Development and Evaluation of a Short Adverse Childhood Experiences Measure

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


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.

Publication types

  • Evaluation Study
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Alcoholism / diagnosis
  • Behavioral Risk Factor Surveillance System*
  • Child
  • Child Abuse / diagnosis*
  • Child Abuse / statistics & numerical data
  • Feasibility Studies
  • Female
  • Humans
  • Life Change Events*
  • Male
  • Middle Aged
  • Prevalence
  • Primary Health Care / methods
  • Risk Factors
  • Sensitivity and Specificity
  • Young Adult