Elsevier

Child Abuse & Neglect

Volume 27, Issue 2, February 2003, Pages 169-190
Child Abuse & Neglect

Development and validation of a brief screening version of the Childhood Trauma Questionnaire

https://doi.org/10.1016/S0145-2134(02)00541-0Get rights and content

Abstract

Objective: The goal of this study was to develop and validate a short form of the Childhood Trauma Questionnaire (the CTQ-SF) as a screening measure for maltreatment histories in both clinical and nonreferred groups.

Method: Exploratory and confirmatory factor analyses of the 70 original CTQ items were used to create a 28-item version of the scale (25 clinical items and three validity items) and test the measurement invariance of the 25 clinical items across four samples: 378 adult substance abusing patients from New York City, 396 adolescent psychiatric inpatients, 625 substance abusing individuals from southwest Texas, and 579 individuals from a normative community sample (combined N=1978).

Results: Results showed that the CTQ-SF’s items held essentially the same meaning across all four samples (i.e., measurement invariance). Moreover, the scale demonstrated good criterion-related validity in a subsample of adolescents on whom corroborative data were available.

Conclusions: These findings support the viability of the CTQ-SF across diverse clinical and nonreferred populations.

Introduction

Over the past two decades, research on the prevalence, causes, and consequences of child abuse and neglect has increased exponentially (Crouch & Milner, 1993, Finkelhor, 1994; Kendall-Tackett, Meyer Williams, & Finkelhor, 1993; Knutson, 1995, Malinosky-Rummell & Hansen, 1993). However, many of the empirical studies in this area are limited by serious methodological shortcomings, including a lack of standardized, adequately validated instruments for retrospectively assessing abuse and neglect (Briere, 1992). Many previous studies have used methods such as chart review or single questions or items to assess maltreatment, although such approaches may be unreliable and lack sensitivity (Briere & Zaidi, 1989). Moreover, studies have often focused on a single form of childhood trauma, typically sexual or physical abuse, despite evidence that multiple types of maltreatment often cooccur (Briere & Runtz, 1988, Rosenberg, 1987). As a result, it has been difficult to disentangle the effects of particular types of trauma from that of other coexisting forms or from the impact of maltreatment in general. Little systematic attention has been paid to issues concerning instrument format, for example, whether maltreatment phenomena are more adequately ascertained using self-report questionnaire or interview methods (Dill, Chu, Grob, & Eisen, 1991; Walker, Bernstein, & Keegan, 1997). A related issue is whether childhood trauma are better conceptualized as dichotomous events (i.e., events that either did or did not occur) or as experiences that vary along continuous dimensions such as frequency, severity, and duration (Lipschitz, Bernstein, Winegar, & Southwick, 1999; Walker et al., 1997). Finally, although several instruments have been developed that incorporate a more methodologically sophisticated approach to the assessment of childhood trauma (Bernstein & Fink, 1998; Bernstein et al., 1994; Bifulco, Brown, & Harris, 1994; Ditomasso, 1995; Fink, Bernstein, Handelsman, Foote, & Lovejoy, 1995; Gallagher, Flye, Hurt, Stone, & Hull, 1992; Herman, Perry, & van der Kolk, 1989; Meyer, Muenzenmaier, Cancienne, & Struening, 1996; Sanders & Becker-Lausen, 1995, Straus & Hamby, 1997; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998; Zanarini, Gunderson, Marino, Schwarz, & Frankenburg, 1989), comparatively little attention has been paid to their validity. While published reports on many of these instruments contain information about reliability, most contain little information about criterion-related validity or construct validity. With the exception of the Childhood Trauma Questionnaire (Bernstein & Fink, 1998, Bernstein et al., 1994), none of these instruments has been validated with respect to the critical question of whether they correctly detected abuse and neglect histories (i.e., criterion-related validity).

This lack of attention to instrument validity is of particular concern, given the controversy over the accuracy of retrospective reports of childhood trauma. Many authors have noted that a variety of factors can affect the accuracy of recollections for childhood events, including normative ones, such as the degradation of memories over time, and pathological ones, such as dissociation and repression (Allen, 1995, Bernstein et al., 1995, Rogers, 1995). The “false memory syndrome” is another example of inaccurate recall, in this case, one that is purportedly iatrogenic in nature (Loftus, 1993). On the other hand, some authors have noted that memories for childhood experiences may actually be enhanced in cases where events are unusual, unexpected, or consequential, such as childhood trauma (Brewin, Andrews, & Gotlib, 1993). One experimental study found that recall was improved for emotionally arousing events and that this enhancement was related to greater beta-adrenergic activation (Cahill, Prins, Weber, & McGaugh, 1994). In light of these controversies, it is essential that trauma researchers demonstrate the validity of their retrospective assessments.

To address the need for reliable and valid assessment of a broad range of maltreatment experiences, Bernstein and colleagues developed a 70-item self-administered inventory, the Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998, Bernstein et al., 1994). The CTQ uses multiple Likert-type items to create dimensional scales, thereby enhancing reliability and maximizing statistical power. Cut scores can be applied to identify individuals with histories of abuse and neglect. In initial studies of adult substance abusers, the CTQ showed excellent test-retest reliability over a 2- to 6-month interval as well as convergent and discriminant validity with a structured trauma interview (Bernstein et al., 1994, Fink et al., 1995). Principal components analysis of the CTQ items yielded four rotated factors which were labeled, physical and emotional abuse, emotional neglect, sexual abuse, and physical neglect (Bernstein et al., 1994). Similar factor analytic results were obtained in a study of adolescent psychiatric patients, with the exception that physical and emotional abuse items loaded on separate factors, rather than a single factor, and that the numbers of items loading highly on each respective factor were somewhat different than in the original study (Bernstein, Ahluvalia, Pogge, & Handelsman, 1997). In the adolescent study, it was possible to corroborate histories obtained with the CTQ through the use of independent evidence, such as information from referring clinicians and agencies, and the reports of other informants. When compared to therapists’ trauma ratings based on all available data about the patient, the CTQ showed good sensitivity and satisfactory or better specificity, supporting its criterion-related validity (Bernstein et al., 1997).

The goals of the present study were twofold. First, we wished to develop a short form of the CTQ that would take no more than 5 minutes to self-administer, to provide more rapid screening for maltreatment histories in both clinical and nonreferred populations. The original 70-item version of the CTQ, which requires 10–15 minutes to give, may be too lengthy for settings in which time constraints are present (e.g., primary care medical settings) or may unduly increase respondent burden, when the CTQ is included in a battery of other tests. A short form of the scale, on the other hand, would overcome some of these limitations. Second, we were interested in examining two important aspects of the construct validity of the CTQ short form: (1) the “measurement invariance” of its factor structure across clinical and nonreferred groups (Hoyle & Smith, 1994), and (2) its criterion-related validity, that is, its relationship to independent validating criteria. Measurement invariance refers to the question of whether a measure holds the same meaning across groups and encompasses several related issues: whether the number and nature of the latent dimensions (i.e., factors) represented by a measure are equivalent across the groups; whether the pattern of factor loadings are the same across groups; and whether the covariances among the latent dimensions are equivalent across groups (Hoyle & Smith, 1994). All of these issues can be addressed through the use of confirmatory factor analysis, a special case of structural equation modeling. In practical terms, measurement invariance means that the CTQ short form would be equally useful in both normal and clinical populations, an essential property in a screening instrument. Moreover, measurement invariance is a precondition for a comparison of means between groups, for example, using the CTQ short form to compare levels of child abuse and neglect across different populations.

Although factor analytic studies of the 70-item CTQ have produced similar results across different populations, they have not demonstrated measurement invariance in the strict sense, in that somewhat different factor structures were obtained (i.e., four vs. five factors, different numbers of items per factor) (Bernstein et al., 1994, Bernstein et al., 1997). In the present study, our aim was to reduce the number of items on each factor to produce a scale with a relatively simple factor structure that would be invariant across diverse clinical and nonreferred groups. In particular, we dropped items from the original CTQ that loaded highly on more than one factor, so that the resulting factors would be as discriminable as possible across multiple populations. We tested the measurement invariance of the CTQ short form in 1978 individuals consisting of four separate samples: a primarily male sample of adult substance abusers enrolled in inpatient and outpatient treatment programs in New York City, male and female adolescent psychiatric inpatients, male and female substance abusers in a community sample from the Southwest, and a normative sample of male and female participants in a longitudinal study selected from greater Los Angeles County. Two of the four data sets—the adult substance abusers from New York City and the sample of adolescent psychiatric patients—had been used previously to examine the validity of the 70-item version of the CTQ (Bernstein et al., 1994, Bernstein et al., 1997). However, we felt justified in using them again in conjunction with the two new samples, because the four samples together provided a diverse set of participants on which to validate the short form of the scale, and because the short form is a substantially different version of the CTQ requiring separate validation. We also performed latent means analyses to test the hypothesis that the adult substance abusers from New York City and the Southwest and the adolescent psychiatric patients would report higher levels of child maltreatment than the normative community sample. The failure to find such differences would be a serious blow to our claims for the scale’s validity, in light of extensive research documenting the high prevalence of maltreatment in clinical populations (Crouch & Milner, 1993, Finkelhor, 1994, Kendall-Tackett et al., 1993, Knutson, 1995, Malinosky-Rummell & Hansen, 1993). Finally, we examined the criterion-related validity of the CTQ short form in a subgroup of the adolescent psychiatric patients on whom corroborative data were available in the form of therapists’ trauma ratings.

Section snippets

Participants

Four diverse sets of participants were used in this study: adult substance abusing patients from New York City, adolescent psychiatric inpatients, substance abusing individuals from a community sample in southwest Texas, and individuals from a normative community sample in Los Angeles County.

Confirmatory factor analysis

Table 1 reports the means, standard deviations, and factor loadings for the individual items that were selected to form the five latent constructs. Alpha coefficients for each group are also reported.

All manifest variables loaded significantly (p≤.001) on their hypothesized latent factors in all four groups. Model modification was minimal and is described below. The fit indexes were quite good which indicated that the hypothesized factor structures were plausible for all four groups: (1) adult

Discussion

The results of the confirmatory factor analyses indicate that with few exceptions the items on the CTQ short form performed equivalently across four diverse populations with differing maltreatment histories, supporting the measurement invariance of the scale. In the initial analyses where each sample was examined separately, the proposed five-factor structure of the CTQ short form (i.e., physical, sexual, and emotional abuse, and physical and emotional neglect) provided a good fit for the data

Acknowledgements

The secretarial and production assistance of Wendy Sallin and Gisele Pham is gratefully acknowledged.

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    Dr. Stein and Dr. Newcomb are supported by a grant from the National Institute on Drug Abuse, DA-01070-28. Dr. Walker is supported by a grant from the National Institute on Mental Health, K20MH01106.

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