Early Life Stress (Retrospective)

Stress in childhood is associated with vulnerability to psychological and physical illness in adulthood, including lung disease, heart disease, diabetes, cancer, depression, and premature mortality (e.g., Anda et al., 2009; Danese et al, 2000; Felitti et al., 1998). Much of the research in this area has focused on the long-term impact of severe forms of early life stress, such as physical or sexual abuse, and physical neglect.

However, less severe and more common forms of early adversity such as growing up in poverty, and in a chaotic and conflictual home environment, are also associated with worse mental and physical health in adulthood (Evans & Kim, 2007; Repetti, Taylor, Seeman, 2002).

Measures to capture stressful experiences in childhood have largely focused on the individual’s retrospective account of their experiences of threatening events or perceptions of threat in childhood. These measures tend to capture the severity of the adversity (via ratings from either the interviewer or the respondent), type of adversity, and number of adversities experienced. Severity, as well as a number of adverse experiences likely both, have negative effects. Different forms of adversity may differentially impact health in adulthood although these distinctions have not been thoroughly tested. 

The validity of retrospective reporting of childhood experiences is debated. Although a traditional view offers cautious support for the use of retrospective reports (Brewin, Andrews, & Gotlib, 1993; Hardt & Rutter, 2004), other data suggests only moderate associations between retrospective reports and prospective measures. For example, in the longitudinal birth cohort Dunedin Study, Reuben et al. (2016) reported that adverse childhood experiences captured by study staff throughout childhood were only moderately associated with retrospective reports of adverse childhood experiences reported by the participants at age 38 (r=.47; weighted Kappa=.31). Whereas the agreement was high for objective events, such as loss of a parent (weighted kappa=.83), the agreement was minimal for items that required subjective judgment or interpretation, such as emotional abuse (weighted kappa=.07). Furthermore, retrospective reports were more strongly associated with subjective health outcomes and more weakly associated with objective health outcomes compared to prospective measures, suggesting potential for common method bias. For the full article see here.

Childhood Trauma Questionnaire

For retrospective measures of childhood trauma, a frequently used measure is the Child Trauma Questionnaire (CTQ; Bernstein et al., 1994). The CTQ is a 28-item self-report questionnaire that captures experiences of maltreatment from ages 0-17, with five subscales: sexual, emotional, and physical abuse, and emotional and physical neglect. This measure captures perceptions of treatment primarily from family members (Example item: People in your family called you things like stupid, lazy, or ugly) and whether necessities were provided (Example item: You didn’t have enough to wear). The measure does not capture stressful life events (e.g. divorce, death of a parent) or stressful environmental contexts (e.g. socioeconomic adversity, unsafe neighborhood, overcrowded home). In large population-based studies, higher CTQ scores are associated with worse mental and physical health across the life span.

Adverse Childhood Events Scale (ACES)

The Adverse Childhood Events Scale (ACES; Felitti et al., 1998) ask participants if prior to age 18 they experienced negative life events such as emotional, sexual, or physical abuse, or instability of the caregiver or close other (e.g. caregivers drank too much or did drugs, or someone in the household went to prison or had a mental illness). This scale assesses exposure (yes/no) and frequency (never to very often) of these stressors, though it does not capture subjective severity like the CTQ does. The original scale was 28-items though it has since been shortened to 10 items. The total score is used to indicate the cumulative number of adverse experiences in childhood. The primary focus is on the family or close-other network, and does not ask about traumas outside of those relationships (e.g. political turmoil, community violence), or take in to account the context of those experiences (e.g. socioeconomic status). A greater number of ACEs are associated with worse mental and physical health in adulthood (e.g. Edwards, Holden, Felitti, Anda, 2003). The World Health Organization published an international version that can be found here. There has also been an effort to create a two-item ACE screener that can be read about here.

Childhood Socioeconomic Status

Other experiences that often fall into the category of ‘early childhood adversity’ are common environmental and social aspects related to poverty and low socioeconomic conditions. These may be more chronic and less severe than psychologically traumatic events but are also important to capture given the association between low socioeconomic status (SES) and worse health. Childhood SES is often measured by asking participants about their parents' level of education and whether their parents owned the home in which they lived. Specific wording for these measures can be found here. 

Risky Family Environment

Less severe and more common forms of early adversity such as disrupted parent-child relationships have also been associated with worse mental and physical health in adulthood (e.g., Russek & Schwartz, 1997). Repetti, Taylor, and Seeman (2002) identified a cluster of family characteristics that are associated with behavioral problems in childhood and worse health throughout life. Specifically, families that are characterized by high levels of conflict and aggression, relationships that are cold, unsupportive, and neglectful, and chaotic daily lives, are termed “risky families” because they leave children at risk for worse health. Children that grow up in risky families have higher rates of mental health problems throughout their lives, and accumulating evidence suggests that they also have worse physical health in adulthood (Carroll et al., 2013; Luecken & Lemery, 2004; Repetti, Robles, & Reynolds, 2011; Repetti et al., 2002; Taylor, Lehman, Kiefe, & Seeman, 2006; Taylor, Lerner, Sage, Lehman, & Seeman, 2004). Thus, the Risky Families Scale was developed to capture 13-item the extent to which the participant lived in a home characterized by high conflict, low parental warmth, and a chaotic or unpredictable daily life from ages 5 – 15 (Taylor et al., 2004).

Childhood Experiences of Care and Abuse Inventory - Neglect Subscale

To capture emotional neglect specifically, there are a set of items that are embedded in the Childhood Experiences of Care and Abuse Inventory, which is a well-validated interview measure developed in the UK (Bifulco, Brown, Harris, 1994; Bifulco, Bernazzani, Moran, & Jacobs, 2005)

 

Author and Reviewer(s):

This summary was prepared by Alexandra D. Crosswell, PhD and reviewed by Andrea Danese, PhD and Bruce McEwen, PhD. If you have any comments on these measures, email Alexandra.Crosswell@ucsf.edu. Version date: December 2017.

References:

Anda, R. F., Dong, M., Brown, D. W., Felitti, V. J., Giles, W. H., Perry, G. S., … Dube, S. R. (2009). The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health, 9(1), 106.

Brewin, C. R., Andrews, B., & Gotlib, I. H. (1993). Psychopathology and early experience: a reappraisal of retrospective reports. Psychological Bulletin, 113(1), 82–98.

Bifulco A, Bernazzani O, Moran PM, Jacobs C. (2005). The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series. The British Journal of Clinical Psychology, 44(Pt 4), 563-581.

 

Bifulco A, Brown GW, Harris TO. (1994). Childhood Experience of Care and Abuse (CECA): a retrospective interview measure. Journal of Child psychology and Psychiatry, 35(8), 1419-1435.

 

Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., … Caspi, A. (2009). Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Archives of Pediatrics & Adolescent Medicine, 163(12), 1135–43.

Evans, G., & Kim, P. (2007). Childhood poverty and health: cumulative risk exposure and stress dysregulation. Psychological Science, 18(11), 953-957.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Household dysfunction to many of the leading causes of death in adults the Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.

Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128(2), 330–366.

Reuben A, Moffitt TE, Caspi A, Belsky DW, Harrington H, Schroeder F, Hogan S, Ramrakha S, Poulton R, Danese A. (2016). Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. Journal of Child Psychology and Psychiatry, 57 (10), 1103-1112.

Taylor, S. E., Lerner, J. S., Sage, R. M., Lehman, B. J., & Seeman, T. E. (2004). Early environment, emotions, responses to stress, and health. Journal of Personality, 72(6), 1365–93.