10 September 2003
Reactive Attachment Disorder Checklist
Student Name:
Student Age:
Name of person completing form:
Reactive Attachment Disorder is considered to be a consistent pattern of inhibited, emotionally withdrawn behaviour toward adult caregivers that have been present for more than 12 months.
NB: This checklist is not a diagnostic tool but provides information about a student’s behaviour. Read each phrase below and mark the response that best describes the individual’s behaviour. Please add comments below each item relating to observations of the student.
Emotionally Withdrawn
← Rarely attempts to seek comfort
←
← Rarely responds to comfort
←
← Displays avoidance or resistance to comforting
←
← Is wooden and gives “stiff” hugs and is not “cuddly”
←
← Shows a lack of guilt or remorse
←
← Blames others for their own mistakes
←
← Shows no positive response to interactions
Social or Emotional Disturbances
← Has a history of insufficient care, for e.g. having emotional needs for comfort, stimulation and affection met, or repeated changes of primary caregivers
←
← Shows minimal social and emotional responsiveness to others
← Has episodes of unexplained irritability, sadness, or fearfulness with adult caregivers.
← Overly friendly to strangers, but unable to be affectionate with those close to them
←
← Has mood swings or temper tantrums
←
← Displays regressive behaviours (baby-talk, noisemaking, animal noises, etc.)
←
← Views the world as unsafe and untrustworthy
Other Behaviours
← Has difficulty with cause-and-effect
←
← Steals or is deceitful
←
← Acts controlling or bossy
←
← Is manipulative
←
← Displays sexual acting out behaviours
←
← Refuses to do assignments or does them poorly
←
← Speaks nonsensically, “jabber”, slurs words or mumbles
←
← Acts superficial and phony
←
← Shows abnormal eating – either gorging or starving
←
← Often prefers to be alone; does not do well in groups
← Has difficulty understanding how their behaviour affects others and shows a lack of empathy
←
← Has poor impulse control
←
← Has physical aggression tendencies, injuring animals or other people
←
← When distressed bangs their head; scratches, bites or cut themselves; or rocks back and forth
←
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