Childhood Adverse Experiences Questionnaire- Initial Scale Development and Validation

The drive of this study was to develop a theoretical tool to measure the construct of adverse experiences in childhood. The psychological conception underlining adverse experiences during this period is studied. Many dimensions have been identified to measure the construct and developed 30 items. Expert’s ideas from India and Iran have been considered. The scale was verified for validity, reliability and factor structure. The tool can be used for clinicians and research purpose to screen the level of difficulties. The exclusive effort of this scale is that it assess a broader range of events occur in childhood which might be traumatic. The findings of this paper will help the identification of stressor types and rate in the childhood period of the person and promote well-being. It clearly needs to take action and facilities into account for this issue regarding high risk group. These tool might be suitable for future research, policy, and treatment efforts aimed at understanding and preventing mental illness.

stressful events into two groups. The non-independent or chronic and those that are independent or acute. (Kaplan, & Sadock, 1995).
The theories of aetiology of psychopathology highlighted the enduring influence of early life experience on psychological health across the lifespan (Kiecolt-Glaser, et al, 2011& Opaas, & Varvin, 2015. In general, the mental disorder origins as outcome of childhood adverse experiences (McLaughlin, 2016, Conti, et al, 2012&. Cabrera, et al, 2007. Karen Horney found the childhood insecurity as the root of later mental illness (Segal, & Yahraes, 1924). There is a risk for adult psychiatric disturbance (McLaughlin, et al, 2012), as well as physical health in adulthood due to childhood adversities (Word Health Organization, 2015, Fagundes, et al, 2013& Scott, et al, 2011. Disclosure to adversities in childhood is associated with following alterations in regional brain grey matter volume (GMV). (Walsh, et al, 2014).
World Mental Health (WMH) Survey Initiative reports that CAs accounted for 29.8% of psychiatric morbidities worldwide (Kessler, et al, 2010). It becoming a co-operative research within the national and international centres. Although, substantial link between adversities in childhood and adult mental as well as physical illnesses have been evidenced through epidemiological studies (Dong, et al, 2005, Pirkola, et al, 2005& Green, et al, 2010. However, Peak of these studies considered either only a single childhood adversity (Schreier, et al, 2009, Raleva, et al, 2013., Vanaelst, et al, 2012& Panter-Brick, et al, 2011, or a few varied types of childhood adversities which did not cover the full wide range of adversities might occur in childhood (Allen, et al, 2014). After all, not many studies investigated the wide types of mental or physical health issues in adulthood, as a consequence of adversities occur in childhood period (Fujiwara, & Kawakami, 2010& Kessler, Davis, Kendler, 1997. Still few studies investigated in this area and its effect later in life course (Flaherty, et al, 2006), and particularly on specific psychotic disorders (Fisher, et al, 2010). However, available interviews and tools are not appropriate enough for all research purposes in broad range of experiences and mostly focus on specific area of adversities. The virtues of utilizing interviews and tools in collecting history of childhood experiences have been acknowledged. Consequently, there is call for standardized self-report questionnaires measuring experience of childhood adversity for adult age.
Obviously, the first and last objective of improving adverse childhood experiences scale is to examining the correlation of ACEs with mental health symptoms to help with human wellbeing. Therefore, if an ACE scale measure childhood adversities in a broader range, the validity of such correlation in general with mental health and possibly with particular disorders would be clearer. Support from available sources with the use of prober varied samples are required to increase the validity of the tool. Combination of the results of multiple psychological studies can indicate common patterns of potential harm-full and health-affect risk factors in childhood. In Iran region not much evidence of research in such area, therefore the present study addresses the study in this area by constructing a wide range adversities occur in childhood period to be used in different research area.

Item and Scale Development Process
The item generation was done by help of operational definition of harmful events and adversities might occur during childhood. The CAQ items are based on results of several studies that included checklists, questionnaire, inventories, scales, and semi structured interviews regarding adversity in clinical and non-clinical settings. Many of studies have provided empirical support for the dimensions of the CAQ in different samples. The dimensions of the CAQ are consistent of a combination of many available childhood adversities studied, instrument and researcher's results, such as World Health Organization Surveys (2010) and etc.… Initially 32 items were created. The items where check with Indian and Iranian psychologists to check for simplicity and validity, clarity in addition of relevance. The expert's advice were considered to alter the sentences formulation and finally deleted some items. After corrections we created an initial pool of 30 items.

Instrument
Final corrections created an initial pool of 30 items, in which the participants respond on a five-point Likert rating scale ranging from 0 (Not at all) to 4 (Very extremely). 0= Not at all, 1= A little, 2= Moderately, 3= extremely, 4= Very extremely. Item ratings are added across all items of a given subscale to obtain subscale scores. Where the maximum-minimum score ranged between 0 and 120 and the higher scores of CAQ indicate a greater perception of childhood adversities in the domain of the subscale.

Participant
Participants were consistence of a group of Iranian with a proficiency in English language in Shiraz, Iran. The sample of 54 including men and women 1.1, in the present analysis the mean age of sample was 21.38 years (SD=5.81).

METHOD
The constructed scale was administered in a survey design and retrospective method. The questionnaire was given to sample in equivalent situation to be filled within enough time, and it was repeated four weeks after again to the same sample group and same condition. Normative data (i.e., means and standard deviations) for the CAQ were reported as follows: for the total 13 factors (n= 54), the mean score was 25.87 (SD=10.34). Table A shows mean score and standard deviation of all subscale of the tool (Table A).

Measure
The Exploratory factor analysis (EFA) was computed to evaluate the factorial structure of the CAQ in a pilot study including 54 inpatients. Suggesting that data are suitable for exploratory factor analysis. Factor analysis indicated that the CAQ consisted of thirteen (13) factors. Principal factor analysis with Varimax Rotation was used to determine the construct validity, considering an Eigen value higher than 1. Factor analysis specification was satisfactory; KMO = .29, Bartlett's Test of Sphericity = 689.80, df = 435, p = .0001, and the Rotation Sums of Squared Loadings = 80.16. Result of an exploratory principal-axis factoring with Varimax Rotation that used 32 CAQ items showed correlation among the factors (except for item 4 and 27 which finally has been removed) with a priori conceptual formulation of the instrument. Two items has been removed and the total items have been decreased to 30 items. The Kaiser-Meyer-Olkin KMO and Bartlett's Test information is presented in table B. To shows the significantly rotated correlation of higher than .30 for 30 items in 23 iterations refer to table C. (Table C).
Factor analysis indicated that the CAQ consisted of thirteen factors and that the Eigen values for these factors ranged from 8.38 to 80.16. These factors explained 80.16% of variance. The first factor is Psycho-Social Adversities (PSA) was measured by 6 items, the second factor name Threat and Deprivation (TD) included 3 items. Third factor labelled as Violence against Mother (VM) contained 1 item. And fourth factor known as Familial Adversities (FA) comprise of 3 items. Factor five named as School-Environmental Adversities (SEA) involved of 3 items. While Neglect and Conflict (NC) as the sixth factor measured by 2 items. The factor 7 was measured by 2 items labelled as Violence and Sexual abuse (VSA), number 8 factor named as Over-Controlling and locking up (OL) contain of 2 items. Ninth factor known as Attack and Robbing (AR) was measured by 1 item. While tenth factor as Accident and Emotional Abuse (AEA) contain of 2 items. The eleventh factor means Familial Mental Health Problems (FMHP) involve 2 items. Twelve factor name as feeling unloved was measured only by 1 item, while the thirteen and last factor Physical Abuse (PA) was measured by 2 items. Table D and E in appendix show the results details of factor analysis, factors and their items (Table D, Table E).

Scale Validation
The objective is to measure the validity of the adverse questionnaire in childhood. The construct validity of the CAQ was evaluated in a sample including 54 inpatients individual whom were masters in understanding English language in Iran. Furthermore, the criterion validity of CAQ and its subscales were measured by using Family Emotional Involvement and Criticism Scale (FEICS; Shields et al., 1992) and Stressful Factors Inventory (SFI; Khodayarifard & Parand, 2007) in this study. As table 5 shows the CAQ and its subscales have a good validity with familial emotional disturbances and stressors as two indicators familial dysfunction and maltreatment during childhood. FEICS and CAQ Family Emotional Involvement and Criticism Scale (FEICS; Shields et al., 1992) were highly correlated with CAQ scale and subscales with correlations .289*. Stressful Factors Inventory (SFI; Khodayarifard & Parand, 2007) were also highly correlated with CAQ scale and subscales with correlations .379 **. Referee to table F for more description of result of the criterion validity of CAQ and its subscales with two other scales. (Table F)

Reliability of CAQ
To examine the reliability of CAQ and its subscales, test-retest was done with Four weeks interval and Cronbach's internal consistency alpha was used for this study. The result indicated that there are significant positive correlations between CAQ and its subscales ( Table G). The reliability of the CAQ was established using Cronbach's alpha, which was found to be .86. (Table H). Test-retest within Four weeks showed that CAQ and its subscales have satisfactory reliability (Table I).

DISCUSION
The key drive of this study was to construct a theoretically grounded and empirically validated scale for childhood adverse measurement. The scale developed is sufficiently in its structure factors and reliability. Its validation was showing a valid instrument in comparing with two other scales.

LIMITATION
This instrument measure adverse experiences during childhood through a prospective method. This might cause some bias in data collection, due to false remembrance. There is need to develop more valuable scale to captured more trustable information of emotional impression of such experiences through qualitative and experimental longitudinal research.

IMPLICATION
The author suggested that this scale might be helpful for many purpose including (i) to enhance the insight of experts, psychologists, sociologist,… (ii) it may help to realize the problematic area (iii) it can be beneficial for a number of settings, such as psychiatric inpatient and nonclinical settings (iv) to help in prevention (v) encourage to focus more on childhood (vi).

CONCLUSION
In order to gain a complete understanding of childhood adverse effect on adult mental and physical well-being, we need to opens more interesting outlines of survey on instruments to collect more and accurate data in future researches. As further studies are needed to find more empirical evidence for realizing more network between adversities in childhood and future conflicts and problems. There is also needs for finding more prevention techniques.    Df 435 Sig. .0001