Peer-reviewed article
Questioning the use of adverse childhood experiences (ACEs) questionnaires
John D. McLennan, Harriet L. MacMillan, Tracie O. Afifi ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This peer-reviewed article critically examines the ACEs-10 questionnaire, one of the most widely used tools for measuring adverse childhood experiences in clinical and research settings. The authors identify significant methodological problems with the instrument, including limited coverage of harmful experiences, oversimplified scoring, and lack of proper psychometric validation. They argue these deficiencies make the tool unsuitable for current use in healthcare and research without substantial improvement. The paper calls for more rigorous development of ACEs measures before they are further deployed.
Key points
- The ACEs-10 questionnaire has limited item coverage and does not comprehensively capture types of childhood adversity
- The instrument combines multiple items and response options in ways that oversimplify complex experiences
- The questionnaire lacks proper psychometric assessment and validation
- Current use of ACEs measures in clinical practice and epidemiological surveys often proceeds without evaluating the tools' strengths and limitations
- The authors recommend addressing these deficiencies before further clinical or research use of ACEs-10 and its derivatives
Limitations
This is a methodological critique rather than empirical research, so it does not provide new data on ACE prevalence or outcomes in specific populations. The article focuses on the ACEs-10 instrument and may not fully address all variations of ACE questionnaires in use globally.
Abstract
Adverse childhood experiences (ACEs) are increasingly recognized as important predictors of poor health outcomes. In response, there is increasing application of ACEs questionnaires in clinical practice and population health surveys. Such efforts are often justified as approaches to identify ACEs, components of trauma-informed care, and/or measures to determine prevalence within epidemiological research. Unfortunately, such measures are often used without evaluating the strengths and limitations of the measures themselves. One of the most commonly used ACEs questionnaires is a ten-question version (ACEs-10), that is composed of two clusters - one asking about different types of child maltreatment, and the other asking select questions about household challenges. Unfortunately, both this questionnaire and its derivatives have substantial drawbacks that warrant careful consideration about their use. Problems include limited item coverage, collapsing of items and response options, a simplistic scoring approach, and the lack of psychometric assessment. These deficiencies are inconsistent with the standards expected for use of measures in healthcare services and research. Given these deficiencies, we recommend that these limitations are addressed before further use of ACEs-10, and its derivatives, for either clinical or research purposes.