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Expanding the Original Definition of Adverse Childhood Experiences (ACEs)

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Abstract

We report two studies examining psychometric properties of an expanded measure of adverse childhood experiences (ACEs) that combined the original ACEs items with items from the Juvenile Victimization Questionnaire. In Study 1, we examined its factorial structure, internal consistency, and concurrent validity in undergraduates (N = 1479). In Study 2, we also examined replicability of frequencies of ACEs, test-retest reliability, and convergent and predictive validity. Results suggested a model with four inter-related factors: maltreatment, household dysfunction, community dysfunction, and peer dysfunction/property victimization. Internal consistency, test-retest reliability, concurrent and convergent validity were acceptable, and findings were replicated across samples. We suggest that this expanded measure is assessing early experiences of victimization and helplessness in the face of perceived intentional emotional and physical threats or actual harm by others, and that although they may not all be “traumatic,” their cumulative impact is associated with poor mental health in young adults.

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References

  • Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., MacMillan, H., & Sareen, J. (2011). Childhood adversity and personality disorders: Results from a nationally representative population-based study. Journal of Psychiatric Research, 45, 814–822. https://doi.org/10.1016/j.jpsychires.2010.11.008.

    Article  PubMed  Google Scholar 

  • Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186.

    Article  Google Scholar 

  • Anda, R. F., Brown, D. W., Dube, S. R., Bremner, J. D., Felitti, V. J., & Giles, W. H. (2008). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive Medicine, 34, 396–403. https://doi.org/10.1016/j.amepre.2008.02.002.

    Article  PubMed  Google Scholar 

  • Anda, R. F., Butchart, A., Felitti, V. J., & Brown, D. W. (2010). Building a framework for global surveillance of the public health implications of adverse childhood experiences. American Journal of Preventive Medicine, 39(1), 93–98. https://doi.org/10.1016/j.amepre.2010.03.015.

    Article  PubMed  Google Scholar 

  • Austin, A. E., & Herrick, H. W. (2014). The effect of adverse childhood experiences on adult health: 2012 North Carolina Behavioral Risk Factor Surveillance System Survey. (No. (SCHS Study No. 167)). Raleigh: North Carolina Department of Health and Human Services, Division of Public Health.

    Google Scholar 

  • Bellis, M. A., Hughes, K., Leckenby, N., Jones, L., Baban, A., Kachaeva, M., Povilaitis, R., Pudule, I., Qirjako, G., Ulukol, B., Raleva, M., & Terzic, N. (2014a). Adverse childhood experiences and associations with health-harming behaviours in young adults: Surveys in eight eastern European countries. Bulletin of the World Health Organization, 92(9), 641–655. https://doi.org/10.2471/BLT.13.129247.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K., & Harrison, D. (2014b). Adverse childhood experiences: Retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36(1), 81–91. https://doi.org/10.1093/pubmed/fdt038.

    Article  PubMed  Google Scholar 

  • Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/S0145-2134(02)00541-0.

    Article  Google Scholar 

  • Björkenstam, E., Hjern, A., Mittendorfer-Rutz, E., Vinnerljung, B., Hallqvist, J., & Ljung, R. (2013). Multi-exposure and clustering of adverse childhood experiences, socioeconomic differences and psychotropic medication in young adults. PLoS One, 8, e53551. https://doi.org/10.1371/journal.pone.0053551.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, T. A. (2014). Confirmatory factor analysis for applied research. Guilford Publications.

  • Brown, S. M., & Heneghan, A. M. (2017). Childhood adversity and the risk of substance use and delinquency: The role of protective adult relationships. Child Abuse & Neglect, 63, 211–221. https://doi.org/10.1016/j.chiabu.2016.11.006.

    Article  Google Scholar 

  • Bruskas, D. (2013). Adverse childhood experiences and psychosocial well-being of women who were in foster care as children. The Permanente Journal, 17(3), e131–e141. https://doi.org/10.7812/TPP/12-121.

    Article  PubMed  PubMed Central  Google Scholar 

  • Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 35(6), 408–413. https://doi.org/10.1016/j.chiabu.2011.02.006.

    Article  Google Scholar 

  • Clark, C., Caldwell, T., Power, C., & Stansfeld, S. A. (2010). Does the influence of childhood adversity on psychopathology persist across the lifecourse? A 45-year prospective epidemiologic study. Annals of Epidemiology, 20, 385–394. https://doi.org/10.1016/j.annepidem.2010.02.008.

    Article  PubMed  Google Scholar 

  • Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The Social Psychology of Health: The Claremont Symposium on Applied Social Psychology (pp. 31–67). Sage: Newbury Park.

    Google Scholar 

  • Cortina, J. M. (1993). What is coefficient alpha? An examination of theory and applications. Journal of Applied Psychology, 78(1), 98–104.

    Article  Google Scholar 

  • Costello, A. B., & Osborne, J. W. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Exploratory Factor Analysis, 10(7), 9.

    Google Scholar 

  • Cronbach, L. J., & Meehl, P. E. (1955). Construct validity in psychological tests. Psychological Bulletin, 52(4), 281–302. https://doi.org/10.1037/h0040957.

    Article  PubMed  Google Scholar 

  • Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., Loo, C. M., & Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771–784. https://doi.org/10.1016/j.chiabu.2004.01.008.

    Article  Google Scholar 

  • Dube, S. R., Williamson, D. F., Thompson, T., Felitti, V. J., & Anda, R. F. (2004). Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic. Child Abuse & Neglect, 28(7), 729–737.

    Article  Google Scholar 

  • Dunn, V. J., Abbott, R. A., Croudace, T. J., Wilkinson, P., Jones, P. B., Herbert, J., & Goodyer, I. M. (2011). Profiles of family-focused adverse experiences through childhood and early adolescence: The ROOTS project a community investigation of adolescent mental health. BMC Psychiatry, 11(1), 109.

    Article  Google Scholar 

  • Felitti, V. J. (1993). Childhood sexual abuse, depression, and family dysfunction in adult obese patients: A case control study. Southern Medical Journal, 86(7), 732–736.

    Article  Google Scholar 

  • Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8.

    Article  PubMed  Google Scholar 

  • Finkelhor, D., Hamby, S. L., Ormrod, R., & Turner, H. (2005). The juvenile victimization questionnaire: Reliability, validity, and national norms. Child Abuse & Neglect, 29(4), 383–412. https://doi.org/10.1016/j.chiabu.2004.11.001.

    Article  Google Scholar 

  • Finkelhor, D., Shattuck, A., Turner, H. A., Ormrod, R., & Hamby, S. L. (2011). Polyvictimization in developmental context. Journal of Child & Adolescent Trauma, 4(4), 291–300. https://doi.org/10.1080/19361521.2011.610432.

    Article  Google Scholar 

  • Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2013). Improving the adverse childhood experiences study scale. JAMA Pediatrics, 167, 70–75.

    Article  Google Scholar 

  • Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2015). A revised inventory of adverse childhood experiences. Child Abuse & Neglect, 48, 13–21. https://doi.org/10.1016/j.chiabu.2015.07.011.

    Article  Google Scholar 

  • Ford, D. C., Merrick, M. T., Parks, S. E., Breiding, M. J., Gilbert, L. K., Edwards, V. J., Dhingra, S. S., Barile, J. P., & Thompson, W. W. (2014). Examination of the factorial structure of adverse childhood experiences and recommendations for three subscale scores. Psychology of Violence, 4(4), 432–444. https://doi.org/10.1037/a0037723.

    Article  PubMed  PubMed Central  Google Scholar 

  • Giovanelli, A., Reynolds, A. J., Mondi, C. F., & Ou, S.-R. (2016). Adverse childhood experiences and adult well-being in a low-income, urban cohort. Pediatrics, 137(4). https://doi.org/10.1542/peds.2015-4016.

  • Green, G., & Green, B. L. (2006). Evaluating the cultural validity of the stressful life events screening questionnaire. Violence Against Women, 12(12), 1191–1213.

    Article  Google Scholar 

  • Hamby, S. L., & Finkelhor, D. (2000). The victimization of children: Recommendations for assessment and instrument development. Journal of the American Academy of Child & Adolescent Psychiatry, 39(7), 829–840. https://doi.org/10.1097/00004583-200007000-00011.

    Article  Google Scholar 

  • Hardt, J., Vellaisamy, P., & Schoon, I. (2010). Sequelae of prospective versus retrospective reports of adverse childhood experiences. Psychological Reports, 107(2), 425–440. https://doi.org/10.2466/02.04.09.10.16.21.PR0.107.5.425-440.

    Article  PubMed  Google Scholar 

  • Harkonmäki, K., Korkeila, K., Vahtera, J., Kivimäki, M., Suominen, S., Sillanmäki, L., & Koskenvuo, M. (2007). Childhood adversities as a predictor of disability retirement. Journal of Epidemiology and Community Health, 61(6), 479–484.

    Article  Google Scholar 

  • Kalmakis, K. A., & Chandler, G. E. (2014). Adverse childhood experiences: Towards a clear conceptual meaning. Journal of Advanced Nursing, 70(7), 1489–1501. https://doi.org/10.1111/jan.12329.

    Article  PubMed  Google Scholar 

  • Karatekin, C. (2018a). Adverse childhood experiences (ACEs) and help-seeking for health-related interventions in young adults. Journal of Psychology: Interdisciplinary and Applied. https://doi.org/10.1080/00223980.2018.1476316

  • Karatekin, C. (2018b). Adverse childhood experiences (ACEs), stress and mental health in college students. Stress and Health, 34, 36–45. https://doi.org/10.1002/smi.2761.

    Article  PubMed  Google Scholar 

  • Karatekin, C., & Ahluwalia, R. (2016). Effects of adverse childhood experiences, stress, and social support on the health of college students. Journal of Interpersonal Violence. https://doi.org/10.1177/0886260516681880.

  • Korkeila, J., Vahtera, J., Nabi, H., Kivimäki, M., Korkeila, K., Sumanen, M., Koskenvuo, K., & Koskenvuo, M. (2010). Childhood adversities, adulthood life events and depression. Journal of Affective Disorders, 127, 130–138. https://doi.org/10.1016/j.jad.2010.04.031.

    Article  PubMed  Google Scholar 

  • Layne, C. M., Greeson, J. K. P., Ostrowski, S. A., Kim, S., Reading, S., Vivrette, R. L., et al. (2014). Cumulative trauma exposure and high risk behavior in adolescence: Findings from the National Child Traumatic Stress Network Core Data set. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), S40–S49. https://doi.org/10.1037/a0037799.

    Article  Google Scholar 

  • Liu, Y., Croft, J. B., Chapman, D. P., Perry, G. S., Greenlund, K. J., Zhao, G., & Edwards, V. J. (2013). Relationship between adverse childhood experiences and unemployment among adults from five US states. Social Psychiatry and Psychiatric Epidemiology, 48(3), 357–369. https://doi.org/10.1007/s00127-012-0554-1.

    Article  PubMed  Google Scholar 

  • Meinck, F., Cosma, A. P., Mikton, C., & Baban, A. (2017). Psychometric properties of the adverse childhood experiences abuse short form (ACE-ASF) among Romanian high school students. Child Abuse & Neglect, 72, 326–337. https://doi.org/10.1016/j.chiabu.2017.08.016.

    Article  Google Scholar 

  • Mersky, J. P., Janczewski, C. E., & Topitzes, J. (2017). Rethinking the measurement of adversity: Moving toward second-generation research on adverse childhood experiences. Child Maltreatment, 22(1), 58–68. https://doi.org/10.1177/1077559516679513.

    Article  PubMed  Google Scholar 

  • Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141–149. https://doi.org/10.1016/j.childyouth.2016.10.021.

    Article  Google Scholar 

  • Pinto, R., Correia, L., & Maia, Â. (2014). Assessing the reliability of retrospective reports of adverse childhood experiences among adolescents with documented childhood maltreatment. Journal of Family Violence, 29, 431–438. https://doi.org/10.1007/s10896-014-9602-9.

    Article  Google Scholar 

  • R Core Team. (2017). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing Retrieved from https://www.R-project.org/. Accessed 11/8/18.

  • Roberti, J. (2006). Further psychometric support for the 10-item version of the perceived stress scale. Journal of College Counseling, 9, 135–147.

    Article  Google Scholar 

  • Rosseel, Y. (2012). Lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36.

    Article  Google Scholar 

  • Schilling, E. A., Aseltine, R. H., & Gore, S. (2007). Adverse childhood experiences and mental health in young adults: A longitudinal survey. BMC Public Health, 7(1), 1140–1151. https://doi.org/10.1186/1471-2458-7-30.

    Article  Google Scholar 

  • Scott, K. M., Smith, D. R., & Ellis, P. M. (2010). Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Archives of General Psychiatry, 67, 712–719.

    Article  Google Scholar 

  • Scott, B. G., Burke, N. J., Weems, C. F., Hellman, J. L., & Carrión, V. G. (2013). The interrelation of adverse childhood experiences within an at-risk pediatric sample. Journal of Child and Adolescent Trauma, 6(3), 217–229. https://doi.org/10.1080/19361521.2013.811459.

    Article  Google Scholar 

  • Syed, H. R., Zachrisson, H. D., Dalgard, O. S., Dalen, I., & Ahlberg, N. (2008). Concordance between Hopkins symptom checklist (HSCL-10) and Pakistan anxiety and depression questionnaire (PADQ), in a rural self-motivated population in Pakistan. BMC Psychiatry, 8(1), 1.

    Article  Google Scholar 

  • Wade, R., Shea, J. A., Rubin, D., & Wood, J. (2014). Adverse childhood experiences of low-income urban youth. Pediatrics, 134(1), e13–e20. https://doi.org/10.1542/peds.2013-2475.

    Article  PubMed  Google Scholar 

  • Ware Jr., J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston: The Health Institute, New England Medical Center Hospitals.

    Google Scholar 

  • Ware, J. E., & Kosinski, M. (2001). SF-36 physical & mental health summary scales: a manual for users of version 1. Lincoln: Quality Metric.

    Google Scholar 

  • Wingenfeld, K., Schäfer, I., Terfehr, K., Grabski, H., Driessen, M., Grabe, H., Löwe, B., & Spitzer, C. (2011). The reliable, valid and economic assessment of early traumatization: First psychometric characteristics of the German version of the adverse childhood experiences questionnaire (ACE). Psychotherapie, Psychosomatik, Medizinische Psychologie, 61(1), e10–e14. https://doi.org/10.1055/s-0030-1263161.

    Article  PubMed  Google Scholar 

  • Zanotti, D. C., Kaier, E., Vanasse, R., Davis, J. L., Strunk, K. C., & Cromer, L. D. (2017). An examination of the test–retest reliability of the ACE-SQ in a sample of college athletes. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0000299.

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  1. Institute of Child Development, University of Minnesota, 51 E. River Road, Minneapolis, MN, 55455, USA

    Canan Karatekin

  2. University of St. Thomas, St Paul, MN, USA

    Maria Hill

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  1. Canan Karatekin
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Correspondence to Canan Karatekin.

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Table 7 The Expanded ACEs Questionnaire
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Karatekin, C., Hill, M. Expanding the Original Definition of Adverse Childhood Experiences (ACEs). Journ Child Adol Trauma 12, 289–306 (2019). https://doi.org/10.1007/s40653-018-0237-5

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