What is the Child Dissociative Checklist?

The Child Dissociative Checklist, often abbreviated as CDC, is a specialized psychological assessment tool designed to identify signs of dissociative disorders in children. Developed by experts in child psychology and psychiatry, this checklist is a crucial resource for clinicians, therapists, and mental health professionals working with children who may exhibit symptoms of dissociation.

Dissociative disorders in children often manifest as a disruption in the normal integration of consciousness, identity, memory, and perception. These disturbances can significantly impact a child's emotional well-being and daily functioning. The Child Dissociative Checklist serves as a structured method to evaluate these complex symptoms, enabling early detection and intervention.

The checklist comprises a series of statements or questions focusing on behaviors, emotions, and experiences commonly associated with dissociative disorders. These can include memory lapses, episodes of trance-like states, sudden changes in behavior or skills, and the presence of alternate identities or imaginary companions. Mental health professionals use the checklist to rate the frequency and intensity of these symptoms, based on observations and reports from both the child and caregivers.

Scoring and interpretation of the CDC are nuanced. The checklist is designed not just to capture the presence of symptoms but to gauge their severity. Higher scores typically indicate a greater likelihood or severity of dissociative symptoms, guiding clinicians toward further diagnostic evaluation or therapeutic interventions.

It's important to note that the Child Dissociative Checklist is not a standalone diagnostic tool. Instead, it is used in conjunction with other assessments and clinical evaluations. Its primary role is to guide mental health professionals in identifying children who may need more comprehensive psychological evaluations and to initiate discussions about potential therapeutic pathways. By facilitating early detection, the CDC plays a vital role in ensuring children receive appropriate and timely care for dissociative disorders.

Printable Child Dissociative Checklist

Download this Child Dissociative Checklist for clinicians, therapists, and mental health professionals working with children who may exhibit symptoms of dissociation.

Using the Child Dissociative Checklist: A guide for professionals

The Child Dissociative Checklist is a clinical tool for assessing dissociative symptoms in children. It's essential for mental health professionals, including psychologists, psychiatrists, and therapists, as well as for caregivers to monitor a child's psychological well-being. Follow this step-by-step guide to access and use the Child Dissociative Checklist effectively:

Step 1: Access the Child Dissociative Checklist

  • Download: Obtain the Child Dissociative Checklist by clicking on the provided link on our website or other professional resources.
  • Viewing the Checklist: The checklist will typically be in a PDF format, convenient for digital viewing.
  • Printing option: You can also print the checklist for ease of use during consultations or for maintaining physical records as part of the child’s psychological assessment file.

Step 2: Gathering information:

  • Obtain information from both the child and reliable sources who know the child well, such as parents, caregivers, or teachers.
  • Ensure that the environment is comfortable and conducive to sharing sensitive information.

Step 3: Administering the checklist:

  • The checklist consists of a series of statements describing behaviors and experiences commonly associated with dissociative disorders in children.
  • Read each item carefully to the child or the caregiver, ensuring they understand the statement.

Step 4: Scoring

  • For each item, score based on the current or past 12 months' relevance to the child.
  • Use the following scale for scoring:
  • 0: Not True (The behavior or experience does not apply to the child)
  • 1: Somewhat or Sometimes True (The behavior or experience applies to some extent or occasionally)
  • 2: Very True (The behavior or experience strongly applies to the child)

Step 5: Interpreting scores:

  • Total the scores for all items. Higher scores indicate a greater likelihood or severity of dissociative symptoms.
  • Use the scores as a preliminary assessment to guide further diagnostic evaluation.

Step 6: Evaluation

  • If the score suggests the presence of dissociative symptoms, consider a comprehensive psychological evaluation.
  • Discuss the results with the child's caregivers and, if appropriate, with the child, to determine the best course of action.

Child Dissociative Checklist example (sample)

To aid users in effectively utilizing the Child Dissociative Checklist, we provide a detailed example as a downloadable PDF. This sample checklist serves as a practical guide, illustrating how a professional might use the tool to identify and track symptoms of dissociative disorders in children, which is essential for psychological assessment and therapeutic interventions.

The sample showcases a fictional scenario, providing insight into how mental health professionals can use the checklist to assess, identify, and track dissociative symptoms in children.

How to access:

  • Preview option: Get a glimpse of the sample right here by previewing it below.
  • Download for in-depth review: Click on the "Download Example PDF" button to obtain a copy. This enables you to review the example at your convenience and refer to it during assessments

Download this Child Dissociative Checklist Example:

Child Dissociative Checklist example (sample)

When would you use this template?

The Child Dissociative Checklist Template is a specialized resource designed for use by mental health professionals, including child psychologists, psychiatrists, therapists, and counselors, in various clinical and therapeutic contexts. Its primary application is in the early identification and assessment of dissociative symptoms in children, a crucial step in addressing complex psychological conditions. Appropriate situations for the CDC template:

  • Initial psychological evaluations: When a child first presents with symptoms such as memory lapses, trance-like states, or sudden behavioral changes, the Checklist Template serves as an initial screening tool. It guides clinicians in systematically evaluating the presence and severity of dissociative symptoms.
  • Monitoring treatment progress: For children already diagnosed with dissociative disorders, the Checklist Template can be used periodically to monitor changes in symptoms and treatment effectiveness. This ongoing assessment helps in fine-tuning therapeutic interventions.
  • Differentiating disorders: In cases where a child’s symptoms overlap with other psychological disorders, such as PTSD or anxiety disorders, the Checklist Template aids in distinguishing dissociative symptoms from other conditions. This ensures a more accurate diagnosis and targeted treatment plan.
  • Educational and care settings: Educators and childcare professionals can use the Checklist Template as a reference to understand the possible signs of dissociative symptoms in children. While they cannot diagnose, this knowledge helps in making informed referrals to mental health services.
  • Research purposes: Researchers studying dissociative disorders in children can utilize the Checklist Template to gather standardized data, contributing to the broader understanding of these conditions.

What do the results mean?

Interpreting the results of the Free Child Dissociative Checklist Template involves understanding the spectrum of dissociative symptoms and their implications for a child's mental health. The checklist, scored on a scale, offers insights into the presence and severity of dissociative symptoms. Here's a breakdown of common results and what they typically indicate:

Low score range:

  • Minimal to no indicators: A low score generally suggests that the child exhibits few or no signs of dissociative symptoms. This could mean the child does not have a dissociative disorder, or the symptoms are not prominently manifesting at the time of assessment.
  • Caution in interpretation: Even with a low score, if there are clinical concerns or reported incidents that suggest dissociative tendencies, further evaluation may be necessary.

Moderate score range:

  • Possible dissociative symptoms: A moderate score indicates that there are some dissociative symptoms present. This range calls for a more in-depth analysis to understand the context and frequency of these symptoms.
  • Need for further assessment: Children in this score range might benefit from a comprehensive psychological evaluation to explore the underlying causes and to determine if these symptoms are part of a broader mental health issue.

High score range:

  • Significant dissociative symptoms: High scores are indicative of more serious dissociative symptoms. This is a strong signal that the child may be experiencing a dissociative disorder.
  • Immediate attention required: Professional intervention is crucial at this stage. A detailed clinical assessment, possibly including interviews, observations, and collaboration with caregivers and educators, is vital for an accurate diagnosis and treatment plan.

General considerations:

  • Contextual factors: It’s important to consider the results in the context of the child's overall environment, history, and other psychological or developmental factors.
  • Professional judgment: The checklist is a tool to guide professionals but should not replace clinical judgment and individualized assessment.

In conclusion, the results from the Free Child Dissociative Checklist Template offer valuable preliminary insights into a child's mental health concerning dissociative symptoms. They guide professionals in decision-making about further evaluations, interventions, and necessary support mechanisms for the child.

Why use Carepatron as your Child Dissociative Checklist app?

Choosing Carepatron as the go-to counseling software for managing the Child Dissociative Checklist Template offers a multitude of advantages for mental health professionals. This specialized software streamlines the process of evaluating and tracking dissociative symptoms in children, enhancing both efficiency and effectiveness.

Centralized workspace:

Carepatron provides an all-encompassing platform that integrates essential tasks like client assessments, progress documentation, appointment scheduling, and billing. This centralized approach is particularly beneficial for child psychologists, therapists, and counselors, allowing them to manage their client information and dissociative checklist data all in one place. Such integration simplifies processes, enabling professionals to devote more attention to client care rather than navigating multiple applications.

Customization and efficiency:

Understanding the diverse needs of mental health professionals, Carepatron offers customizable tools and workflows. This flexibility allows for the Child Dissociative Checklist Template to be adapted and utilized according to each child's specific case, ensuring a more personalized approach to assessment and treatment planning.

Empowerment and easy sharing:

With Carepatron, administrative tasks are streamlined, enhancing the overall quality of service delivery. The app enables effortless sharing of the Child Dissociative Checklist results and other relevant documents, promoting better collaboration between professionals, caregivers, and educational staff involved in a child’s care.

Accessibility and security:

The app is accessible on various devices, ensuring easy use and availability. Carepatron adheres to stringent global security standards, safeguarding sensitive information like the results of the Child Dissociative Checklist and other personal health data of children.

Collaborative support:

Carepatron encourages a collaborative environment by connecting professionals with colleagues, clients, and other stakeholders. This support is crucial for the effective management and follow-up of cases involving dissociative symptoms in children.

In summary, Carepatron stands out as an invaluable Child Dissociative Checklist Template software, blending functionality, customization, security, and technological integration to cater to the specific needs of professionals in child psychology and mental health care. It's an essential tool for those dedicated to the effective assessment and support of children with dissociative symptoms.

Counseling Sotware


Pinegar C. (1995). Screening for dissociative disorders in children and adolescents. Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 8(1), 5–16. https://doi.org/10.1111/j.1744-6171.1995.tb00517.x 

Putnam, F. W. (1990). Child Dissociative Checklist (CDC) [Database record]. APA PsycTests.https://doi.org/10.1037/t02069-000 

Putnam, F. W., Helmers, K., & Trickett, P. K. (1993). Development, reliability, and validity of a child dissociation scale. Child abuse & neglect, 17(6), 731–741. https://doi.org/10.1016/s0145-2134(08)80004-x 

Wherry, J. N., Neil, D. A., & Taylor, T. N. (2009). Pathological dissociation as measured by the child dissociative checklist. Journal of child sexual abuse, 18(1), 93–102. https://doi.org/10.1080/10538710802584643

What is the Child Dissociative Checklist Template?
What is the Child Dissociative Checklist Template?

Commonly asked questions

What is the Child Dissociative Checklist Template?

The Child Dissociative Checklist Template is a tool used by mental health professionals to screen for dissociative symptoms in children. It consists of a series of statements that help in identifying behaviors and experiences indicative of dissociative disorders.

Who should use the Child Dissociative Checklist Template?

The checklist is designed for use by qualified professionals such as child psychologists, psychiatrists, therapists, and counselors. It's not intended for use by individuals without professional mental health training.

How is the Child Dissociative Checklist Template scored?

The checklist is scored on a scale with each item rated as 0 (Not True), 1 (Somewhat or Sometimes True), or 2 (Very True). The total score can indicate the presence and severity of dissociative symptoms.

Join 10,000+ teams using Carepatron to be more productive

One app for all your healthcare work