| Never (0) |
Sometimes (2) |
Always (4) |
||
|---|---|---|---|---|
| 1. | How often do you prefer covering your ears for certain sounds or to decrease the level of sound? | |||
| 2. | How often do you feel uncomfortable reading or performing tasks in a noisy environment? | |||
| 3. | How often do you face problem in concentrating on any task due to the intolerance to sound? | |||
| 4. | How often do you think that your routine, as well as work related performance, has decreased due to intolerance to sound? | |||
| 5. | How often have you felt that you cannot enjoy music because of intolerance to sound? | |||
| 6. | How often do you find it difficult to listen for a longer duration when surrounded by many sounds? | |||
| 7. | How often do you feel difficulty in listening to music using earphones or headphones? | |||
| 8. | How often do you face tolerance problems while conversing in a noisy situation? | |||
| 9. | How often do you feel that certain sounds bother you more or cause difficulty while conversing? | |||
| 10. | How often do you avoid doing a certain task or going out because you have to be in a noisy place/situation? | |||
| 11. | Have you ever felt isolated among a group of people due to intolerance to sound (e.g. Party/other functions? | |||
| 12. | How often people tell you that you cannot tolerate sounds or your tolerance level for certain types of sound are very less? | |||
| 13. | How often do you prefer staying in-door because you feel that you might have to face loud sounds outside? | |||
| 14. | How often have you felt like changing your workplace because of excessive sound? | |||
| 15. | How often do you feel sad that you cannot tolerate certain sounds like traffic noise? | |||
| 16. | How often do you feel that a noisy place brings more stress and irritation? | |||
| 17. | How often do you get angry when you are surrounded by sounds? | |||
| 18. | How often are you scared of any particular sound? | |||
| 19. | How often have you faced emotional problems due to intolerance to sound? | |||
| 20. | How often do you feel disappointed due to the face that intolerance to sound is affecting your relationship with family and friends? | |||
| 21. | How often do you feel irritated because of sounds? | |||
| Total Score | ||||
∗Questions 1 to 7 tap ‘Functional handicap’; 8 to 14 tap ‘Social handicap’; and 15 to 21 tap ‘Emotional handicap’ of the client.
Sub-scores for each domain can also be obtained by adding the scores of respective questions falling in each category.
Sub-scores: