Catherine Jacobs

The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series.

BACKGROUND Childhood neglect and abuse, as measured by retrospective interview, is highly predictive of psychiatric disorder in adult life and has an important role in aetiological models. However, such measures are labour-intensive, costly, and thus restricted to relatively modest sample sizes. A compact self-report assessment of childhood experience is invaluable for research screening purposes and large-scale survey investigation. METHOD A self-report questionnaire (CECA.Q) was developed to mirror an existing validated interview measure: the childhood experience of care and abuse (CECA). The questionnaire assessed lack of parental care (neglect and antipathy), parental physical abuse, and sexual abuse from any adult before age 17. A high-risk series of 179 London women were interviewed using the CECA together with the PSE psychiatric assessment, and completed the CECA.Q at later follow-up. Repeat CECA.Qs were returned for 111 women and 99 women additionally completed the parental bonding instrument (PBI; Parker, Tupling, & Brown, 1979). RESULTS Satisfactory internal scale consistency was achieved on the CECA.Q for antipathy (alpha = .81) and neglect (alpha = .80) scales. There was satisfactory test-retest for both care and abuse scales. Significant associations were found between CECA.Q scales and the parallel interview scales with cut-offs determined for high sensitivity and specificity. CECA.Q neglect and antipathy scales were also significantly related to PBI parental care. CECA.Q scales were significantly related to lifetime history of depression. Optimal cut-off scores revealed significant odds ratios (average of 2) for individual scales and depression. When indices were compiled to reflect peak severity of each type of adversity across perpetrator, odds-ratios increased (average 3). A dose-response effect was evident with the number of types of neglect/abuse and rate of lifetime depression. CONCLUSION The CECA.Q shows satisfactory reliability and validity as a self-report measure for adverse childhood experience. The merits of having parallel questionnaire and interview instruments for both research and clinical work are discussed.

Concordance between mother and offspring retrospective reports of childhood adversity

Obtaining accurate accounts of adverse experiences that occur during childhood remains a major issue for researchers examining lifespan models of psychiatric disorder. Documented evidence of abuse and neglect is rarely available as the vast majority of exposed children never come to the attention of the relevant authorities (Ammerman, 1998). Consequently, research into the psychological and physical effects of childhood adversity tends to rely on reports provided by the individual themselves or their close family members. An individual’s own retrospective self-report of adverse childhood experiences can potentially present problems in terms of reliability and validity as the person’s current mental state, repression of the traumatic events, general processes of forgetting, subsequent events and embarrassment may affect both the likelihood of disclosure and the accuracy of the information provided (Briere & Conte, 1993; Lysaker, Beattie, Strasburger & Davis, 2005; Maughan & Rutter, 1997). However, the weight of evidence suggests that personal accounts of early experience are relatively accurate (see Brewin, Andrews & Gotlib, 1993). One strategy that has been employed to validate such accounts is to obtain corroboration from a relative of the individual’s childhood experiences. For instance, siblings who grew up in the same household have been demonstrated to provide both concordant and corroborating retrospective accounts of the family environment and abuse exposure (Bifulco et al., 1997; Brown, Craig, Harris, Handley & Harvey,_2007). However, other types of corroboration are often required, for example where siblings were separated in childhood, or where they are difficult to track down for assessment, or when they are unaware of some aspects of family adversity (e.g., hidden parental discord or secretive sexual abuse to only one child) or for example if they were very young at the time of the experience (Brown et al., 1997; Platt, 1980). Therefore, obtaining alternative corroborative accounts from older family members who were present for the majority of the target person’s childhood would be an advantage in producing valid data. Indeed, mothers are often ideal candidates for corroboration as they are usually present during their offspring’s childhood and can also provide details of other useful aspects of the individual’s early experiences (e.g., obstetric complications, pre- and post-natal development), thus potentially saving the researcher both time and money. However, obtaining two sets of accounts can be costly in large studies and sometimes it is not possible to obtain information directly from the individual themselves. For instance, studies based on longitudinal birth cohorts regularly rely on mothers’ accounts of young children’s exposure to adversity as it can be difficult, and perhaps even unethical to question the children directly (Bifulco, Brown, Lillie & Jarvis, 1997; Kinard, 1995). Mothers’ accounts of the early childhood environment are also utilised in studies of adults with psychiatric disorders (Cannon et al., 1997). However, it is unknown whether mothers are able to provide retrospectively a reasonably reliable and accurate account of their children’s exposure to a range of adverse experiences. Clearly it is quite possible they may under-report or minimise their own abusive and neglectful behaviour towards the child to present a more socially desirable picture of themselves or their partners, due to their style of communicating with others, or because they lack insight into their own past parenting behaviour (Bifulco et al., 1997). This requires investigation to inform the design of future studies in this area. Therefore, as part of a larger investigation of intergenerational transmission of risk for depression, this study aimed to explore whether maternal retrospective reports of childhood adversity were concordant with those provided directly by their offspring. Examination of this issue is important to investigate whether maternal reports could be used (i) instead of self-reported adversity (e.g., where the individual is mentally unfit, unavailable or too young to be interviewed); and (ii) to corroborate individual’s reports of adversity and provide additional information. Concordance of mother-offspring reports has previously been explored in relation to physical abuse, revealing moderate agreement (Tajima, Herrenkohi, Huang & Whitney, 2004), but not other forms of childhood adversity; hence this analysis is intended to further advance the field by exploring concordance for a wider range of adverse childhood experiences. Moreover, this study employed a standardised comprehensive interview measure of childhood adversity that utilises concrete examples and interviewer-based scoring procedures (Bifulco, Brown & Harris, 1994). This should provide a more robust test of concordance than brief self-report questionnaires which are often prone to bias as they rely on respondents’ subjective perceptions of their past experiences (Brown & Rutter, 1966).