BBCSS for Adults Form Brain Body Center Sensory Scales (BBCSS) for AdultsDate First Name Last Name Email Auditory Processing1) How often do you respond negatively to unexpected or loud noises (for example, hide or cringe at noise from ambulance, train, fire or car alarm, fireworks)? Almost Always Frequently Sometimes Almost Never Not Sure2) How often do you become distracted, or have difficulty following verbal instructions when there is a lot of noise around? Almost Always Frequently Sometimes Almost Never Not Sure3) How often do you hold your hands over or plug your ears? Almost Always Frequently Sometimes Almost Never Not Sure4) How often do you not to hear what others say (for example, you fail to pay attention to what others say)? Almost Always Frequently Sometimes Almost Never Not Sure5) How often do you have trouble working with background noise (for example, air conditioner, traffic noises, airplanes)? Almost Always Frequently Sometimes Almost Never Not Sure6) How often do you not respond when your name is called, even though you know your hearing is not a problem? Almost Always Frequently Sometimes Almost Never Not Sure7) How often are you unusually angry, frightened, or in pain when others cry or scream? Almost Always Frequently Sometimes Almost Never Not Sure8) How often do others have to speak loudly or get very close to your face to get your attention? Almost Always Frequently Sometimes Almost Never Not Sure9) How often are you unaware of continuous noise in the environment (for example, TV, stereo)? Almost Always Frequently Sometimes Almost Never Not Sure10) How often are you overly aware, distracted, or disturbed by continuous noise in the environment (for example, TV, stereo)? Almost Always Frequently Sometimes Almost Never Not Sure11) How often do you take a long time to respond when spoken to, even to familiar voices? Almost Always Frequently Sometimes Almost Never Not Sure12) How often do you startle easily at sound, compared to others, with loud or high-pitched noises (for example, vacuum, blender, fire alarms)? Almost Always Frequently Sometimes Almost Never Not Sure13) How often are you distracted by sounds not normally noticed by other people (for example, air conditioning fans, trains or planes outside)? Almost Always Frequently Sometimes Almost Never Not Sure14) How often do you respond negatively (i.e. become distracted or anxious) when entering places with continuous background noises (for example, grocery stores, schools, shopping malls)? Almost Always Frequently Sometimes Almost Never Not SureVisual Processing15) How often are you bothered by bright lights after others’ eyes have adapted to the same light? Almost Always Frequently Sometimes Almost Never Not Sure16) How often do you cover your eyes or squint? Almost Always Frequently Sometimes Almost Never Not Sure17) How often are you unable to tolerate bright lights? Almost Always Frequently Sometimes Almost Never Not Sure18) How often are you unable to tolerate flashing lights? Almost Always Frequently Sometimes Almost Never Not Sure19) How often do you get agitated when exposed to bright lights? Almost Always Frequently Sometimes Almost Never Not Sure20) How often are you sensitive to bright lights (for example, squint or close eyes)? Almost Always Frequently Sometimes Almost Never Not Sure21) How often are you sensitive to flashing lights (for example, squint or close eyes)? Almost Always Frequently Sometimes Almost Never Not Sure22) How often do you hesitate to go outside when it’s sunny? Almost Always Frequently Sometimes Almost Never Not Sure23) How often are you easily distracted by movement only you can see? Almost Always Frequently Sometimes Almost Never Not Sure24) How often are you easily distracted by movements of objects (i.e. mechanical objects or repetitive movements)? Almost Always Frequently Sometimes Almost Never Not SureTactile Processing (Touch)25) How often are you distressed or overly-sensitive to tooth-brushing? Almost Always Frequently Sometimes Almost Never Not Sure26) How often are you distressed or overly-sensitive to face-washing? Almost Always Frequently Sometimes Almost Never Not Sure27) How often are you distressed or overly-sensitive to fingernail-cutting? Almost Always Frequently Sometimes Almost Never Not Sure28) How often are you distressed or overly-sensitive to hair-brushing? Almost Always Frequently Sometimes Almost Never Not Sure29) How often do you remove labels or tags from most clothing, or ask that they be removed? Almost Always Frequently Sometimes Almost Never Not Sure30) How often do you refuse to wear certain fabrics or find certain fabrics irritating? Almost Always Frequently Sometimes Almost Never Not Sure31) How often do you find certain garments are too tight, scratchy or irritating? Almost Always Frequently Sometimes Almost Never Not Sure32) How often do you prefer to not wear certain clothing items? Almost Always Frequently Sometimes Almost Never Not Sure33) How often do you resist hugging? Almost Always Frequently Sometimes Almost Never Not Sure34) How often do you react negatively or overly sensitively to hand-holding? Almost Always Frequently Sometimes Almost Never Not Sure35) How often do you react emotionally or overly sensitively to being touched? Almost Always Frequently Sometimes Almost Never Not Sure36) How often do you react emotionally or overly sensitively when touching very cold objects with your hands? Almost Always Frequently Sometimes Almost Never Not Sure37) How often do you react emotionally or overly sensitively when very cold objects touch your face? Almost Always Frequently Sometimes Almost Never Not SureIngestion and Digestion38) How often do you avoid certain tastes? Almost Always Frequently Sometimes Almost Never Not Sure39) How often do you resist certain textures of food? Almost Always Frequently Sometimes Almost Never Not Sure40) How often do you avoid certain food smells? Almost Always Frequently Sometimes Almost Never Not Sure41) How often do you resist certain temperatures of food? Almost Always Frequently Sometimes Almost Never Not Sure42) How often do you gag? Almost Always Frequently Sometimes Almost Never Not Sure43) How often do you vomit? Almost Always Frequently Sometimes Almost Never Not Sure44) How often do you have acid reflux? Almost Always Frequently Sometimes Almost Never Not Sure45) How often do you have excessive intestinal gas? Almost Always Frequently Sometimes Almost Never Not Sure46) How often are you constipated? Almost Always Frequently Sometimes Almost Never Not Sure47) How often do you experience stomach or intestinal cramping? Almost Always Frequently Sometimes Almost Never Not Sure48) How often do you have difficulty swallowing solid foods? Almost Always Frequently Sometimes Almost Never Not Sure49) How often do you suck on objects other than food (for example, pen, lip, own tongue)? Almost Always Frequently Sometimes Almost Never Not Sure50) How often do you eat (or want to eat) significantly less than you think is appropriate for your size or age? Almost Always Frequently Sometimes Almost Never Not SureI understand that I must give 48 hours notice to avoid a full charge for a canceled session - Select -I AgreeI Do Not AgreeSubmitAuditory Processing 1Out of 56% Visual Processing 2Out of 40% Tactile Processing 3Out of 52% Ingestion and Digestion 4Out of 52%
