Table 1.

Summary and Comparison of Methods to Assess ACEs

ACEs Measurement Tool Name and Sponsor	TP, PP, and DS	Adversity Content*	Scoring and Reporting Convention†	DH, TVS, and IG	Concurrent Content Included	Comparison With NSCH-ACEs; AQ and UAT Versus NSCH
Original ACE Study (CDC and Kaiser Permanente, San Diego Health Appraisal Clinic)10,21,72,73,87	TP: Adults about self PP: Research DS: Self-report	No.: 28 questions; 10 topics Types: PA, PN‡, EA, EN‡, SA, HHSA, HHMI, DV, DIV‡, J Age: some§ FIE: some§	CS: 0–10 (0–7 in first wave) CA: 0, 1, 2–3, ≥4 typical	DH: Used/adapted available questions (eg, Conflict Tactics Scale; Childhood Trauma Questionnaire; Wyatt (sexual abuse), etc) TVS: Testing and validation occurred in the context of the study, although no publications specific to this were found IG: Questionnaires available on CDC ACEs page	Demographic characteristics, health history, current conditions and symptoms	AQ: PN, EN, PA, SA, EA UAT: PD, CNV, DIS, economic hardship
WHO ACE-International Questionnaire; sponsored by International ACE Research Network (led by WHO and CDC)16,24,77,78	TP: Adults about self PP: Advocacy, program planning, and international comparisons DS: Self-report	No.: 29 questions; 13 topics Types: PA, PN, EA, EN, SA, HHSA, HHMI, DV, DIV/PD, J, B, CNV, OE Age: no FIE: some	CS: 0–13 CA: Not specified O: Binary and frequency (only some “yes” responses count) scoring	DH: Used all from BRFSS and added questions to increase international cultural applicability TVS: Field testing done in 6 countries; currently undergoing reliability and validity testing IG: Interview guidelines, scoring metrics, and other supporting documents available	Demographic characteristics, marriage, and family information	AQ: PA, PN, EA, EN, SA, B, OE UAT: DIS, economic hardship
BRFSS; sponsored by the CDC22,74–76,88,89	TP: Adults about self PP: State policy and practice DS: Self-report	No.: 11 questions; 8 topics Types: PA, EA, SA, HHSA, HHMI, DV, DIV, J Age: no FIE: some§	CS: 0–8 CA: 0, 1, 2, 3, 4, ≥5	DH: Modified from original CDC/Kaiser study TVS: Focus group testing; factor analysis IG: Interviewer script; information about state implementation, some analysis guidelines (all for overall survey)	Many other health modules, no other questions in ACEs module	AQ: PA, EA, SA UAT: PD, CNV, DIS, economic hardship
NSCH-ACEs19,23,28,60	TP: Adults about child PP: Research DS: Parent-report	No.: 9 questions; 9 topics Types: HHSA, HHMI, DV, DIV, J, PD, CNV, DIS, OI Age: no FIE: no	CS: 0–9 CA: 0, 1, ≥2	DH: Adapted from original CDC/Kaiser study for parent-reported survey TVS: Extensive cognitive and pilot testing IG: Information on survey implementation, scoring, reporting, and microdata available	Physical and emotional health; health care access, insurance, medical homes, family interactions, parental health, school experiences, and safe neighborhoods
Center for Youth Wellness ACE-Questionnaire Child, Teen, and Teen Self-Report64	TP: Adults about child (Child and Teen versions) and child about self PP: Health care services DS: Parent- and self-report	No.: 17 or 19 questions¶; 17 or 19 topics¶ Types: PA, PN, EA, EN, SA, HHSA, HHMI, DV, DIV, J, B, PD, CNV, DIS, OI, OE Age: no FIE: no	CS: 0–17/0–19¶ CA: 0–3 (no symptoms), 0–3 (with symptoms), ≥4	DH: Original CDC/Kaiser questions, additional questions from experts and community stakeholders TVS: Under way IG: User guide (background, implementation, scoring) and questionnaires available for download to health care professionals	None; intended as part of primary care visit	AQ: PA, EA, EN, SA, B, OI, OE UAT: economic hardship
Y-VACS; Sponsored by National Institute for Mental Health63	TP: Adults about child, child about self, and adults about self PP: Health care services, research DS: Parent-, clinician-, and self-report	No.: 20 questions; 20 topics each (4 different versions) Types: PA, PN, EA, SA, HHSA, HHMI, DV, DIV, J, B, CNV, OI, OE Age: no FIE: yes	CS: 0–20 CA: Not specified# O: Each item scored 0–2 on frequency and 1–3 on severity	DH: Adapted from original CDC/Kaiser questions, additional questions added on the basis of common “other” responses in initial draft# TVS: Inter-rater reliability analyses performed# IG: Questionnaires available on request from authors#	None	AQ: PA, EA, SA, B, OI, OE UAT: PD, DIS, economic hardship
The Institute for Safe Families/ACE Task Force Philadelphia Urban ACE Study; Sponsored by Robert Wood Johnson Foundation67	TP: Adults about self PP: Research/policy recommendations DS: Self-report	No.: 22 questions; 14 topics Types: PA, PN, EA, EN, SA, HHSA, HHMI, DV, J, B, CNV, DIS, OI Age: no FIE: some§	CS: 0–14 CA: 0, 1–3, ≥4	DH: Used original CDC/Kaiser questions, added questions to make applicable to an urban population TVS: Logistic regression done to test associations between original CDC and additional ACEs scores and demographic characteristics IG: Questionnaire and overall methodology information available in report	Past/current health conditions, sexual history, drug use	AQ: PA, PN**, EA, EN, SA, B, OI UAT: PD, DIV
NSCAW; Sponsored by the Office of Planning, Research, and Evaluation, Administration for Children and Families90,91	TP: Adults about child PP: Research DS: Parent-, caregiver-, and caseworker-report (and CPS reports)	No.: 21 questions; 10 topics Types: PA, PN, EA, EN, SA, HHSA, HHMI, DV, DIV/PD, J Age: no FIE: no	CS: 0–10 CA: 0, 1, 2, 3, ≥4	DH: Mapped CDC/Kaiser ACEs constructs to questions that already existed in NSCAW TVS: None documented (questions mostly from already validated scales, such as the Childhood Trauma Scale)# IG: None available (data sets can be requested by researchers via National Data Archive on Child Abuse and Neglect at Cornell University)#	Physical, mental, and emotional well-being and functioning, family characteristics, community environment, and service needs and use	AQ: PA, PN, EA, EN, SA UAT: PD, CNV||, DIS, economic hardship||
Marie-Mitchell and O’Connor Child ACE tool; Sponsored by the Commonwealth Fund via the Academic Pediatric Association Young Investigator Award14	TP: Adults about child PP: Primary care practice DS: Parent-report and medical records	No.: 6 or 7 questions††; 6 or 7 topics†† Types: HHSA, HHMI, DV, J, OI (could include PA, PN, EA, EN, SA, DIV, PD), OE Age: no FIE: no	CS: 0–6/0–7†† CA: 0–2, 3–6/3–7††	DH: Developed from risk factors described in the literature on ACEs TVS: Pilot testing only IG: None	Developmental screening, child health status, and health care use	AQ: OI (could include PA, PN, EA, EN, SA) UAT: CNV, DIS, economic hardship
Montefiore—Clinical ACE questionnaire Adult/Child65,66	TP: Adults about child and adults about self PP: Health care services DS: Parent- and self-report	No.: 25 questions; 10 topics Types: PA, PN, EA, EN, SA, HHSA, HHMI, DV, DIV, J Age: no FIE: some§	CS: 0–10 CA: 0–3, ≥4; 0, 1, 2, 3, ≥4	DH: Modified slightly from original CDC/Kaiser questions TVS: Validated for Group Attachment-Based Intervention use by analyzing association between ACEs and unresolved/cannot classify outcomes on the Adult Attachment Interview IG: Implementation described in article by Murphy et al42	None in ACEs questionnaire, study also includes items on body mass index and stressors	AQ: PA, PN, EA, EN, SA UAT: PD, CNV, DIS, economic hardship
WSU ACEs tool for schools; Sponsored by the Spokane County Community Network with funds awarded by the Washington State Family Policy Council49,68	TP: Adults about child PP: Research DS: Teacher-report	No.: 11 topics Types: PA, PN, EA, SA, HHSA, HHMI, DV, DIV, J, PD, CNV, OI Age: no FIE: no‡‡	CS: 0–11 CA: 0, 1, 2, ≥3 O: Asked lifetime as well as past year prevalence	DH: Modified from original CDC/Kaiser questions TVS: None shown IG: None available	Demographic characteristics, academic problems, health concerns	AQ: CPS report (including PA, EA, SA), PN, OI UAT: DIS, economic hardship‡‡
WSU ACEs tool for Head Start; Sponsored by Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, US Department of Justice49,68	TP: Adults about child and adults about self PP: Research DS: Parent- and self-report	No.: 9 topics Types: PA, EA, EN, SA, HHSA, HHMI, DV, DIV, J, OI Age: no FIE: no	CS: 0–9 CA: varies	DH: Modified from original CDC/Kaiser questions TVS: None shown IG: None available	Demographic characteristics, child development, child adjustment	AQ: EA, EN, CPS report (including PA, SA), OI UAT: PD, CNV, DIS, economic hardship
Children’s Hospital of Philadelphia CAQ (under development); Sponsored by the Stoneleigh Foundation	TP: Adults about child and older children about self# PP: Community organization# DS: Parent- and self-report#	No.: 8 topics# Types: PA, PN, EA, EN, SA, DIV, DIS, OI#(under development) Age: unknown# FIE: unknown#	CS/CA: Under development#	DH: Questions created from statements from interviews with children and youth impacted by ACEs# TVS: None yet# IG: None available#	Demographic characteristics, protective factors (eg, positive relationship and coping skills)#	AQ: PA, PN, EA, EN, SA# UAT: DIV (uses single parent)# (under development)
The National Crittenton Foundation’s ACEs Survey; Aided by Dr. Roy Wade for development and implementation69–71	TP: Adults about child and adults about self PP: Social services, program planning DS: Parent- and self-report	No.: 10 topics Types: PA, PN, EA, EN, SA, HHSA, HHMI, DV, DIV, J Age: no FIE: no	CS: 0–10 CA: 0, 1, 2, 3, ≥4; 0, 1–3, 4–7, 8–10	DH: Questions ACEs# TVS: None# IG: Extensive provider implementation guidelines and tips available in toolkit	Demographic characteristics, well-being assessment (stress, coping, and connection to adults)	AQ: PA, PN, EA, EN, SA UAT: PD, CNV, DIS, economic hardship

ACE indicates adverse childhood experience; AQ, additional questions; B, bullying; BRFSS, Behavioral Risk Factor Surveillance Survey; CA, categorical score; CAQ, Childhood Adversity Questionnaire; CDC, Centers for Disease Control and Prevention; CNV, community and neighborhood violence; CPS, Child Protective Services; CS, continuous score; DH, design highlights; DIS, discrimination; DIV, parents divorced; DS, data source; DV, domestic violence; EA, emotional abuse; EN, emotional neglect; HHMI, household mental health problem; HHSA, household alcohol or substance abuse; IG, implementation guidelines available; J, parent incarcerated/spent time in jail; NSCAW, National Survey of Child and Adolescent Well-being; NSCH, National Survey of Children’s Health; OE, other environmental/extrapersonal trauma; OI, other interpersonal trauma; PA, physical abuse; PD, parental death; PN, physical neglect; PP, primary purpose; SA, sexual abuse; TP, target population; TVS, testing and validation status; UAT, unaddressed topics; WHO, World Health Organization; WSU, Washington State University; and Y-VACS, Yale-Vermont Adversity in Childhood Scale.

See the Technical Appendix (http://www.cahmi.org/wp-content/uploads/2015/01/ACEs-Measurement-paper-Technical-Appendix.pdf) for more details on each instrument.

^*For adversity content, No. indicates number of adversity topics and number of survey items; Types indicates type of adversity; Age indicates the age at which the adverse childhood experience occurred; and FIE indicates frequency, intensity, or effect.

^†O indicates scoring and reporting convention other than continuous or categorical.

^‡Included in second wave of study only.

^§Not included in scoring mechanisms.

^||Included in the larger NSCAW, but not in the questions used for the ACEs scale.

^¶Multiple questionnaire versions for different people (eg, parents, children, clinicians, adults about themselves).

^#Personal communication: for NSCAW, M.B. Webb, September 29, 2015; for Y-VACS, J. Hudziak, October 7, 2015; for CAQ, R. Wade, November 2, 2015; for Crittenton, S. Lopez, March 17, 2016.

^**Covers the same information as in the NSCH question on economic hardship, but is considered to be a question on physical neglect.

^††One questionnaire with multiple options for scoring (can use with or without question on maternal education).

^‡‡This information derived from reports on the study; the tool itself was not available to examine.