Childhood MPD, in contrast to adult MPD, may fulfill diagnostic criteria for several different disorders. Referral problems can include depression, oppositional behavior, conduct disorders, learning disabilities, and borderline personality characteristics. The incidence of MPD in children is difficult to assess because, according to Kluft, dissociative disorders are largely undiagnosed in children. There is general agreement in the literature that early, ongoing abuse or trauma trigger the onset of multiple personalities. Other than child abuse or child sexual abuse, several traumatic circumstances can contribute to MPD. These include witnessing the violent or traumatic death of caretakers or loved ones, experiencing other traumatic conditions due to war, and dealing with chronic and debilitating pain. Currently, there is apparently very little research on the use of standardized tests for the diagnosis of MPD in children. There is a pressing need for adequate criteria. A child with MPD must be relieved of the stressors that caused the disorder and then treated. Treatment includes the establishment of a safe, nurturing environment; the forming of a therapeutic alliance; improvement of functioning and the management of behavioral problems; the systematic meeting of alternative personalities, and the integration of alternative personalities. Findings from a small sample of therapists shows there is significant variation in the treatment of MPD clients. There was a general lack of awareness about the presence of MPD in children and how to detect the syndrome early.