Capturing the Complexity of Childhood Sexual Abuse: An Exploratory Evaluation of Expanded ACE-10 Items

The Adverse Childhood Experiences scale (ACE-10) is widely used to assess potentially traumatic events in childhood. However, it remains unclear whether the ACE-10 adequately captures the complexity of childhood sexual abuse (CSA), as CSA is assessed using a single dichotomous item in the measure. The current study evaluates whether incorporating three additional sexual abuse items improves the scale’s measurement properties and explanatory utility. Using a general population sample of 667 adult women, an exploratory factor analysis was conducted to compare the factor structure of the original ACE-10 with an expanded version that includes items assessing age at sexual abuse, the victim–perpetrator relationship, and if the abuse happened once or multiple times. Structural equation models were then estimated to examine how factors derived from each version of the scale relate to depression, anxiety, sexual victimization, and substance abuse in adulthood. Results indicate that the inclusion of additional CSA items yields improved factor discrimination. Additionally, the expanded ACE-10 provided greater nuance regarding how various forms of adverse childhood experiences are related to adverse outcomes later in life. These findings suggest that the standard ACE-10 may insufficiently capture the complexity of CSA and that the expansion of items in this area can meaningfully enhance measurement precision.