The 10-item Adverse Childhood Experience International Questionnaire (ACE-IQ-10): psychometric properties of the Dutch version in two clinical samples

Adverse Childhood Experiences (ACEs) are potentially traumatic events linked to health issues and public health costs. The World Health Organization (WHO)’s ACE International Questionnaire – International Questionnaire (ACE-IQ) is a widely used tool to screen ACEs, though its factorial structure remains debated. This study addresses gaps in ACE-IQ research being the first examining factor structures invariance across gender, age, and educational levels, considering both binary and frequency scores. Through convenience sampling, 1205 participants were recruited. The Italian version of the ACE-IQ, validated through back-translation, was administrated. Data were analyzed using exploratory and confirmatory factor analyses. Category-based analysis using binary scoring suggested a two-component model: At-risk environment and Maltreatment, showing good fit after adjustments, and with the frequency scoring system yielded unsatisfactory results with two excluded categories. Item-based binary scoring analysis identified five factors with good fit, but issues persisted across gender and education levels with one factor. The category-based analyses revealed a two-factor solution for both ACE-IQ’s scoring systems, consistent with previous research. The binary scoring system’s category-based structure demonstrated invariance across gender and age, but not educational levels, while the frequency scoring system’s structure showed potential weaknesses. The item-based analysis suggested a five-factor solution and emphasized the distinctiveness of sexual abuse.

Adverse childhood experiences (ACEs) are a significant risk factor for the development of mental disorders in adulthood, and their accurate assessment using the ACE-IQ questionnaire in psychiatric practice requires consideration of several methodological specifics. Objective: To analyze the application of the Adverse Childhood Experiences International Questionnaire (ACE-IQ) for assessing ACEs in patients with mental disorders, and to examine potential limitations and methodological aspects of working with this instrument. Material and Methods: A literature review was conducted on the topic of ACEs and their association with mental disorders in adulthood. The structure of the ACE-IQ questionnaire and the specifics of its application in psychiatric practice were examined. Results: The Adverse Childhood Experiences International Questionnaire (ACE-IQ) is a convenient and informative instrument for the systematic assessment of adverse childhood experiences (ACEs). Patients with psychiatric disorders represent a complex and heterogeneous population, for whom many of the topics in the questionnaire may be challenging and potentially traumatic to answer. Moreover, there is a high likelihood of distortion of facts and appraisals by the patient regarding their ACEs within the context of their current mental disorder and its phase. To obtain accurate results when utilizing the ACE-IQ with psychiatric patients, establishing a trusting therapeutic alliance is essential. The clinician should be prepared to monitor changes in the patient’s mental state throughout the questionnaire administration, and the involvement of a clinical psychologist is advisable. Detailed clarification of individual questions and terminology in the questionnaire is crucial, taking into account the patient’s sociocultural background. Interpretation of the ACE-IQ results warrants caution due to the potential distortion of facts by the patient within the framework of their present psychiatric condition. Conclusion: The ACE-IQ questionnaire is a valuable tool for assessing adverse childhood experiences; however, its application in psychiatric practice requires consideration of several methodological specifics. The correct use of the questionnaire will allow obtaining reliable data on the relationship between ACEs and mental disorders, which is important for understanding the role of social factors in the etiology of mental illnesses and the development of preventive programs.

(1) Adverse childhood experiences (ACE) are a global challenge, prioritized in the United Nations’ Sustainable Development Goals. The ACE questionnaire is widely adopted in the USA as a tool for measuring population-level trends, such as negative health, behavioral, and economic outcomes. Intuitively, children in resource-scarce settings are exposed to higher levels of trauma. To understand the global picture, the World Health Organization (WHO) adapted the ACE international questionnaire (ACE-IQ), to inform policy and target interventions. However, evaluation of whether the ACE-IQ captures the experiences of around 160 million working children remains limited. (2) I applied the ACE-IQ scoring tools to detailed case studies of working children, comparing issues highlighted by holistic assessment to those captured by the ACE-IQ. (3) The ACE-IQ struggles to capture nuance across cultural contexts. As a consequence, application of the ACE-IQ as a policy tool risks “policy failure”. The tool reflects prevalent Western concerns, such as school attendance and parental supervision, but global concerns affecting working children such as forced economic migration and famine are neglected. This limitation produces “policy myopia”, sidelining certain global challenges. (4) The ACE-IQ is a useful public health tool, increasingly used to define policy goals. However, given the limitations of the ACE-IQ, the consequences of prioritizing these particular policy goals need to be actively acknowledged and mitigated.

Background: The current study aimed to investigate the psychometric properties of the Adverse Childhood Experiences – International Questionnaire (ACE-IQ) with individuals engaging in non-suicidal self-injury. Numerous studies have supported the association of adverse childhood experiences with non-suicidal self-injury. However, the majority of the measures used were limited to basic forms of abuse and neglect, indicating a need for the use of a more inclusive measure, such as the ACE-IQ. The psychometric properties of the measure though have only been briefly investigated with other populations, suggesting that a more thorough examination might be beneficial before its use. Method: Two hundred eighty-four adult participants (77.5% females) with a mean age of 23.4 (SD=5.7) were recruited online via specific self-harm groups on social media platforms. Participants were asked to complete an online survey consisting of three self-report measures regarding early childhood experiences and engagement in non-suicidal self-injury. Results: The findings of this study supported ACE-IQ’s reliability (Cronbach’s alpha = 0.854), convergent validity (r= 0.85, p0.001 with the CTQ-SF), predictive validity (R2 = 0.12, p=0.001 of the SHI total score) and discriminant validity (F-value = 13.90, p0.001). An exploration of the factor structure demonstrated a 5-factor solution (physical abuse, sexual abuse, emotional abuse, exposure to violence, family environment). Conclusions: It was concluded that ACE-IQ is a reliable and valid measure to be used for research or clinical purposes with individuals engaging in non-suicidal self-injury, although further research is needed on its factor structure. Research and clinical implications are discussed.

Prevalence, Patterns, and Correlates of Pain in Medically Hospitalized Pediatric Patients With Somatic Symptom and Related Disorders.

A key diagnostic criterion of Somatic Symptom and related Disorders (SSD) comprises significant distress and excessive time-and-energy consuming thoughts, feelings, and behavior pertaining to somatic symptoms. This diagnostic criterion is lacking in central sensitivity syndromes (CSS), such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. This strong emphasis on disturbed psychological processing of somatic symptoms, suggests that psychological flexibility is low in SDD. Psychological flexibility is defined as the ability to approach difficult or challenging internal states (thoughts, emotions, and bodily sensations) in a non-judgmental, mindful way, and being committed to pursue one's values. To clarify the potential significance of psychological flexibility in SSD, we examined its levels in 154 people referred to specialized treatment for SDD, as compared to reference groups from the general population encompassing 597 people with CSS and 1422 people without SSD or CSS (controls). Mean levels of psychological flexibility (adjusted for demographic covariates) were lowest for SSD and highest for controls (F = 154.5, p < 0.001, pη2 = 0.13). Percentages of people with low psychological flexibility (<0.8 SD below the mean of controls) were: SSD 74%, CSS 42%, controls 21%. In SSD, higher psychological flexibility was associated with better mental health (β = 0.56, p < 0.001), but interaction analysis rejected that psychological flexibility preserved health when having more severe somatic symptoms (β ≤ 0.08, p ≥ 0.10). The results indicate that lower psychological flexibility is a prevalent problem in SSD that is associated with lower mental health. This suggests that it is worthwhile to take account of psychological flexibility in SSD in screening, monitoring, and therapy.

Childhood trauma and current psychological functioning in adults with social anxiety disorder

BackgroundIf somatization is an independent personality trait, it is not clear whether it is specific to the temperament or maladaptive spectrum of personality. We aimed at the head-to-head comparison of temperament and maladaptive systems and spectra of personality to predict both somatization and somatic symptom and related disorders (SSRD).MethodsThe samples included 257 cases with SSRD (70.8% female) and 1007 non-SSRD (64.3% female) from Western Iran. The Personality Inventory for DSM-5 (PID-5), Personality Diagnostic Questionnaire-4 (PDQ-4), Temperament and Character Inventory (TCI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), Affective and Emotional Composite Temperament Scale (AFECTS), and Positive Affect and Negative Affect Model (PANAS) was used to data collection. A somatization factor plus temperament and maladaptive spectra of personality were extracted using exploratory factor analysis. Several hierarchical linear and logistic regressions were used to test the predictive systems and spectra.ResultsAll personality systems jointly predict both somatization and SSRD with a slightly higher contribution for temperament systems. When the temperament and maladaptive spectra were compared, both spectra above each other significantly predicted both somatization (R2 = .407 versus .263) and SSRD (R2 = .280 versus .211). The temperament spectrum explained more variance beyond the maladaptive spectrum when predicting both the somatization factor (change in R2 = .156 versus .012) and SSRD (change in R2 = .079 versus .010).ConclusionAll temperament and maladaptive frameworks of personality are complementary to predicting both somatization and SSRD. However, the somatization is more related to the temperament than the maladaptive spectrum of personality.

Background Child and adolescent psychological trauma exposure is associated with psychopathology in the adult population in general, but literature on childhood trauma (CT) in adults with ADHD is scarce. Aims To determine the prevalence of CT among adult patients with ADHD, and whether a history of CT implies different adult outcomes of psychiatric comorbidities, and functional impairment than without. Method Previously unmedicated adult outpatients with ADHD (n = 250, median age 32 years) entered the study. Participants were diagnosed with ADHD using the Diagnostic Interview for ADHD in Adults, second edition (DIVA 2.0), and were assessed by historical data, validated questionnaires, and structured clinical interviews for CT and mental disorders including post-traumatic stress disorder (PTSD) and functional impairment. Analyses compared ADHD patients with and without CT. Results Prevalence of CT was 44%. Of those with PTSD (n = 21), many had CT (85%, p < 0.001). In binary logistic regression analyses, CT was linked to an increased likelihood of concomitant panic disorder (unadjusted odds ratio, OR = 3.0, p < 0.001, and adjusted OR = 2.7, p < 0.01) and any anxiety disorders and two or more comorbid psychiatric disorders (adjusted OR = 1.9, p < 0.05 and OR = 1.7, p < 0.05, respectively), and was associated with significant functional impairment. Conclusions These findings suggest that awareness of child and adolescent trauma is clinically relevant among young to middle-aged adult ADHD patients, and implications for earlier detection of CT and treatment warrant further studies.

The prevalence and severity of neurocognitive dysfunctioning of patients with somatic symptom and related disorders (SSRD) is unknown. Furthermore, the influence of comorbid depression and anxiety has not been evaluated. This study examines neurocognitive dysfunctioning of patients with SSRD and explores if comorbid depression and anxiety is associated with specific neurocognitive dysfunctioning. Cross-sectional study with consecutive patients suffering from SSRD visiting an outpatient specialty mental health care Centre of Excellence for SSRD. Extensive neuropsychological assessment and assessment of depression and anxiety symptom levels using the Patient-Health-Questionnaire-9 and General Anxiety Disorder questionnaire-7 were performed at intake. Multivariate analysis was performed. The study sample consisted of 201 SSRD patients, with a mean age of 43 years (Standard deviation = 13) years; 37.8% were male. Neurocognitive dysfunction in the domains information processing speed, sustained and divided attention, working memory, verbal and visual memory were reported, compared with normative data. Comorbid depression and anxiety occurred frequently within the sample (75.1% and 65.7%, respectively). Neurocognitive dysfunctioning was worse in patients suffering from comorbid depression [multivariate F (7,161) = 2.839, p = 0.008] but not in patients with comorbid anxiety. Poor neurocognitive performance of patients with SSRD is common and worsens in case of comorbid depression. This may explain treatment dropout of patients with SSRD from neurocognitive behavioral therapy. Research on novel interventions is needed targeting neurocognitive functioning of patients with SSRD, particularly those with comorbid depression.

Somatic symptom and related disorders (SSRD) are characterized by a mixture of neurological and psychiatric features and include functional neurological (FND) and somatic symptom disorders (SomD). While these complex neuropsychiatric disorders show evidence of genetic susceptibility, there are no genome-wide association studies (GWAS) of SSRD, and the heritability is unknown. We did a GWAS of a total of 22,203 patients with SSRD, and 1,831,107 controls of European ancestry. We identified one genome-wide significant locus (chromosome 8:65565084) in SSRD, and one additional locus (chromosome 16:49074278) in the SomD subgroup (n cases = 18,536). The observed-scale SNP heritability was estimated to be 7.3 % for SSRD, 15.7 % for FND and 7.7 % for SomD. FND and SomD were strongly genetically correlated (rg=0.94, SE=0.11, p=3.9E-18). SSRD showed significant genetic correlation with psychiatric disorders (highest with anxiety, post-traumatic stress disorders, depression, rg=0.3-0.8), neurological disorders (migraine, chronic pain, rg=0.4-0.6) and immune-related diseases (rg=0.2-0.3). Functional follow-up analysis of SSRD loci implicated the genes CYP7B1, BHLHE22, and CBLN1, which are involved in metabolic and brain-related processes, suggesting common underlying pathways. We identified genomic loci associations with SSRD and showed strong genetic correlation between FND and SomD and with neurological and psychiatric disorders, as well as immune-related diseases. The current findings highlight shared underlying pathophysiological processes between SSRD diagnostic categories.

The limited understanding and literature concerning somatic symptom and related disorders (SSRDs), especially in older adults, further complicates accurate and sensitive diagnosis and assessment for this growing and specialized population. As the population of older adults is expected to grow exponentially, the purposes of this paper are to identify and elucidate key diagnostic and assessment challenges for SSRDs among older individuals to inform further research and guide practice. This paper also describes common self-report measures for SSRDs and describes the psychometric evidence for the use of these measures with older adults. Regarding diagnosis, older adults have higher rates of somatic multimorbidity and can incorrectly attribute somatic symptoms to normal aging. Furthermore, cognitive impairment rates are higher in older adults, impacting the accuracy of reporting SSRD symptoms. Regarding assessment, there are no elder-specific measures of SSRDs. Moreover, few of the current SSRD measures have been specifically validated for use with older adults. In addition, due to lack of education and awareness, mental health clinicians and medical providers may hold stigmatizing views of older adults with SSRD symptoms. The complex symptom presentation of SSRDs in older adults also complicates the efficacy of assessments. The paper concludes with suggestions for further research on SSRDs with diverse older adult populations.

Psychometric validation of the French version of the adverse childhood experiences international questionnaire (ACE-IQ)

Comparison of ACE-IQ and CTQ-SF for child maltreatment assessment: Reliability, prevalence, and risk prediction

Specialist paediatric services manage a variety of presentations of functional somatic symptoms. We aimed to describe the presentation and management of children and adolescents with somatic symptom and related disorders (SSRDs) requiring admission to a tertiary children's hospital with the objective of informing the development of a local clinical pathway. Patients admitted to any hospital department from May 2016 to November 2017 were identified through an electronic medical record (EMR)-linked diagnosis of SSRD. Each record was reviewed for demographic details and admission histories. The frequency of interspecialty consultations and multidisciplinary team (MDT) family meetings were recorded. One hundred twenty-three patients with SSRD were admitted on 203 occasions to 17 different departments. The median (range) age was 14.3 (7.3-18.3) years. Interspecialty consultations occurred in 84.6% of patients, and MDT family meetings occurred in 18.9% patients. SSRD was diagnosed as an inpatient in 79.9% patients, yet only 40.7% of patients, including those with multiple admissions, had SSRD recorded as a discharge diagnosis.Conclusion: Despite high rates of consultation with hospital teams, the frequency of MDT family meetings was low, and less than half the patients had SSRD documented at discharge. This affirms the value of developing a local clinical pathway. What is Known • Functional somatic symptoms are commonly seen in children and adolescents. • Few studies have explored the reach of functional somatic symptoms across a tertiary paediatric hospital; the majority of inpatient studies have focused on a limited set of disorders or cases referred to psychiatry departments. What is New • Symptoms that spanned multiple body systems were the most common presentation of SSRDs in admitted children and adolescents. • Somatic symptom disorders are less likely to be recorded as a discharge diagnosis compared with functional neurological symptom disorder.