Trauma Awareness and Treatment Center

Child
Dissociative Checklist (CDC)

Version
3.0

Name: ________________________________ Date: __________ Age: _____ Sex:   M     F

Below
is a list of behaviors that describe children.  For each item that describes your child now
or within the past 12 months, please circle 2 if the item is very true of your child.  Circle 1 if the item is somewhat or sometimes true of your child.  If the item is not true of your child, circle 0.

0    1     2 1. Child does not remember or denies traumatic or painful
experiences that are known to have occurred.

0     1     2 2. Child goes into a daze or trance-like state at times
or often appears “spaced out.”  Teachers may report that he or
she “daydreams” frequently in school.

0     1     2 3. Child shows rapid changes in personality.  He or she
may go from being shy to being outgoing, from feminine to masculine,
from timid to aggressive

0     1     2 4. Child is unusually forgetful or confused about things
that he or she should know, e.g. may forget the names of friends,
teachers or other important people, loses possessions or gets lost
easily.

0     1     2 5. Child has a very poor sense of time.  He or she loses
track of time, may think that it is morning when it is actually
afternoon, gets confused about what day it is, or becomes confused
about when something happened.

0     1     2 6. Child shows marked day-to-day or even hour-to-hour
variations in his or her skills, knowledge, food preferences,
athletic abilities, e.g. changes in handwriting, memory for
previously learned information such as multiplication tables,
spelling, use of tools or artistic ability.

0     1     2 7. Child shows rapid regressions in age-level of behavior
e.g., a twelve-year-old starts to use baby-talk, sucks thumb or draws
like a four-year-old.

0     1     2 8. Child has a difficult time learning from experience,
e.g. explanations, normal discipline or punishment do not change his
or her behavior.

0     1     2 9. Child continues to lie or deny misbehavior even when
the evidence is obvious.

0     1     2 10. Child refers to him or herself in the third person
(e.g. as she or her) when talking about self, or at times insists
on being called by a different name.  He or she may also claim that
things that he or she did actually happened to another person.

0     1     2 11. Child has rapidly changing physical complaints such
as headache or upset stomach.  For example, he or she may complain of
a headache one minute and seem to forget all about it the next.

0     1     2 12. Child is unusually sexually precocious and may
attempt age-inappropriate sexual behavior with other children or
adults.

0     1     2 13. Child suffers from unexplained injuries or may even
deliberately injure self at times.

0     1     2 14. Child reports hearing voices that talk to him or her.
The voices may be friendly or angry and may come from “imaginary
companions” or sound like the voices of parents, friends or
teachers.

0     1     2 15. Child has a vivid imaginary companion or companions.
Child may insist that the imaginary companion(s) is responsible for
things that he or she has done.

0     1     2 16. Child has intense outbursts of anger, often without
apparent cause and may display unusual physical strength during these
episodes.

0     1     2 17. Child sleepwalks frequently.

0     1     2 18. Child has unusual nighttime experiences, e.g. may
report seeing “ghosts” or that things happen at night that he or
she can’t account for (e.g. broken toys, unexplained injuries).

0     1     2 19. Child frequently talks to him or herself, may use a
different voice or argue with self at times.

0     1     2 20. Child has two or more distinct and separate
personalities that take control over the child’s behavior.