Assessing Exposure to Childhood Adversity in Adults: A Systematic Review of Validated Self-Report Childhood Adversity Questionnaires.

Introduction: Children exposed to adverse experiences are more likely to experience mental health problems in adulthood. However, adverse childhood experience (ACE) assessment is highly heterogeneous, hampering widespread screening and trauma-informed care provision. We aimed to systematically identify and critically evaluate all-validated, self-report ACE questionnaires, working with people with lived experience (PWLE).

Methods: The review followed PRISMA guidelines to systematically search databases for validated self-report measures, completed by adults, assessing at least two ACEs. Articles were excluded if they were not written in English, were not original articles, assessed poor childhood health or adverse experiences happening in adulthood, and/or only assessed one ACE. Psychometric properties were evaluated using Cohen's criteria for evidence-based assessments, the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist, and a content validity form co-designed with PWLE.

Results: We identified 112 eligible studies covering 31 ACE questionnaires. Cohen's criteria classified 9 questionnaires as "well-established" and 2 as "approaching well-established." No questionnaire was rated as "sufficient" quality across all the COSMIN measurement properties. The ACE Study questionnaire, Childhood Experiences Survey (CES), and the ACE International Questionnaire had the highest number of properties rated as sufficient. The Childhood Trauma Questionnaire-Short Form (CTQ-SF) was most frequently evaluated but received "insufficient" ratings across all measurement properties. PWLE scored content validity highest for the CES.

Conclusion: Consequently, no ACE questionnaires received good psychometric ratings, with the most widely used questionnaire (CTQ-SF) not performing well, which has implications for selecting an appropriate instrument. With increasing emphasis on trauma-informed health care, there is an urgent need to co-develop ACE questionnaires with PWLE to balance content validity with usability.