2.2.2. Adverse Childhood Experiences

Adverse childhood experiences were assessed by the ACE Score Calculator, a validated screening instrument used to estimate the prevalence of ACEs [46]. This tool of 10 items, developed by the researchers of the ACE study based on the original ACE Questionnaire, is appropriate for screening purposes and allows individuals to calculate their own scores based on the original scoring criteria of the ACE Study [15]. A short form of eight items of the original ACE Questionnaire was also used in the Health Behavior in School-Aged Children (HBSC) Study and proved to be reliable [38].

The ACE Score Calculator helps assess exposure to 10 types of ACEs including 5 types of abuse (emotional, physical, and sexual), neglect (physical and emotional), and 5 types of dysfunctional family environment (mentally ill or substance-abusing member of household, physical violence in the household, parental separation/divorce, incarcerated family member(s) prior to age 18). The ACE Score is calculated by summing up all 10 ACE variables and serves as a measure of overall ACE exposure ranging from 0 (meaning no exposure to the 10 categories of ACEs) to 10 (meaning exposure to all 10 categories). Responses were categorized by type of ACE and were dichotomized into no history or any history of adversity prior to age 18. Responses were analyzed also by number of adverse experiences (none, 1, 2–3, 4 or more) prior to age 18.

Dube et al. (2014) found good to excellent reliability in the reports of ACEs during adulthood. The test–retest reliability in the responses to questions about ACEs and the resulting ACE score was found to be good and moderate to substantial. These findings confirm that retrospective responses to the forms of childhood maltreatment and household dysfunction are generally stable over time [31]. Wingenfeld et al. (2010) investigated the psychometric characteristics of the ACE Score Calculator and revealed that it is a reliable, valid, and economic screen for the retrospective assessment of ACEs [47].

The English version of the ACE Score Calculator was translated to Hungarian by the authors, and cross-cultural adaptation was carried out through an iterative forward–backward translation compared by an independent third person. The preambles, item contents, and response options for items can be found in the Appendix A (Table A1).
