Greenspan Infant/Child Regulatory Patterns Survey

Name of Child:
Date(s) of observation:
Date of rating:
Name of observer:
Date of Birth:
Place(s) of observation:
Chronological Age:
Who present at observation(s):

Rating Scale:

0 = capacity not present
1 = capacity fleetingly present
2 = capacity intermittently present
3 = capacity present most of the time
4 = capacity present all of the time in all circumstances

0 1 2 4 Is able to be calm and/or calm down and not be excessively irritable, clinging, active or panicked
0 1 2 4 Is able to calm down and take an interest in sights and sounds and people and is not excessively withdrawn, apathetic or unresponsive
0 1 2 4 Is able to focus attention and not be excessively distractible
0 1 2 4 Enjoys a range of sounds including high and low pitch, loud and soft and different rhythms and is not upset or confused by various sounds
0 1 2 4 Enjoys various sights, including reasonably bright lights, visual designs, facial gestures, moving objects and is not upset or confused by various sights
0 1 2 4 Enjoys being touched (on face, arms, legs, stomach, trunk and back), bathed and clothed, and is not bothered by things touching skin
0 1 2 4 Enjoys movement in space (being held and moved up and down, side to side, etc.), does not get upset with movement and does not crave excessive movement
0 1 2 4 Is able to maintain motor tone and carry out age appropriate motor planning sequences (e.g., put fist in mouth, reach for object)
0 1 2 4 Enjoys a range of age appropriate foods and is not bothered (e.g., with abdominal pain, skin rashes, irritability or other symptoms) by age-appropriate, healthy food as part of a balanced diet
0 1 2 4 Is comfortable and asymptomatic around household odors and materials and is not bothered by any routine level of household odors such as cleaning materials, paint, oil or gas fumes, pesticides, plastic, composite woods or synthetic fabric.

If the rating is less than four for any of the above, also rate the following items:

Rating Scale:

0 = capacity not present
1 = capacity fleetingly present
2 = capacity intermittently present
3 = capacity present most of the time
4 = capacity present all of the time in all circumstances

Child tends to be hyper- or overly sensitive to:

0 1 2 4 Touch (light or heavy)
0 1 2 4 Sound (high pitch, low pitch, or loud)
0 1 2 4 Sights (bright lights)
0 1 2 4 Own movement in space (e.g. being moved horizontally or vertically)
0 1 2 4 Smells (e.g., routine household odors, perfumes)

Child tends to be hypo- or under sensitive (i.e., doesn't respond to sensations and may crave them)

0 1 2 4 Touch
0 1 2 4 Sound
0 1 2 4 Sights
0 1 2 4 Movement in space
0 1 2 4 Smells

Child tends to have difficulty processing, organizing (making sense of) or sequencing:

0 1 2 4 Sounds (e.g., following two step direction)
0 1 2 4 Sights (e.g., identifying or copying a design like a circle)
0 1 2 4 Own motor pattern (e.g., tying shoes)
0 1 2 4 Spatial concepts (e.g., figuring out the geography of a new house)

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