Attachment Disorder Experts - Psychological Services for Reactive Attachment Disorders

Symptoms Checklist

Child's Name:			Completed By:
Child's Date of Birth:		(mm/dd/yyyy)	E-Mail:

There are six categories of traits and symptoms of attachment disorder: behavioral, cognitive, emotional, social, physical, and moral-spiritual. Children vary in regard to the number of symptoms they have and in the severity of their symptoms. Please place a mark in the appropriate column for each symptom as it pertains to your child. For each of the symptoms checked as moderate or severe, please give a brief description of your child's behavior. Specific examples (given by parents) are available by clicking on a question, as desired.

	None	Mild	Moderate	Severe
1. Lack of impulse control

	None	Mild	Moderate	Severe
2. Self-destructive, physical/psychological

	None	Mild	Moderate	Severe
3. Destruction of property

	None	Mild	Moderate	Severe
4. Aggression toward others, physical/verbal

	None	Mild	Moderate	Severe
5. Consistently irresponsible

	None	Mild	Moderate	Severe
6. Inappropriately demanding and clingy

	None	Mild	Moderate	Severe
7. Stealing

	None	Mild	Moderate	Severe
8. Deceitful (lying, conning)

	None	Mild	Moderate	Severe
9. Hoarding

	None	Mild	Moderate	Severe
10. Inappropriate sexual conduct and attitudes

	None	Mild	Moderate	Severe
11. Cruelty to animals

	None	Mild	Moderate	Severe
12. Sleep disturbance

	None	Mild	Moderate	Severe
13. Enuresis and encopresis

	None	Mild	Moderate	Severe
14. Frequently defies rules (oppositional)

	None	Mild	Moderate	Severe
15. Hyperactivity

	None	Mild	Moderate	Severe
16. Abnormal eating habits

	None	Mild	Moderate	Severe
17. Preoccupation with fire, gore, or evil

	None	Mild	Moderate	Severe
18. Persistent nonsense questions and incessant chatter

	None	Mild	Moderate	Severe
19. Hyper vigilant

	None	Mild	Moderate	Severe
20. Difficulty with novelty and change

	None	Mild	Moderate	Severe
21. Lack of cause and effect thinking

	None	Mild	Moderate	Severe
22. Learning disorders

	None	Mild	Moderate	Severe
23. Speech Disorders

	None	Mild	Moderate	Severe
24. Perceives self as victim (helpless)

	None	Mild	Moderate	Severe
25. Grandiose sense of self-importance/entitlement

	None	Mild	Moderate	Severe
26. Not affectionate on parents' terms

	None	Mild	Moderate	Severe
27. Intense displays of anger (rage)

	None	Mild	Moderate	Severe
28. Frequently sad, depressed or hopeless

	None	Mild	Moderate	Severe
29. Inappropriate emotional responses

	None	Mild	Moderate	Severe
30. Marked mood changes

	None	Mild	Moderate	Severe
31. Superficially engaging and charming

	None	Mild	Moderate	Severe
32. Lack of eye contact for closeness

	None	Mild	Moderate	Severe
33. Indiscriminately affectionate with strangers

	None	Mild	Moderate	Severe
34. Lack of or stable peer relationships

	None	Mild	Moderate	Severe
35. Cannot tolerate limits and external control

	None	Mild	Moderate	Severe
36. Doesn't like criticism and blames others for own mistakes or problems

	None	Mild	Moderate	Severe
37. Victimizes others (perpetrator, bully), revenge

	None	Mild	Moderate	Severe
38. Victimized by others

	None	Mild	Moderate	Severe
39. Lacks trust in others

	None	Mild	Moderate	Severe
40. Exploitative, manipulative, controlling, bossy

	None	Mild	Moderate	Severe
41. Poor hygiene

	None	Mild	Moderate	Severe
42. Chronic body tension

	None	Mild	Moderate	Severe
43. Accident prone

	None	Mild	Moderate	Severe
44. High pain tolerance/overreaction to minor injury

	None	Mild	Moderate	Severe
45. Tactilely defensive

	None	Mild	Moderate	Severe
46. Genetic predispositions/hypochondriac

	None	Mild	Moderate	Severe
47. Lack of meaning and purpose

	None	Mild	Moderate	Severe
48. Lack of faith, compassion, and other spiritual values

	None	Mild	Moderate	Severe
49. Identification with evil and the dark side of life

	None	Mild	Moderate	Severe
50. Lack of remorse and conscience

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