The dimensionality of adverse childhood experiences: A scoping review of ACE dimensions measurement

Abstract

Objective: Despite extensive research, the concept of adverse childhood experiences (ACEs) is not fully developed and there is low agreement on how the concept should be defined and measured. The purpose of this study was to 1) identify different conceptual dimensions associated with ACEs, such as timing or frequency; and 2) determine how these dimensions have been operationalized and analyzed to this point, in order to advance the conceptual understanding of ACEs.

Methods: We conducted a scoping review of empirical journal articles on ACEs published after the original ACE-Study in 1998 to summarize the use of dimensions for the 10 conventional ACE domains. We used a PRISMA methodology to identify articles that assessed at least two of the 10 conventional ACE domains and at least two ACE dimensions. A standardized data extraction spreadsheet was used to record basic article information and specifics on ACE domains and dimensions.

Results: Of 15,417 initial search results, 61 articles met all selection criteria. We identified four primary dimensions used for most ACE domains: frequency, timing, perception, and the role of the perpetrator. Additionally, we found several secondary and domain-specific dimensions, which relate to the intensity of the adverse event.

Discussion: We identified the most commonly used ACE dimensions, but these lack standardized phrasing of items and response options. The inclusion of ACE dimensions may increase the accuracy of the association between ACEs and health outcomes and provide for more tailored treatment plans for people who have experienced ACEs. Future research should include a more comprehensive list of ACE domains and aim to develop a clearly articulated, standardized approach to assessing and analyzing ACE dimensions.