Category: Health Psychology / Behavioral Medicine - Adult


Screening for Childhood Adversity in Primary Care: A Psychometric Investigation of the ACE Questionnaire

Friday, November 17
12:00 PM - 1:30 PM
Location: Sapphire Ballroom I & J, Level 4, Sapphire Level

Keywords: Health Psychology | Assessment | Measurement
Presentation Type: Symposium

Research consistently demonstrates robust associations between adverse childhood experiences (ACEs) and mental and physical health problems in later life.  While several measures of childhood adversity have been developed, no single measure has emerged as being the most reliable and valid report of childhood adversity.  In order to validate an ACEs inventory best suited for use in primary care settings, participants were recruited from three primary care clinics in the Calgary area (n = 233).  Participants completed several questionnaires that assess a variety of early adverse experiences, including the Adverse Childhood Experiences (ACE) Questionnaire, the Child Abuse and Trauma Scale (CATS), the Childhood Trauma Questionnaire (CTQ), and the World Health Organization Adverse Childhood Experiences International Questionnaire (WHO).  Convergent validity was evidenced amongst the scales, with correlations ranging between r = .84 - .95.  Data analysis also revealed that all the scales possessed strong internal consistency, as measured by Cronbach's α: .95 (ACE), .96 (CATS), .96 (CTQ), and .89 (WHO).  Finally, factor analyses were conducted to determine if each scale could be reduced to a smaller and more efficient tool, and if various ACEs clustered into identifiable domains.  All analyses revealed a final two-factor solution, with a strong primary factor comprised of most ACE items, but a smaller second factor comprised of only the sexual abuse items.  All items across all the scales loaded on one of these two factors, with the exception of the WHO, which had one item that did not contribute to this solution. 

Several conclusions were derived from the data.  First, it was concluded that all the scales had evidence of utility in primary care, although the WHO was somewhat weaker.  Second, it was determined that a shortened version of the ACE Questionnaire likely has the most utility for widespread screening in primary health care settings, as it assesses the 10 main ACE questions asked in most trauma-informed work, is relatively easy to administer, and has strong psychometric properties.  Third, the existence of a two-factor solution across all the scales suggests that future research and treatment efforts should consider the unique needs and characteristics of adults who experienced sexual abuse as children compared to adults who may have experienced a variety of other types of abuse, neglect and household dysfunction but were not sexually abused.

A subset of ***30?*** participants was also asked to complete the ACEs questionnaire a second time three months after the initial administration in order to assess the test-retest reliability of the measure.  These participants also completed the 9-item Patient Health Questionnaire (PHQ-9) at the time of each administration in order to assess the extent to which any changes in reporting of ACEs might be related to changes in current mood state.  The results of the analyses of these data will also be presented.

Keith S. Dobson

Professor of Clinical Psychology
University of Calgary


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Screening for Childhood Adversity in Primary Care: A Psychometric Investigation of the ACE Questionnaire

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