Pocket ACE: Child sexual abuse survivors missed by the ACEs Study Questionnaire

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Background: A 1998 seminal study catapulted adverse childhood experiences (ACEs) into the zeitgeist and shaped assessment of these experiences and long-term health consequences via The ACEs Study Questionnaire (ACE-SQ). However, the ACE-SQ's childhood sexual abuse (CSA) item requires the perpetrator have been 5-years or older than the survivor for endorsement. This may not adequately capture CSA and limit the questionnaire's ability to detect survivors. Objective: This study assessed whether CSA survivors were missed by this 5-year modifier, whether service access was restricted, and whether those missed were at elevated risk for adverse outcomes. Participants and setting: A sample of 974 women (M age = 30.46) completed an online survey. Methods: Histories of CSA were assessed using the original ACE-SQ and an alternative version without the 5-year modifier. Participants were grouped by endorsement (Modifier, No Modifier, No CSA) and compared across numerous physical and mental health outcomes using MANOVA, ANOVA, and logistic regression. Results: Numerous CSA survivors are presently missed by the 5-year modifier (n = 118 of N = 249). This group demonstrated the same elevated depression (t = 3.44, p = .002, d = 0.34), heightened somatic symptom burden (t = 3.34, p = .003, d = 0.35), and poorer subjective health (t = -2.86, p = .012, d = 0.27) as those captured by the modifier. Conclusions: Recommendations for research, practice, and policy include removing the 5-year modifier from CSA assessment, creating an empirically informed CSA definition, and eliminating or adjusting requisite cut-scores for accessing services.