Revision of the ACES to ACES-R4

Download ACES-R4 here.

The original ACES (Adverse Childhood Experiences Scale) was initially developed by the Centers for Disease Control in conjunction with Kaiser Permanente in the mid-1990s. It has since been used in a variety of research studies.

However, the initial ACES had several psychometric problems. First, most of the questions were double-barreled meaning that each question consisted of more than one construct. Additionally, the constructs were not equivalent. For example, the questions on physical abuse consisted of whether one was slapped vs. hit so hard that an injury resulted. The question on sexual abuse consisted of whether one was touched sexually vs. actually forced to have intercourse. The second problem was that the question responses consisted of only yes or no without any indication of duration of the abuse or problem.

The attached revision addresses both concerns. First, the questions with multiple parts were divided into separate questions. This resulted in clearer questions addressing a single issue. The second revision was to introduce a Likert scale to determine the frequency of occurrence to distinguish an isolated incident from repeated events or a pattern of problems.

Current research with only the first issue addressed found that the greater the number of discrete events experienced, the greater the probability that individuals entering an addiction treatment program would manifest indications of either PTSD or major depressive episodes. Thus, even with only the double-barreled issue addressed, the ACES showed a potential for identifying those individuals more likely to manifest mental health conditions in a treatment population.

This revision is presented as a possible means to gather more precise indications of experiences. Further research will be undertaken to determine whether this revision will provide more useful information than the original.