Child Attachment Checklist

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Child Attachment Checklist Child 's Name: ________________________________________ ___________________Date: ____________. Parent's Name: ________________________________________ ___________________________________. Symptoms None Mild Moderate Severe 1 Is unable to give and receive love 0 1 2 3 4 5 6 7 8 9 10. 2 Is oppositional, argumentative, defiant 0 1 2 3 4 5 6 7 8 9 10. 3 Is emotionally phony, hollow or empty 0 1 2 3 4 5 6 7 8 9 10. 4 Is manipulative or controlling 0 1 2 3 4 5 6 7 8 9 10. 5 Has frequent or intense angry outbursts 0 1 2 3 4 5 6 7 8 9 10. 6 Is an angry Child inside 0 1 2 3 4 5 6 7 8 9 10.

Child Attachment Checklist Child’s Name: _____Date: _____ Parent’s Name: _____

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