION

• Looks at objects out of sides of eyes
• Is bothered by certain lights

Self-regulation – Behavior: Irritability, Aggression, Self- injurious

• Tantrums or meltdowns (Tantrums last minutes, and occur times/day)
• Cries easily when frustrated
• Hits or kicks others
• Scratches or pulls other’s hair

Please circle the response for each item that most accurately describes your child.

• Bites others
• Throws things at others
• Pulls own hair (Where on the head?)
• Bites self (Which part of the body e.g. left thumb?)
• Hits self (Which part of the body?)
• Gets aggressive or ‘hyper’ with exposure to certain smells

3. HEARING

• Reacts poorly to certain everyday noises
• Covers ears with certain sounds
• Reacts strongly when others cry loudly or scream
• Is startled by sudden noises

Self-regulation – Toilet Training

• Is dry at night (scale is reversed on purpose)
• Diaper is wet in the morning
• Wears a diaper during the day
• Is toilet trained (scale is reversed on purpose)

4. TASTE/SMELL:

• • Gags with certain smells
• Avoids foods with certain textures
• Tooth brushing is difficult
• Mouths or chews objects

Self-regulation – Digestion

• Will only eat familiar foods
• Does not seem to be interested in food
• Eats very few foods (five to ten items)
• Bowels are loose
• Bowel movements (“poops”) are frequent (more than 3 per day)
• Requires regular use of laxative to avoid constipation
• Bowel movement (“poop”) is hard and dry
• Has a bowel movement every other day
• Has a bowel movement twice a week
• Has a bowel movement once a week
• Bowel movements are often green

TOTALL: ……………………