Attachment Disorder Treatment

Symptoms	None	Moderate	Severe
1. Cries; miserable all the time, chronically fussy	______	______	______
2. Resists comforting or nurturance	______	______	______
3. Resists or dislikes being held	______	______	______
4. Poor eye contact or avoids eye contact	______	______	______
5. Flat, lifeless affect (too quiet)	______	______	______
6. Likes playpen or crib more than being held	______	______	______
7. Rarely cries (overly good baby)	______	______	______
8. Angry or rageful when cries	______	______	______
9. Exceedingly demanding	______	______	______
10. Looks sad or empty-eyed	______	______	______
11. Delayed milestones (creeping, crawling, etc.)	______	______	______
12. Stiffens or becomes rigid when held	______	______	______
13. Likes to be in control	______	______	______
14. Does not hold on when held (no reciprocal holding)	______	______	______
15. When held chest to chest, faces away	______	______	______
16. Doesn't like head touched (combed, washed)	______	______	______
17. Generally unresponsive to parent	______	______	______
18. Cries or rages when held beyond his wishes	______	______	______
19. Overly independent play or makes no demands	______	______	______
20. Reaches for others to hold him rather than parent	______	______	______
21. Little or reduced verbal responsiveness	______	______	______
22. Does not return smiles	______	______	______
23. Shows very little imitative behavior	______	______	______
24. Prefers Dad to Mom	______	______	______
25. Gets in and out of parents lap frequently	______	______	______
26. Physically restless when sleeping	______	______	______
27. Does not react to pain (high pain tolerance)	______	______	______
28. Overly affectionate to strangers	______	______	______
29. Feeding problems	______	______	______
30. Speech development delayed	______	______	______

Completed by:________________________________	Relationship to child:_________________________________
Address: __________________________ ___________________________________	Phone:(day) ______________________________________
Date completed:____________________	Phone:(evening) ______________________________________


Note: This list was adapted from Walter Buenning, Ph.D., Toddler adoption: The weaver's craft by Mary Hopkins-Best and What you should know before you adopt a child by Institute for Attachment and Child Development. It is utilized by the Attachment and Bonding Center of Ohio as part of the pre-service application process.