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Am J Prev Med. 2017 Feb;52(2):163-172. doi: 10.1016/j.amepre.2016.09.033. Epub 2016 Nov 16.

Development and Evaluation of a Short Adverse Childhood Experiences Measure.

Author information

1
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: wader2@email.chop.edu.
2
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
3
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
4
Division of Violence Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.

Abstract

INTRODUCTION:

Clinicians require tools to rapidly identify individuals with significant childhood adversity as part of routine primary care. The goal of this study was to shorten the 11-item Behavioral Risk Factor Surveillance System Adverse Childhood Experiences (ACEs) measure and evaluate the feasibility and validity of this shortened measure as a screener to identify adults who have experienced significant childhood adversity.

METHODS:

Statistical analysis was conducted in 2015. ACE item responses obtained from 2011-2012 Behavioral Risk Factor Surveillance System data were combined to form a sample of 71,413 adults aged ≥18 years. The 11-item Behavioral Risk Factor Surveillance System ACE measure was subsequently reduced to a two-item screener by maintaining the two dimensions of abuse and household stressors and selecting the most prevalent item within each dimension.

RESULTS:

The screener included household alcohol and childhood emotional abuse items. Overall, 42% of respondents and at least 75% of the individuals with four or more ACEs endorsed one or both of these experiences. Using the 11-item ACE measure as the standard, a cut off of one or more ACEs yielded a sensitivity of 99%, but specificity was low (66%). Specificity improved to 94% when using a cut off of two ACEs, but sensitivity diminished (70%). There was no substantive difference between the 11-and two-item ACE measures in their strength of association with an array of health outcomes.

CONCLUSIONS:

A two-item ACE screener appropriate for rapid identification of adults who have experienced significant childhood adversity was developed.

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