Sense and Self-Regulation Checklist (SSC)

Abstract

The Sense and Self-Regulation Checklist (SSC) is a standardized, caregiver-administered psychometric assessment tool designed to evaluate comorbid sensory processing abnormalities and physiological/behavioral self-regulatory impairments in young children, specifically those diagnosed with autism spectrum disorder (ASD) or presenting with suspected neurodevelopmental delays under the age of six. Developed by pediatric physician and public health researcher Dr. Luisa M. T. Silva and psychometrician Dr. Mark Schalock, the SSC was constructed in response to the growing recognition that co-occurring physiological and sensory symptoms significantly compound the primary diagnostic deficits of autism. The instrument evaluates two overarching functional domains—sensory processing and self-regulation—encompassing critical operational subdomains: tactile/pain sensitivity, auditory reactivity, visual responsiveness, taste/smell selectivity, orientation and attention, self-soothing, sleep architecture, behavioral irritability and aggression, toilet training, and gastrointestinal/digestive function. The checklist utilizes an accessible four-point Likert-type rating format ranging from 0 (Never) to 3 (Often), designed specifically to accommodate caregivers with an elementary school literacy level while capturing nuanced clinical profiles. Psychometric investigations indicate robust internal consistency across total and subscale metrics (Cronbach’s alpha typically exceeding .85), stable test-retest reliability across multi-week evaluation intervals, and high sensitivity to therapeutic change, particularly in clinical trials evaluating pediatric sensory interventions such as Qigong Sensory Training (QST). This article provides a comprehensive academic analysis of the SSC, delineating its historical inception, structural dimensions, theoretical foundations rooted in sensory integration and autonomic regulation models, psychometric validity and reliability metrics, scoring parameters, and applied clinical utility in pediatric neuropsychology and occupational therapy.

Keywords

Sense and Self-Regulation Checklist, SSC, Autism Spectrum Disorder, Sensory Processing, Self-Regulation, Comorbid Symptoms, Sensory Modulation, Pediatric Psychometrics, Tactile Defensiveness, Autonomic Regulation, Occupational Therapy, Qigong Sensory Training.

Authors

The Sense and Self-Regulation Checklist was authored and standardized by Luisa M. T. Silva, MD, MPH, and Mark Schalock, PhD.

• Luisa M. T. Silva, MD, MPH: Dr. Silva is a pediatrician and public health researcher renowned for her pioneering work in pediatric sensory modulation, neurological rehabilitation, and non-pharmacological interventions for autism spectrum disorders. Serving as the founder and lead researcher at the Qigong Sensory Training Institute (QSTI) in Salem, Oregon, Dr. Silva has directed numerous funded clinical trials examining neurodevelopmental plasticity, somatosensory touch therapies, and autonomic self-regulation in early childhood development.
• Mark Schalock, PhD: Dr. Schalock is a specialist in research methodology, educational evaluation, and psychometrics, previously affiliated with the Teaching Research Institute at Western Oregon University. His methodological expertise spans statistical design, factor-analytic validation of behavioral assessment instruments, and program evaluation within pediatric special education and disability research.

Purpose

The primary clinical and empirical objective of the Sense and Self-Regulation Checklist (SSC) is to provide an ecologically valid, caregiver-reported measurement of the frequency and severity of co-occurring sensory and self-regulatory abnormalities in toddlers and young children with autism spectrum disorder and related neurodevelopmental conditions. While formal diagnostic classifications historically categorized autism primarily by social communication impairments and restricted, repetitive patterns of behavior, empirical research has increasingly documented that comorbid somatic, sensory, and autonomic disturbances exert a profound impact on child functioning, developmental trajectories, and household stress.

In pediatric populations under six years of age, sensory modulation disorders—manifesting as tactile defensiveness, auditory hyperreactivity, visceral pain agnosia, or sensory seeking—frequently co-occur with severe breakdowns in basic physiological homeostasis. These breakdowns manifest clinically as chronic sleep initiation and maintenance disorders, gastrointestinal dysmotility (including refractory constipation, diarrhea, and abdominal distress), difficulties with bowel and bladder continence, and persistent emotional dysregulation characterized by severe tantrums, unprovoked aggression, and self-injurious behaviors (SIBs). The SSC was engineered to bridge the clinical assessment gap between distinct sensory profiling tools and broad behavioral rating scales by explicitly linking sensory processing abnormalities to homeostatic and autonomic self-regulation deficits.

From an applied clinical perspective, the SSC fulfills several critical diagnostic and interventional functions:

• Early Baseline Profiling: The instrument facilitates the systematic mapping of a child’s sensory and autonomic symptom burden at the time of initial autism diagnosis, establishing quantitative baselines prior to therapeutic intervention.
• Treatment Outcome Monitoring: The tool exhibits documented sensitivity to intervention-induced changes, making it particularly effective for evaluating the efficacy of occupational therapy, sensory integration protocols, touch-based therapies (such as Qigong Sensory Training), and biomedical or nutritional interventions targeting gut-brain axis disruptions.
• Accessible Caregiver Screening: Constructed deliberately with an elementary school reading level, the SSC democratizes psychometric assessment by allowing diverse socio-demographic populations and non-specialist caregivers to report subtle sensory-regulatory phenotypes accurately without requiring clinical jargon.
• Cross-Disciplinary Diagnostic Communication: By capturing somatic complaints (e.g., gastrointestinal abnormalities, sleep disruptions) alongside overt behavioral reactions (e.g., meltdowns, tactile resistance), the tool serves as a shared communication conduit among pediatricians, occupational therapists, pediatric neurologists, and speech-language pathologists.

Psychological Construct

The psychological construct operationalized by the SSC is the interdependent relationship between Sensory Modulation and Autonomic Self-Regulation during early childhood development. Rather than viewing sensory reactivity and physiological regulation as distinct, segregated domains, the instrument conceptualizes them as bidirectional, mutually reinforcing components of neurodevelopmental stability. In a typical neurodevelopmental trajectory, the central nervous system smoothly filters, modulates, and integrates environmental stimuli, which in turn permits the parasympathetic nervous system to maintain physiological homeostasis (rest, digestion, emotional restoration, and calm social engagement). In autism, disruptions across sensory processing pathways directly disrupt autonomic balance, precipitating behavioral and visceral distress.

1. Sensory Processing and Modulation Dimensions

The sensory dimensions within the SSC encompass both hyperreactivity (sensory avoidance or defensiveness) and hyporeactivity (sensory seeking or under-responsiveness) across multiple sensory modalities:

• Tactile and Pain Processing: Evaluates abnormal neurocutaneous responses to ordinary mechanical stimuli. Hyperreactivity manifests as tactile defensiveness during grooming activities (haircuts, face washing, nail clipping) or rigid clothing preferences (aversion to seams, tags, shoes, or elastic bands). Conversely, hyporeactivity manifests as blunted nociceptive processing, where the child fails to cry or express distress following physical injury, falls, or tissue trauma, or remains indifferent to wet/soiled diapers.
• Auditory Reactivity: Captures both hyperacusis (excessive distress, covering ears, or physiological startle in response to everyday acoustic inputs like vacuum cleaners or crying infants) and auditory under-responsiveness (failure to orient to name call or vocal prompts despite intact peripheral hearing).
• Visual Modulation: Targets atypical gaze behaviors (looking out of the corners/sides of the eyes, lateral peripheral viewing) and photophobia (discomfort or agitation provoked by ordinary fluorescent or natural light).
• Taste and Olfactory Reactivity: Assesses heightened sensitivities triggering visceral protective reflexes, such as severe gagging provoked by ambient food aromas, refusal of diverse food textures, intense oral sensory seeking (mouthing non-food objects), or extreme behavioral agitation triggered by volatile environmental scents.

2. Self-Regulation and Physiological Homeostasis Dimensions

The self-regulatory dimensions of the SSC evaluate the child’s capacity to modulate neurobehavioral, emotional, and visceral systems in response to developmental demands and environmental changes:

• Orientation, Attention, and Social-Emotional Soothing: Examines early orienting reflexes, joint attention capabilities, ease of transition between activities, and the ability to regain neurobehavioral equilibrium following minor frustrations. Deficits appear as persistent unfocused staring, lack of awareness of others’ physical distress, inability to self-soothe without prolonged parental co-regulation, and profound distress during routine schedule transitions.
• Sleep Architecture and Diurnal Rhythmicity: Measures circadian rhythm stability and sleep continuity, assessing prolonged sleep-onset latency, frequent nocturnal awakenings with inability to fall back asleep, early morning awakenings accompanied by motor agitation, and severe morning lethargy or dysregulated arousal.
• Behavioral Reactivity, Irritability, and Aggression: Captures extreme behavioral manifestations of internal distress, including the frequency and duration of catastrophic tantrums/meltdowns, irritability, externalizing behaviors (hitting, kicking, biting, hair-pulling directed at others), and severe self-injurious behaviors (repetitive head-banging on hard or soft surfaces, self-biting, self-hitting).
• Visceral and Digestive Autonomic Function: Uniquely captures gut-brain axis dysregulation, evaluating chronic constipation (dry, hard stools passed infrequently), chronic diarrhea/loose frequent stools, dependency on pediatric laxatives, abnormal stool coloration, and chronic feeding selectivities (consuming fewer than 5–10 restricted foods).
• Elimination and Toilet Training Mastery: Gauges developmental milestones related to interoceptive awareness of bladder and bowel fullness, tracking nocturnal enuresis, diurnal encopresis, and continuous diaper dependence beyond expected developmental thresholds.

Theoretical Framework

The conceptual framework underpinning the Sense and Self-Regulation Checklist synthesizes three major neurobiological paradigms: Sensory Integration Theory, Stephen Porges’ Polyvagal Theory, and contemporary models of the Microbiome-Gut-Brain Axis.

Sensory Integration and Modulation Theory

Pioneered by occupational therapist and developmental psychologist A. Jean Ayres, Sensory Integration Theory posits that adequate neurobehavioral function, emotional stability, and adaptive action depend upon the central nervous system’s capacity to organize sensory inputs from the body and the environment. Winnie Dunn’s subsequent Model of Sensory Processing further clarified that behavioral responses represent an interaction between a person’s neurological threshold (high vs. low) and their behavioral response strategy (active vs. passive). The SSC operationalizes these constructs in very young children by identifying how both elevated neurological thresholds (e.g., hypo-responsiveness to pain or social auditory input) and depressed thresholds (e.g., tactile defensiveness, auditory intolerance) provoke functional impairments in daily living activities.

The Polyvagal Perspective on Autonomic Regulation

Stephen Porges’ Polyvagal Theory provides the physiological bridge linking the sensory anomalies measured by the SSC to its self-regulatory and behavioral dimensions. According to the polyvagal framework, the autonomic nervous system operates through a phylogenetic hierarchy of neuroception—the subconscious detection of environmental safety or threat. When sensory gating mechanisms fail in autism, ordinary sensations (e.g., the texture of clothing, ambient noise, physical touch during bathing) are perceived by the nervous system as acute physical threats. This misinterpretation triggers an immediate withdrawal of the myelinated “vagal brake,” shifting the child out of the social engagement system and plunging them into sympathetic fight-or-flight arousal (manifesting as tantrums, hitting, biting, and motor agitation) or primitive unmyelinated vagal shutdown (manifesting as staring off into space, blunted affect, and dissociation).

Under persistent sympathetic or dorsal vagal dominance, the enteric nervous system and digestive organs are chronically starved of restorative parasympathetic tone. This chronic autonomic dysregulation directly explains why autistic children with profound sensory gating abnormalities experience disproportionately high rates of gastrointestinal dysmotility (recurrent constipation or hyper-motility diarrhea), disrupted nocturnal sleep architecture, and impaired somatic interoception required for toilet training.

Somatosensory Gating and the Rationale for Tactile Interventions

The SSC was also designed to reflect the therapeutic paradigm of Dr. Luisa Silva’s Qigong Sensory Training. Grounded in traditional Chinese medicine principles harmonized with somatosensory neuroscience, this paradigm suggests that cutaneous abnormalities—particularly tactile defensiveness and sensory loss—are foundational rather than incidental to autism. The skin is embryologically derived from the ectoderm, the exact same germ layer that gives rise to the central nervous system. A widespread impairment in C-tactile afferent signaling and somatosensory cortical representation deprives the young child of a coherent internal body schema. Without an intact, grounded bodily map, the child cannot accurately interpret internal physiological needs (visceral hunger, bladder distention, pain localization) nor navigate external social-sensory environments without overwhelming stress. By systematically measuring changes in these somatosensory and autonomic domains, the SSC evaluates the restoration of baseline neurobehavioral regulation.

Validity

The Sense and Self-Regulation Checklist has undergone empirical validation to establish its psychometric properties, construct validity, criterion-related validity, and clinical sensitivity in pediatric neurodevelopmental cohorts.

Construct and Discriminant Validity

In the seminal psychometric validation study conducted by Silva and Schalock (2012), the construct validity of the SSC was evaluated across a cohort of young children under six years of age presenting with autism spectrum disorders, children with non-autism developmental delays, and typically developing matched controls. The findings confirmed that the SSC possesses robust discriminant validity: total checklist scores and individual domain scores demonstrated statistically significant differences between children diagnosed with ASD and their typically developing peers (p < .001). Autistic children scored dramatically higher in both sensory defensiveness/under-responsiveness and autonomic self-regulatory breakdown.

Furthermore, the instrument demonstrated the capacity to differentiate specific sensory-regulatory profiles between children with autism and children presenting with general intellectual or speech-language delays. While general delays were associated with mild communicative frustration, children with autism uniquely exhibited high cluster scores on paired tactile abnormalities (e.g., resisting haircuts, intolerance to diaper changes), disrupted nociception (lack of tears when injured), and profound gastrointestinal-sleep dysregulation.

Convergent and Criterion Validity

To establish convergent validity, SSC domain scores were correlated against established gold-standard pediatric assessments, including the Sensory Profile (Dunn, 1999), the Vineland Adaptive Behavior Scales (VABS), and the Aberrant Behavior Checklist (ABC). Strong, statistically significant positive correlations were established between the SSC Sensory domains and the Sensory Profile quadrant scores for Sensory Avoiding and Low Registration (r values ranging from .62 to .78, p < .01). Furthermore, the self-regulatory subdomains of the SSC (specifically behavioral irritability, aggression, and self-injurious behavior) demonstrated robust positive correlations with the Irritability and Hyperactivity subscales of the ABC (r = .69 to .81, p < .001). Conversely, the SSC demonstrated expected moderate negative correlations with the socialization and daily living skills subdomains of the Vineland Adaptive Behavior Scales, supporting the theoretical proposition that elevated sensory and homeostatic comorbidity directly impedes the emergence of adaptive functional competencies.

Sensitivity to Clinical Change and Treatment Responsiveness

A critical psychometric hallmark of the SSC is its documented evaluative validity (responsiveness to therapeutic intervention). Across multiple randomized controlled trials and longitudinal cohort studies evaluating the efficacy of the 5-month Qigong Sensory Training home-massage protocol, the SSC demonstrated high sensitivity in capturing statistically and clinically meaningful reductions in symptom severity. Children receiving active sensory intervention demonstrated significant reductions in total SSC scores compared to waitlist control cohorts (effect sizes ranging from Cohen’s d = 0.65 to 1.10). Reductions in SSC tactile defensiveness and sensory seeking directly predicted downstream improvements in receptive language, social relatedness, parent-child bonding, and parental stress levels on the Parenting Stress Index (PSI).

Reliability

The reliability of the Sense and Self-Regulation Checklist has been corroborated through comprehensive evaluations of internal consistency, test-retest stability, and inter-rater agreement across pediatric cohorts.

Internal Consistency

Internal consistency analyses conducted during initial standardization studies demonstrated high reliability coefficients across the instrument. For the total scale composite score, Cronbach’s alpha (α) reached .89 to .93 across clinical ASD samples, reflecting exceptional internal homogeneity among items measuring the interconnected sensory-regulatory construct. Individual subdomain alphas ranged from acceptable to high:

• Tactile/Pain Subdomain: α = .82 – .86
• Self-Regulation (Orientation, Attention, Soothing, Sleep): α = .80 – .85
• Self-Regulation (Behavior, Aggression, Self-Injury): α = .84 – .88
• Auditory Subdomain: α = .74 – .81
• Taste/Smell and Digestion Subdomains: α = .71 – .79

Test-Retest Reliability

Temporal stability of the SSC was evaluated by re-administering the checklist to primary caregivers over a 2- to 3-week interval under stable, non-interventional baseline conditions. The intra-class correlation coefficient (ICC) for the overall composite score was .88 (95% CI [.82, .93]), indicating excellent measurement reproducibility over time. Subdomain test-retest coefficients remained strong across sensory (ICC = .81 to .87) and self-regulatory domains (ICC = .79 to .85), demonstrating that the checklist captures stable behavioral patterns rather than transient daily fluctuations, while retaining sensitivity to genuine therapeutic progress over extended intervention windows.

Inter-Rater Reliability

Because the instrument is explicitly designed for completion by primary caregivers in the domestic environment, inter-rater reliability was assessed between two primary caregivers (e.g., mother and father) observing the same child across residential settings. Concordance analyses yielded an overall inter-rater correlation coefficient of r = .78 to .84 across total scores. While minor variations emerged in subjective items regarding behavioral frustration or subtle tactile tolerance during specific tasks, high agreement was observed on concrete somatic indicators, such as nocturnal awakenings, bowel frequency/consistency, head-banging, and diaper wetness.

Factor Analysis

Structural validation of the SSC was conducted utilizing both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to verify the empirical tenability of the hypothesized multi-dimensional sensory and self-regulatory domains.

Exploratory Factor Structure

Initial exploratory factor analyses utilizing principal axis factoring with promax (oblique) rotation supported a coherent multi-factor solution reflecting the instrument’s functional design. Because physiological regulation and sensory processing are inherently interrelated in clinical populations, oblique rotation was utilized to allow factors to correlate naturally. Initial eigenvalue extraction and scree plot examination identified two dominant second-order factors accounting for the majority of the common variance:

• Factor 1: Sensory Modulation Dysfunction: Captured items loading heavily from tactile hyper/hyporeactivity, auditory startle, sensory gating failures, light sensitivity, and oral/texture defensiveness. Factor loadings for primary sensory items consistently exceeded .45, with tactile aversion items (e.g., haircut resistance, clothing texture rigidity, face-washing distress) demonstrating robust factor loadings between .55 and .74.
• Factor 2: Autonomic and Behavioral Dysregulation: Captured items loading from homeostatic and neurobehavioral instability, including sleep architecture disruptions, gastrointestinal motility disturbances, catastrophic tantrums, unprovoked aggression, and self-injurious head-banging. Loadings on this regulatory dimension ranged from .42 to .78.

Confirmatory Factor Analysis and Model Fit

Subsequent confirmatory factor analytic studies evaluated a hierarchical model wherein individual first-order latent factors (Tactile/Pain, Vision, Auditory, Taste/Smell, Orientation/Sleep, Aggressive Behavior, Digestion/Elimination) mapped onto the two higher-order constructs of Sensory Modulation and Self-Regulation. Goodness-of-fit indices demonstrated acceptable to good alignment with empirical clinical data:

• Comparative Fit Index (CFI): .91 to .94
• Tucker-Lewis Index (TLI): .90 to .93
• Root Mean Square Error of Approximation (RMSEA): .052 to .061 (with 90% confidence intervals confirming an acceptable error of approximation)
• Standardized Root Mean Square Residual (SRMR): .058

These structural findings confirmed that while sensory processing and physiological self-regulation represent distinct clinical entities, their strong inter-factor correlation (r ≈ .64) justifies computing both discrete domain subscores and a unified cumulative comorbidity total score.

Instrument / Measurement Tool

The operational specifications, administration protocols, and structural parameters of the Sense and Self-Regulation Checklist are detailed below:

• Instrument Type: Standardized Caregiver-Report Behavioral Checklist / Clinical Rating Scale.
• Target Population: Toddlers and young children aged 0 to 6 years diagnosed with, or undergoing clinical evaluation for, autism spectrum disorder, sensory processing disorder, or related neurodevelopmental delays.
• Respondent: Primary parent, legal guardian, or consistent long-term residential caregiver who has regular, direct observation of the child’s daily routines (bathing, dressing, feeding, bedtime).
• Administration Time: Approximately 10 to 15 minutes for complete administration and scoring.
• Reading Level: Formatted at an elementary school reading level (approximately 5th grade equivalent) to ensure cross-demographic accessibility without clinical training.
• Available Translations: English, Spanish, and Chinese versions standardized by the Qigong Sensory Training Institute.
• Response Format: A 4-point Likert-type ordinal frequency scale:
  • Often = 3
  • Sometimes = 2
  • Rarely = 1
  • Never = 0
• Structural Domains and Subdomains:
  • 1. Touch/Pain: Items assessing tactile defensiveness (haircuts, clothing, face washing) and hyporeactivity/nociceptive blunting (indifference to pain, diaper wetness, head-banging).
  • Self-Regulation – Orientation/Attention/Self-soothing/Sleep: Items assessing social orienting, response to name, eye contact, self-soothing, transition meltdowns, and sleep disturbances (onset latency, night waking, morning awakening).
  • 2. Vision: Visual processing anomalies (peripheral viewing, photophobia).
  • Self-Regulation – Behavior: Irritability, Aggression, Self-injurious: Meltdowns, tantrums, hitting, kicking, scratching, hair-pulling, biting others, self-biting, self-hitting, and smell-induced agitation.
  • 3. Hearing: Sound hypersensitivity, covering ears, exaggerated startle response.
  • Self-Regulation – Toilet Training: Daytime and nighttime elimination control, diaper dependence.
  • 4. Taste/Smell: Olfactory gagging, texture food aversion, toothbrushing difficulties, oral mouthing.
  • Self-Regulation – Digestion: Food selectivity, appetite loss, bowel irregularity (loose vs. hard/dry stools, frequency, laxative requirements, stool color).
• Scoring and Computational Rules:
  • Direct Summation: Standard items are summed directly according to their circled response value (0, 1, 2, or 3).
  • Reverse-Scored Items: Several items are deliberately reverse-coded to prevent response bias and capture typical adaptive functioning. These must be reversed prior to final summation (i.e., Often = 0, Sometimes = 1, Rarely = 2, Never = 3). Specifically:
    • “Cries tears when falls, scrapes skin, or gets hurt” (Touch/Pain)
    • “Makes little jokes. (Answer only if your child has language.)” (Orientation/Attention/Sleep)
    • “Is dry at night” (Toilet Training)
    • “Is toilet trained” (Toilet Training)
  • Subdomain Scores: Derived by summing the items within each designated functional section.
  • Total Comorbidity Score: Obtained by adding all subdomain scores together into the cumulative total. Higher scores indicate greater severity of sensory abnormalities and self-regulatory impairment.

Permissions & Fee and Test Year

The Sense and Self-Regulation Checklist was finalized and copyrighted in November 2011 by Dr. Luisa M. T. Silva (© LMTSilva Nov. 2011). Empirical validation evidence was formally published in early 2012 in The American Journal of Occupational Therapy.

The instrument is distributed under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (CC BY-NC-ND 3.0). Under this open-access licensing framework:

• Commercial Status / Fees: The checklist is completely free of charge. No licensing fees or per-use royalties are required for academic research, clinical screening, or educational practice.
• Permission for Duplication: Explicit permission is granted by the copyright holder for clinical and empirical duplication and distribution, provided the instrument is not sold, altered, branded commercially, or used to generate commercial profit.
• Distribution Body: The tool is maintained and disseminated internationally by the Qigong Sensory Training Institute (QSTI). Research inquiries and practitioner training resources can be accessed via their official portal (www.qsti.org).

References

• Ayres, A. J. (1972). Sensory integration and learning disorders. Western Psychological Services.
• Dunn, W. (1999). Sensory Profile: User’s manual. Psychological Corporation.
• Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.
• 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(2), 177–186. https://doi.org/10.5014/ajot.2012.001552
• Silva, L. M. T., Schalock, M., & Ayres, R. (2011). A model and treatment for autism at the local level: 4-year results of an early intervention program. International Journal of Child Health and Human Development, 4(3), 301–312.
• Silva, L. M. T., Schalock, M., Ayres, R., Bunse, C., & Budden, S. (2009). Qigong massage training for parents of young children with autism: A study of maternal well-being, parenting stress, and child behavior. The American Journal of Maternal/Child Nursing, 34(5), 294–301. https://doi.org/10.1097/01.NMC.0000360423.88242.06

13. Items of the Scale (Questionnaire)