Mary Jo Hedrick of the Center of Excellence in Early Childhood Learning and Development at East Tennessee State University, together with Jessica Templeton, Andrei Sigunov, and Andrea D. Clements of the university’s Department of Psychology, has developed and preliminarily validated the Variability in Adverse Childhood Experiences Scale, or VACE. Rather than asking whether a person experienced a given adversity, the VACE asks how often. The instrument keeps the familiar ACE domains as its backbone, preserving compatibility with the original scoring scheme, but replaces each dichotomous item with a frequency-based rating. The result is a measure that can distinguish a single incident of household substance abuse from a chronic, years-long pattern of exposure—a distinction the original scale, by design, cannot make.

The rationale for the change rests on a substantial body of developmental science. Decades of work on stress neurobiology suggest that the duration, timing, and frequency of adversity matter enormously for how the developing brain and body respond. Chronic, unpredictable stress can alter the architecture of brain regions involved in emotion regulation and self-processing, dysregulate endocrine and cardiovascular reactivity, and sensitize stress-response systems in ways that a one-off event may not. Researchers such as McLaughlin and Sheridan have argued for dimensional approaches that move beyond cumulative risk counts, and a 2022 review of adversity measurement tools by Oh and colleagues documented how many existing instruments fail to capture intensity, frequency, or timing. Reviews of ACE measures and methods by Karatekin and colleagues have similarly highlighted the field’s overreliance on crude binary indicators.

The binary scoring approach carries other costs as well. A person who endured repeated, severe sexual abuse and a person who experienced one episode of parental separation can theoretically arrive at the same ACE score, yet their clinical needs and biological burdens may differ profoundly. Prior work by Dolson and colleagues, published as “Pocket ACE,” documented child sexual abuse survivors whose experiences were missed entirely by the standard ACEs Study Questionnaire, underscoring how much nuance the traditional instrument can lose. Scholars such as McLennan, MacMillan, and Afifi have openly questioned whether ACE questionnaires in their current form should be used at all for individual-level decision-making. The VACE authors position their scale not as a replacement but as a complement: a frequency-sensitive overlay on the established framework that clinicians and researchers already know how to interpret.

To evaluate the new measure, the research team recruited 370 participants drawn from undergraduate and community samples. Each participant completed the VACE along with the Childhood Trauma Questionnaire–Short Form, a widely used and well-validated retrospective measure of abuse and neglect, and standardized instruments assessing depressive symptoms, perceived stress, and substance use. A subset of participants completed the VACE a second time two weeks later, allowing the researchers to estimate short-term test–retest stability. The analytic plan was comprehensive for a preliminary validation study: internal consistency analysis, intraclass correlation for retest reliability, exploratory factor analysis to uncover the scale’s underlying structure, convergent validity correlations, and hierarchical regression models testing whether the VACE added predictive value beyond traditional binary ACE scoring.

The psychometric results were encouraging. Internal consistency, measured by Cronbach’s alpha, came in at 0.79, a level conventionally regarded as acceptable for a multidimensional self-report instrument. Test–retest reliability over the two-week interval, quantified with an intraclass correlation coefficient, was 0.66 with a 95 percent confidence interval of 0.40 to 0.84, which the authors characterize as good; confidence intervals that wide are not unusual for initial reliability estimates in modest subsamples, and the authors acknowledge that firmer stability estimates will require larger retest cohorts.

Perhaps the most conceptually interesting finding came from the exploratory factor analysis. Rather than collapsing into a single unidimensional index of adversity, the VACE items sorted into two correlated factors. The first, labeled Direct and Interpersonal Adversity, captures harms inflicted directly on the child, such as abuse and household maltreatment. The second, labeled Community and Contextual Adversity, reflects adversity embedded in the child’s broader environment, such as neighborhood disadvantage and community-level dysfunction. The two factors correlated at 0.56, indicating meaningful overlap but clearly separable dimensions. This two-factor structure echoes the ecological model of human development articulated by Bronfenbrenner and aligns with recent scoping reviews, including work by Krinner and colleagues, showing that childhood adversity is best understood as multidimensional rather than as a simple running total.

Convergent validity was strong. VACE scores correlated 0.76 with the Childhood Trauma Questionnaire–Short Form, a relationship robust enough to suggest the two instruments are tapping substantially the same underlying construct while leaving room for the VACE to capture additional variability that the CTQ-SF does not. But the study’s headline result concerns incremental predictive validity. In hierarchical regression analyses, the researchers entered traditional binary ACE scores first and then added VACE frequency scores to see whether the new measure explained any additional variance in downstream outcomes. It did. VACE frequency scores accounted for significant incremental variance in depressive symptoms (a change in R-squared of 0.042, p < .001), perceived stress (change in R-squared of 0.056, p < .001), and substance use (change in R-squared of 0.021, p = .004) beyond what binary ACE scoring alone provided.

Those incremental variance figures may look modest at first glance, but in psychological research they represent a meaningful gain. Roughly two to six percent of additional explained variance in outcomes as heterogeneous as depression, stress perception, and substance use—achieved purely by changing how exposure is quantified—suggests that frequency information carries real signal about the dose–response relationship between adversity and health. The finding is consistent with longitudinal work by Farooq and colleagues linking the duration and timing of ACE exposure to adolescent depression and self-harm, and with Schroeder and colleagues’ demonstration that the accumulation, timing, and duration of early adversity independently predict behavior problems. If frequency matters as much as these results imply, then measures that ignore it may systematically underestimate the burden carried by the most chronically exposed children.

The authors are careful to frame the VACE as preliminary. The sample of 370 undergraduates and community members is not representative of the full diversity of populations in which ACE measurement matters, and retrospective self-report introduces well-known recall limitations that no questionnaire can fully escape. Longitudinal validation—tracking frequency scores forward to predict health outcomes as they unfold—remains the critical next step, as does replication across more diverse racial, socioeconomic, and cultural groups. The authors also note that the data supporting the findings are not publicly available but can be requested from the corresponding author. Still, the initial evidence suggests the VACE occupies a useful middle ground in a contested field: it retains backward compatibility with the ACE scoring framework that two decades of research and clinical practice have been built upon, while adding the dimensional precision that critics of binary scoring have long demanded. For a field increasingly focused on tailoring prevention and intervention to the actual texture of childhood adversity rather than its mere presence, a measure that can say how often—not just whether—may prove to be a valuable new instrument in the toolkit.

Subject of Research: Development and preliminary psychometric validation of the frequency-based Variability in Adverse Childhood Experiences Scale (VACE)

Article Title: Item Development and Preliminary Validation of the Variability in Adverse Childhood Experiences Scale (VACE)

Article References: Hedrick, M. J., Templeton, J., Sigunov, A., & Clements, A. D. (2026). Item Development and Preliminary Validation of the Variability in Adverse Childhood Experiences Scale (VACE). Journal of Child &amp; Adolescent Trauma. https://doi.org/10.1007/s40653-026-00978-0

Image Credits: AI Generated

DOI: 10.1007/s40653-026-00978-0

Keywords: adverse childhood experiences, ACE scale, childhood adversity, psychometrics, scale development, trauma, frequency-based measurement, depression, perceived stress, substance use, convergent validity, factor analysis