Adolescent Dissociative Experiences Scale (A-DES)

The Adolescent Dissociative Experiences Scale (A-DES) was developed by Armstrong et al. (1997) to address the need for a validated measure of dissociation specific to adolescents aged 11-18. The 30-item scale was designed within a theoretical framework that conceptualises dissociation along a continuum from normal to pathological experiences, while also acknowledging that adolescence may represent a key developmental transition point where normal and pathological dissociation begin to diverge (Armstrong et al., 1997).

While the Child Dissociative Checklist (CDC) provides a parent-report measure for younger children and the Dissociative Experiences Scale (DES) (Carlson & Putnam, 1993) serves as a measure for adults, the A-DES specifically targets the adolescent developmental period where dissociative experiences may manifest differently. The depersonalisation/derealisation subdomain of the A-DES includes items specifically designed to assess dissociated identity (feelings of being disconnected from parts of oneself) and dissociated relatedness (sense that interpersonal relationships are unaccountably changeable and unreal), which are particularly relevant to adolescent development (Armstrong et al., 1997).

The A-DES consists of items that assess dissociative experiences across four domains that reflect fundamental aspects of dissociation:

Dissociative amnesia (7 items): assesses gaps in memory and awareness. Examples include getting back tests or homework with no memory of doing them, finding writings or drawings that one must have created but doesn’t remember creating, being told about things one has done but with no recollection, and having significant memory gaps in one’s personal history or daily activities.

Absorption and imaginative involvement (6 items): measures high engagement in fantasy or activities with reduced awareness of surroundings. Examples include becoming so wrapped up in watching TV, reading, or playing video games that one has no awareness of surrounding events, becoming absorbed in fantasy or daydreams, and the ability to shut out real-world distractions when focused on specific activities.

Passive influence (5 items): examines experiences of not having volitional control over one’s actions, behaviors, or sensations. Examples include inconsistent abilities (performing tasks well one time but poorly another without explanation), feeling compelled to do things without wanting to, and experiencing sensations or behaviors that feel involuntary or controlled by something else.

Depersonalisation/derealization (12 items): reflects feelings of disconnection from oneself or perceiving the world as unreal or distorted. Examples include feeling like one is in a fog or spaced out, watching oneself as if from outside one’s body, feeling that one’s body doesn’t belong to oneself, experiencing the world as unreal or dreamlike, feeling like there are different people inside oneself, and experiencing sudden unexplained changes in relationships with friends or family.

Research has consistently demonstrated a relationship between elevated A-DES scores and trauma history. Armstrong et al. (1997) found that adolescents who reported both physical and sexual abuse scored significantly higher than those reporting no abuse. Similarly, Brunner et al. (2000) reported that adolescent psychiatric patients with a history of sexual abuse had significantly higher A-DES scores than those without such history. The scale has also shown discriminant validity, with studies finding that adolescents with dissociative disorders score significantly higher than both normal adolescents and those with general psychiatric disorders (Armstrong et al., 1997; Zoroglu et al., 2002).

The A-DES serves multiple clinical purposes. As a screening instrument, it can identify adolescents with significant dissociative symptoms who may require further assessment for dissociative disorders. Clinical experience suggests that dissociative symptoms are frequently overlooked in adolescent assessments, particularly as these symptoms may be mistaken for typical teenage behaviour, oppositional defiance, or attention difficulties (Armstrong et al., 1997).

Early identification allows for targeted interventions, reducing the risk of difficulties continuing into adulthood. For diagnostic formulation, the scale can help clinicians distinguish between normal developmental experiences and pathological dissociation. It may also assist in identifying dissociative subtypes within common adolescent psychiatric disorders, which could have implications for treatment planning.

Clinicians may find the A-DES particularly valuable as an interview tool. After completion, items endorsed by the adolescent can serve as a starting point for clinical discussion about dissociative experiences that might otherwise be difficult for the young person to verbalise or recognise spontaneously. This approach can facilitate engagement with adolescents who may struggle to articulate their internal experiences during unstructured clinical interviews.

The total score ranges from 0-56 with higher scores indicating more intense experiences of gender dysphoria. Subscale raw scores ranges are listed below:

•   Preoccupation (8 items: 1, 2, 4, 5, 7, 9, 12, 13): higher preoccupation scores indicate a person spends a great deal of time distressed or consumed by gender-related thoughts (range 0-32) 
•   Stability (6 items: 3, 6, 8, 10, 11, 14): higher stability scores indicate more frequent fluctuations in gender identity (range 0-24)

The GPSQ-2 can be used to screen for gender-related distress, to inform treatment planning, and to monitor changes over time in therapy or after interventions.

On first administration, a stacked bar graph shows the total and each of the two subscale scores in gender-diverse percentiles. Percentiles give context to a client’s score, showing how they compare to their peers. For example, a percentile of 50 represents the typical level of gender dysphoria distress among members of the gender-diverse community.

A horizontal comparison graph is also presented showing the respondent’s score in comparison to the cis-gender, gender-diverse and clinical samples.  

When administered more than once, a line graph is presented for the raw total score with gender-diverse percentile labels on the right.

A second line graph is presented plotting each of the two subscales in gender-diverse percentile terms.

Significant changes in the total score are indicated by shifts of half a standard deviation or greater (approximately 6 total score points or more) following the guidelines of the Minimally Important Difference (Turner et al., 2010).

Severity categories for the total and subscales scores were created by Bowman (2022) and adjusted by NovoPsych to align them (total and subscale) based on the percentile distribution of the total score in the gender-diverse sample from Bowman (2024): 

• Percentiles 1st-15th = “Not at all distressed” / “Not at all preoccupied” / “Highly stable”
• Percentiles 16th-40th = “Not very distressed” / “Not very preoccupied” / “Somewhat stable”
• Percentiles 41st-66th = “Somewhat distressed” / “Somewhat preoccupied” / “Not very stable”
• Percentiles 67th-99th = “Highly distressed” / “Highly preoccupied” / “Not at all stable”

The A-DES demonstrates good construct validity across multiple studies. Convergent validity has been established through its significant correlation (r = .77) with the adult Dissociative Experiences Scale (DES) in a sample of college students (Smith & Carlson, 1996). The scale also correlates moderately with the Child Behavior Checklist (CBCL) Total score (r = .41), as well as with the CBCL Externalizing (r = .44) and Internalizing (r = .33) scales (Seeley et al., 2004). Further supporting its validity, the A-DES correlates significantly with therapist ratings of dissociation (r = .55) in clinical samples (Seeley et al., 2004).

Internal reliability of the A-DES is excellent across studies, with Cronbach’s alpha coefficients consistently in the range of .92 to .94 (Armstrong et al., 1997; Farrington et al., 2001; Muris et al., 2003; Smith & Carlson, 1996). Reliability for the theoretical subscales is also generally good, with alpha coefficients of .85 for amnesia, .72 for absorption, .73 for passive influence, and .82 for depersonalisation/derealization (Armstrong et al., 1997). Test-retest reliability over a two-week period has been reported as .77 (Smith & Carlson, 1996), while split-half reliability coefficients range from .90 to .94 across studies (Armstrong et al., 1997; Farrington et al., 2001; Smith & Carlson, 1996).

Regarding dimensionality, factor analytic studies have consistently found evidence for a one-factor solution rather than the theoretical four-factor structure. Farrington et al. (2001) conducted a principal components analysis with a sample of 768 non-clinical adolescents and found that a single factor accounted for 39.1% of the variance, with all items loading at least .40 on this factor. Similarly, Muris et al. (2003) reported that a single-factor solution accounted for 36.4% of the variance in their sample of 331 non-clinical adolescents. Lindfors et al. (2022) used more robust item response theory methods and also concluded that a one-dimensional structure was best supported, with the original theoretical four-factor model showing poor fit. These findings suggest that, at least in non-clinical samples, the A-DES primarily measures a unidimensional construct of dissociation rather than distinct subtypes.

Normative data for the A-DES is available from several studies. In the original validation study, Armstrong et al. (1997) reported mean scores for their clinical sample of adolescents with dissociative disorders (M = 4.8, SD = 1.1), general psychiatric disorders (M = 2.2, SD = 1.6), and psychotic disorders (M = 3.7, SD = 1.8). Smith and Carlson (1996) provided data from a non-clinical sample of adolescents (M = 2.24, SD = 1.4). Farrington et al. (2001) reported means for their large non-clinical sample of British adolescents aged 11-16 years (M = 2.66, SD = 1.81), with no significant age or gender differences found. Only one study, conducted by Muris et al. (2003), reported a total mean score and standard deviation for the total scale as well as each for each of the four subscales. In their sample of 331 non-clinical adolescents, they reported a total mean score of 1.27 (SD = 1.18), an amnesia score of 1.36 (SD = 1.37), an absorption and imaginative involvement score of 1.79 (SD = 1.46), a depersonalization/derealization mean score of .82 (SD = 1.16), a passive influence mean score of 1.58 (SD = 1.50)

A cutoff score of 4.0 has been suggested for identifying adolescents with pathological dissociation (Kisiel & Lyons, 2001). Based on the available normative data and clinical findings across studies, NovoPsych presents interpretive guidelines for the A-DES. Four severity categories are proposed:

• Low (0-1.9), encompasses scores within one standard deviation of non-clinical means (Muris et al., 2003).
• Mild (2.0-2.9), captures scores consistent with general psychiatric samples (Armstrong et al., 1997) and overlaps several non-clinical samples (Smith & Carlson, 1996; Farrington et al., 2001).
• Moderate (3.0-3.9), represents scores exceeding general psychiatric means but falling below the clinical threshold of 4.0, and is similar to means observed in adolescents with psychotic disorders (Armstrong et al., 1997).
• High (4.0 and above), consistent with the clinical cutoff suggested by Kisiel and Lyons (2001) and corresponds to mean scores observed in adolescents with dissociative disorders (Armstrong et al., 1997).

These interpretive categories provide clinicians with a framework for contextualising A-DES scores relative to both non-clinical and clinical reference groups, facilitating differentiation between normative adolescent experiences and potentially pathological dissociation.

When the A-DES score exceeds 4.0, further assessment for a dissociative disorder is recommended, potentially including structured clinical interview. It should be noted that relying strictly on this threshold might miss cases with clinically significant dissociation, as Armstrong et al. (1997) found meaningful dissociative symptoms even in their general psychiatric sample (mean = 2.2). Therefore, considering a reduced cutoff in the Moderate range (3.0-3.9) will yield higher sensitivity, particularly when there is a trauma history or when scores on specific subscales are notably elevated.

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