Validity and reliability of the 10-Item Adverse Childhood Experiences Questionnaire (ACE-10) among adolescents in the child welfare system

Introduction

Multiple evidence suggests that the vast majority of children in the Child Welfare System (CWS) are victims of early, chronic, and multiple adverse childhood experiences. However, the 10-item version of the Adverse Childhood Experiences Questionnaire (ACE-10) has never been tested in such a particularly vulnerable population as adolescents living in the CWS. We aimed to assess the psychometric properties of the ACE-10 in a community sample of 240 Hungarian adolescents placed in family style group care (FGC) setting.

Methods

Demographic data, the 10-item version of the Adverse Childhood Experiences Questionnaire (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Bullying Measure were used.

Results

Our results showed acceptable internal consistency (α = 0.701) and item-total correlations (rpb = 0.25-0.65, p < 0.001). However, our results also reflect that item 6 ("Parental separation/divorce") is weakly correlated with both the cumulative ACE score and the rest of the questionnaire items. When item 6 is removed, the 9-item version of the ACE produces more favorable consistency results (α = 0.729). Strong and significant associations of the cumulative ACE score with emotional and behavioral symptoms and bully victimization confirm the concurrent criterion validity of both versions of the instrument.

Discussion

Our findings suggest that ACE-9 and ACE-10 are viable screening tools for adverse childhood experiences in the CWS contributing to the advancement of trauma-informed care. We recommend considering the use of either the 9-item or the 10- item version in the light of the characteristics of the surveyed population. The implications and limitations are discussed.

[The impact of adverse childhood experiences on mental and somatic health in childhood and adolescence]

Multiple studies prove that children who were exposed to adverse childhood experiences within their families are increasingly at risk of various high-risk behaviours, bullying, mental and somatic disorders. In children/adolescents who undergo terrifying experiences on a repetitive, sometimes daily basis without being provided support and the basic safety they would need, all aspects of personality development will be seriously affected. Urgent action is needed in Hungary to identify these children and provide them with therapeutic support. The field of childhood adversities and their consequences has been undeservedly neglected by research, despite the fact that preventive and therapeutic interventions could be specifically designed based on this knowledge during childhood and adolescence. In our study, we present international data on the prevalence of adverse childhood experiences. We discuss in detail the association of adverse childhood experiences with biological and cognitive impairments attachment disorders, externalising and internalising disorders, somatic disorders and health risk behaviours in childhood and adolescence. Besides presenting empirical data on adverse experiences and consequences, the purpose of our publication is to raise awareness and sensitisation among professionals. Orv Hetil. 2023; 164(37): 1447-1455.

Psychometric properties of the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) among Hungarian adolescents

Introduction

Although a number of studies have been conducted since the 1995 initiation of the ACE study to map the effects of adverse childhood experiences, few studies have examined the psychometric properties of the individual versions of the ACE questionnaire.

Aims

The Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) has only been tested in a single study in an adult population, while its applicability in a particularly vulnerable population, the adolescents, has not been investigated yet. Our present study aims to address this gap in an adolescent sample of 792 subjects from a non-representative general population.

Methods

Besides demographic data, the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Symptom Checklist (HBSC-SCL) were employed.

Results

Our results showed acceptable internal consistency (ɵ = 0.86, α = 0.64) and adequate internal validity (r = 0.28-0.70, p < 0.001). In addition, proper concurrent criterion validity of the questionnaire was found when tested along the SDQ and HBSC-SCL items.

Conclusion

Our results demonstrate that the ACE-10 is suitable for assessing intrafamilial adverse childhood experiences in adolescents.

Pathological personality traits of maladaptive daydreamers measured by the Personality Inventory for DSM-5 in a psychiatric sample

This study aimed to estimate the frequency of maladaptive daydreaming and to explore the pathological personality traits of probable maladaptive daydreamers. Our sample consisted of 239 psychiatric patients. After screening, 42 persons were probable maladaptive, while 197 participants prove to be normal daydreamers. Two pathological domains and three facets measured by the Personality Inventory for DSM-5 showed a moderate significant correlation with the Maladaptive Daydreaming Scale. The score of nearly every domain and facet was slightly higher among probable maladaptive daydreamers. To quantify the difference between the groups, effect sizes were calculated: Significant difference was found on the domain level in Antagonism, while on the facet level in Hostility, Grandiosity, Attention Seeking, Unusual Beliefs and Experiences, Cognitive and Perceptual Dysregulation. The group of probable maladaptive daydreamers was further examined to identify potential subgroups. Cluster analysis revealed heterogeneity in the severeness and patterns of pathological personality domains. Cluster 1 showed higher mean scores on the PID domains and on the MDS compared to Cluster 2. Clusters 1 and 2 broke further down into two subclusters: Cluster 1a and Cluster 1b differed in their mean scores on the domains of Antagonism and Detachment; the mean scores of Cluster 2a were uniformly low on each domain, while the mean values of Cluster 2b were scattered in a mixed way on the domains. Our results suggest that maladaptive daydreaming might manifest with differently pathological personality profiles in the background. This aspect might worth considering in planning treatment.

Adverse childhood experiences increase the risk for eating disorders among adolescents

Purpose

Traumatic events often feature prominently in eating disorders. A questionnaire survey to assess the relation of eating disorder risk to the frequency of adverse childhood experiences (ACEs) and the possible association of eating disorder risk with a particular type of ACE was conducted in a community sample of Hungarian adolescents.

Methods

Demographic and anthropometric data, risk for eating disorders (by SCOFF questionnaire), and ACEs (by ACE score calculator) were collected from 432 adolescents aged 12-17 years.

Results

Adolescents who had undergone four or more ACEs were 5.7 times more likely to be in the high eating disorder risk group than those who did not report any ACEs. Cumulative maltreatment showed a greater association with overall risk for eating disorders than cumulative family dysfunction. There is an increased risk of eating disorders from emotional maltreatment (OR = 3.475), physical maltreatment (OR = 3.440), sexual maltreatment (OR = 10.973), and emotional neglect (OR = 3.331). Dysfunctional family circumstances revealed an association with household mental illness (OR = 3.401).

Conclusion

Our study of the connection between eating disorder risk and ACE is the first of its kind in Central and Eastern Europe. Maltreatments had a greater role than family dysfunctions in increasing the risk of eating disorders. Our findings contribute to a more precise understanding of the role that ACEs play in eating disorders. It is important to bring to clinicians' attention the importance of ACEs in the diagnosis and therapy of eating disorders and their potentially fundamental significance for therapy.

Transfer of Mental Health Services for Medical Students to Cyberspace during the COVID-19 Pandemic: Service Use and Students' Preferences for Psychological Self-Help Techniques

The high risk of mental health problems among medical students has been compounded by the COVID-19 pandemic, which greatly reduced social contact. The mental health support service of the medical school of one Hungarian university was transferred to the online learning management system and was expanded by self-help materials in three domains: Improving study skills, stress management techniques, and reducing stress related to the COVID-19 pandemic. We wanted to understand the preferences of medical students for psychological self-help techniques by investigating the pattern of access to online self-help materials and the characteristics of the users. Access to the online materials between April 2020 and April 2021 among Hungarian and international medical students was analyzed using the logging data of the system. Of all the students who logged in during the examination period (n = 458), 36.6-40.4% viewed materials to improve study skills and 23-29% viewed stress management materials, of which short-duration audio format techniques were preferred. The access rate of content targeting coping with the mental health effects of COVID-19 was 9.5-24%. Support to improve study skills is significantly more preferred than interventions targeting distress-reduction. The pattern of access can be used for the development of interventions that are of most interest to medical students.

The psychometric properties of the Hungarian version of the Personality Inventory for DSM-5 in a clinical and a community sample

The alternative dimensional model for personality disorders characterizes the individual on pathological personality traits, which can be measured by the Personality Inventory for DSM-5 (PID-5). Our study focused on the psychometric properties of the Hungarian version of PID-5 in 239 psychiatric patients and 226 non-clinical participants. The distribution of gender, age, and educational level were the same in the two samples. In the clinical sample, we examined the assumed unidimensionality of the 25 facets. The results of the exploratory factor analysis for five factors indicated the supposed five-factor structure. The convergent validity was studied by correlations with Big Five Inventory. The PID-5 domains showed moderate or strong correlation with the domains of Big Five except for Psychoticism. The comparison of the clinical and non-clinical samples revealed that psychiatric patients had a higher score on all pathological facets and domains, except for the domain of Antagonism with all its related facets, and the facet of Risk Taking. As a whole, we recommend the use of the Hungarian version of the PID-5 in research and clinical practice.

Assessing adverse childhood experiences, social, emotional, and behavioral symptoms, and subjective health complaints among Hungarian adolescents

BACKGROUND

Adverse Childhood Experiences (ACEs) can have lifelong adverse impacts; they can play a role in the development of subsequent emotional, cognitive, and social impairments leading to somatic and mental difficulties, as well as health damaging behaviours. Unfortunately, there are currently no research data available in Hungary regarding the frequency of ACEs among adolescents.

AIMS

A cross sectional questionnaire survey was conducted in a community sample of Hungarian adolescents to assess the frequency of ACEs and analyse their association with current social, emotional, and behavioural symptoms (SEB), and subjective health complaints (SHC).

METHODS

Demographic data, ACEs, SEB and SHC status of 516 adolescents aged 12 to 17 were collected. ACEs were assessed using the ACE Score Calculator; for SEB the Strengths and Difficulties Questionnaire, and for SHC some specific items from the Health Behaviour of School Children questionnaire were employed. To analyse the relationship of ACEs to SEB and SHC logistic regression was performed.

RESULTS

Our results showed that the frequency of ACEs, SEB and SHC is high among adolescents. One-fourth of the students reported ≥ 2 categories of childhood exposures, and 7.4% reported having experienced ≥ 4 types of ACEs. The most prevalent forms of child maltreatment were emotional neglect (15.5%) and emotional abuse (14.5%). The most frequent dysfunctional household condition was parental divorce or separation (23.8%), followed by household substance abuse (8.9%) and household mental illness (8.1%). Almost one-fifth of students (17.5%) reported SEB symptoms (peer relationship problems in 21.7%, emotional symptoms in 14.6%, conduct problems in 18.3%, hyperactivity in 15%). The prevalence of SHC was also high: more than half of the students experienced at least one subjective health complaint multiple times a week. Significant associations were found between ACEs and the SEB/SHC reported by students.

CONCLUSIONS

Adverse childhood experiences, social, emotional, and behavioural symptoms, and SHC are common among Hungarian adolescents. The cumulation of ACEs is associated with a higher number of SEB and SHC symptoms. Therefore, prevention programmes, early recognition, risk reduction, and therapy are needed.

[Assessment of pathological personality traits and gender characteristics by Personality Inventory for DSM-5 in a psychiatric and a normal sample]

INTRODUCTION

The DSM-5 describes two types of classification of personality disorders: a categorical and a dimensional classification. The alternative model of personality disorders in the DSM-5 determines new diagnostic criteria for personality disorders with a criterion B describing the presence of pathological personality facets. For the assessment of these domains and facets, the Personality Inventory for DSM-5 (PID-5) was created.

METHODS

A sample of patients receiving psychiatric care (n=239) and a normal sample (n=226) were involved in the study. The two samples did not differ significantly regarding gender, age, and the levels of education. The PID-5 was applied to assess the pathological domains and facets.

RESULTS

Psychiatric patients scored significantly higher on four out of five PID domains compared to the members of the general population. Regarding the PID facets, the two study groups differed significantly in 18 out of 25 facets. Regarding the PID domains and facets, gender differences were found in the clinical sample: Negative Affectivity was more typical for women, while Antagonism was more dominant for men. Women receiving psychiatric care were cha - rac terized by Emotional Lability and Anxiousness, while Manipulativeness, Deceitfulness, Callousness and Risk Taking were more dominant for men of the clinical sample.

CONCLUSION

Our results confirmed the applicability of the dimensional personality model. The PID-5 can discriminate between psychiatric and normal samples. Our findings suggested that in the case of the general population, traditional gender characteristics disappeared, while psychiatric patients seemed to preserve the traditional gender roles.

[The concept and characteristics of metacognition and its role in schizophrenia]

Schizophrenia research in the last decades led to rapid development of our knowledge regarding the cogni - tive deficits in the disease. Presence of neurocognitive and social cognitive deficits in schizophrenia is widely confirmed by empirical studies. Metacognition is one of the most recent and relatively less studied field of schizophrenia. Our lite rature review aims to introduce the concept and characteristics of metacognition. Then we overview the relation - ship between schizophrenia associated neurocognitive and social cognitive impairments and metacognitive deficits. Associations between the metacognitive deficits and the symptomatology will also be discussed. Finally, a method for the treatment of metacognitive deficits in schizophrenia will be suggested. The results of the overviewed studies sup - port, that the umbrella term of metacognition encompassing the neurocognitive and social cognitive deficits, may provide a comprehensive model to better understand how cognitive deficits contribute to the development and main - tanance of symptoms, and schizophrenia-associated serious social dysfunctions.

[Childhood traumatization, dissociation and nonsuicidal self-injurious behavior in borderline personality disorder]

INTRODUCTION

Childhood traumatization plays a significant role in the etiology of borderline personality disorder. Studies found a significant association between childhood traumatization, dissociation, and nonsuicidal self-injurious behavior.

AIM

The aim of our study was to assess dissociation and nonsuicidal self-injury among borderline inpatients and to reveal the association between childhood traumatization, dissociation, and self-injurious behavior.

METHOD

The sample consisted of 80 borderline inpatients and 73 depressed control patients. Childhood traumatization, dissociation and self-injurious behavior were assessed by questionnaires.

RESULTS

Borderline patients reported severe and multiplex childhood traumatization. Cumulative trauma score and sexual abuse were the strongest predictors of dissociation. Furthermore, we have found that cumulative trauma score and dissociation were highly predictive of self-injurious behavior.

CONCLUSION

Our results suggest that self-injurious behavior and dissociation in borderline patients can be regarded as indicators of childhood traumatization. Orv Hetil. 2017; 158(19): 740-747.

[Treatment of metacognitive impairments in schizophrenia - The Metacognitive Training]

In the recent years plenty of therapeutic treatment methods have been developed, aimed at neurocognitive impairments in schizophrenia. These trainingprograms can hold up promising results in the improvement of neurocognitive functions. Nevertheless the generalisation on the daily life is not perspicuous. A reason for it might be the supposition, that further factors such as metacognition and social cognition may play a mediator role between neurocognition and functional outcomes. As a result, many socialcognitive remediation methods and programs have emerged targeting the impairment of deficits both in the field of neuro- and social cognition and deficits of metacognition. We review the specific impairments in schizophrenia (e.g. deficits of Theory of Mind, disorder of emotional perception, specific cognitive biases or impairment of metamemory), the construction and speciality of the Metacognitive Training, and the findings of studies aimed at the efficacy of the method. In addition to the socialcognitive remediation, the goal of Metacognitive Training is the correction of the cognitive biases playing an important role in the emergence and subsistence of delusions.

[Psychometric properties of the Hungarian version of the Codependence Questionnaire]

The purpose of this study is to assess the internal consistency of the subscales of the Hungarian Version of the Codependent Questionnaire (CdQ, Roehling & Gaumond, 1996). Thus, a reliable measurement of codependency for professionals become available in Hungary. The Hungarian Version of the Codependent Questionnaire enables professionals to identify codependent individuals.

METHODS

Our sample (N=137) was recruited from the general population and from self-help groups (82 individuals); and patients with borderline personality disorder (55 individuals) were recruited as clinical control group. The reliability of the questionnaire was assessed by Cronbach's alfa and principal component analysis. In addition, in order to investigate the latent structure, factors analyses and hierarchical cluster analysis were used.

RESULTS

Based on our results, the Cronbach's alfa values of the subscales of 'control', 'reliability' and 'intimacy' indicate appropriate reliability, however, the subscale of 'enmeshment' indicates poor reliability. The originally assumed factor structure is not supported by the results of the statistical analyses. The subscales are not separate from each other, which is also indicated by the correlations of the total scores of the subscales.

CONCLUSION

The reliability of the Hungarian Version of the Codependent Questionnaire is nearly identical to the original data, except for one subscale ('enmeshment subscale'). Based on these results the Hungarian Version of the Codependent Questionnaire is considered to be reliable. Besides the Hungarian adaptation, the strength of this study is the investigation of a clinical sample. The use of the questionnaire is recommended without the subscale of 'enmeshment' and further 5 items, and it is suggested to use as one scale.

[The concept, the symptoms and the etiological factors of codependency]

The concept of codependency stems from the field of chemical dependency. Initially, codependent individuals meant women who dominated their partners and took care of them, while women actually were dependent upon their husbands. Nowadays, it has been recognized that men can become codependent as well, and its presence is not limited only to the relationship. This paper reviews the various interpretations of codependency and the empirical researches on the etiological factors of codependency. The explanatory models of codependency can be placed on a continuum of severity: psychopathology on the level of personality disorder, behavioural addiction, or excessive feminine behaviour. The etiology is mutifactorical: biological, psychological and social elements are also listed among etiology factors. The individual variability of the predisposition to care, failure of prefrontal cortex to inhibit empathic responses, a multitude of aversive experiences in a dysfunctional family (e.g. parental conflicts, emotional abuse, neglect and parentification), changes in the perception of women's role, and the emergence of substance abuse in the family could play a role in the development of codependency. Codependency is often unrecognized. Codependent individuals visit the health care system with stress-related or depressive symptoms which can mask the underlying causes, thus, it is possible that they will only receive symptomatic treatment. Through its trans-generational nature, codependency endangers children growing up in the family.

[Traditional and modern views of dissociation]

Dissociation is a failure to integrate aspects of identity, memory, perception, and consciousness. Dissociation is conceptualized as a dimensional process existing along a continuum from normal and relatively common dissociative experiences to severe and clinically relevant forms. There is a growing body of clinical and empirical evidence that dissociation may occur especially as a defense during trauma. In case of traumatic events dissociation considered as an attempt to maintain mental control just as physical control is lost. Dissociation can be either a symptom of some complex mental disorder or a distinct clinical entity categorized among dissociative and somatoform disorders in DSM-IV. The article describes the conceptual issues of dissociation and presents a new classification by Nijenhuis where the so-called somatoform dissociative symptoms are included as well in the list of dissociative symptoms. Finally, this paper summarizes the measures of dissociative phenomena and the cognitive-behavioral approaches of dissociation, and highlights the main features of the new structural dissociation model.

[Integrative approach in the psychotherapy of borderline personality disorder]

In the last 20 years six psychotherapy methods have been developed specifically for borderline personality disorder. Solid RCT evidences suggests the efficacy of all the methods. Roughly equivalent improvement was obtained from the different types of psychotherapies. Today we have reached a new phase of the borderline "psychotherapy boom", the integrative approach. According to the integrative treatment advocates we should not choose among these effective treatments but we can incorporate in the therapy all the components that work. The integrative approach uses general factors common to all effective therapies, combined with specific treatment techniques taken from different therapies in order to treat the given patient's psychopathology. These common factors are: coherent framework; attention to strategies for building strong positive alliance and maintaining patient motivation; creating a safe and structured therapeutic environment; clear treatment frame; transparency of the goals and roles; focus upon presenting problems; higher level therapeutic activity; here-and-now focus; and facilitating self-reflection. Treatment focuses on change while maintaining a validating and supportive stance. General strategies can be supplemented by more specific techniques such as cognitive-behavioral interventions for reducing maladaptive behavior, training for developing emotion regulation skills and interpersonal skills coming from dialectical behavior therapy. Methods drawn from psychodynamic approaches can be used for the modification of underlying interpersonal cognitive-emotional schemas.

Distribution of prostaglandins E and F in different regions of the rat brain

The regional distribution of prostaglandins E and F in 24 different areas of the rat brain was studied. For bioassay the rat uterine horn preparation was used. Prior to bioassay the samples were purified with organic solvents and in some cases by chromatography on silica as well. For measurement of PGF2 alpha content in certain areas a radioimmunoassay was used. Each region was found to contain prostaglandins but in uneven concentrations. Highest concentration, related to the protein content, was present in the median eminence, 57.6 ng PGE and 34.4 ng PGF per mg protein. Parietal cortex, olfactory tubercle, cerebellar cortex, caudate nucleus, substantia nigra, and paraventricular nucleus are also rich in prostaglandins. Low values were found in frontal cortex, thalamus, and septum. The distribution of prostaglandins throughout the areas examined do not show any direct correlation with that of transmitter substances. The uneven distribution can be attributed to differences in the endogenous biosynthetic capacity of each region.