title: Development and Evaluation of a Short Adverse Childhood Experiences Measure.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: wader2@email.chop.edu.
authors.forename: Roy
authors.initials: R
authors.lastname: Wade
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Becker
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Bevans
authors.affiliation: Division of Violence Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Ford
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Forrest
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis; D040343:Behavioral Risk Factor Surveillance System; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult