1. Hannah Holbrook BA 1, Kerry O’Loughlin BA 1, Robert Althoff MD, PhD 1, Heather Douglas-Palumberi MA 2, Joan Kaufman PhD 2, James Hudziak MD 1 1 Vermont Center for Children, Youth, & Families, University of Vermont College of Medicine 2 Yale Child Study Center, Yale University School of Medicine The Yale-Vermont Adversity in Childhood Scale: A quantitative approach to adversity assessment Introduction Results This work was funded by NIMH grant R01 MH098073. Discussion The psychometric properties of the Y-VACS were assessed based on a sample of 171 children who had endured various levels of adversity. Two independent raters reviewed a subset of these data (N=75) and generated a Y-VACS and an ACEs score for each child. In completing these surveys, information was gathered from the following sources: Child Protective Services (CPS) records, the Traumatic Experiences Survey Instrument (TESI), the Partner-Violence Inventory (PVI), the UCLA PTSD Reaction Index (R.I.), and independent information gleaned from the Y-VACS child and parent reports that was not evident in previously listed sources. Correlations between parent- and child-reports were calculated. Latent class analysis (LCA) of clinician ratings was conducted. Child intra-familialChild extra-familialChild total Parent intra-familialr =.54**r =.16r =.48** Parent extra-familialr =.24*r =.37**r =.34* Parent totalr =.55**r =.28*r =.54** Methods 3.Inter-rater reliability Cronbach’s alpha statistics were calculated in SPSS to assess inter-rater reliability for Y-VACS and ACEs scores. Results indicate high inter-rater reliability for scores on both the ACEs (α =.95, p <.001) and Y-VACS (α =.95, p <.001). On the Y-VACS, inter-rater reliability was higher for intra- familial adversity (α =.95, p <.001) than extra-familial adversity (α =.83, p <.001). Figure 2. Y-VACS total scoresFigure 1. ACEs total scores The Y-VACS demonstrates strong psychometric properties in our population, including normal distribution of scores and high inter-rater reliability. Its dimensional approach to frequency and severity ratings, along with its inclusion of extra-familial adversity, allow for more meaningful differences between various adversity profiles than those generated by ACE scores. Although parent- and child-reports correlate, the degree of correlation between the two emphasizes the importance of a multi-informant approach to quantifying child adversity. Latent class analyses reveal two distinct profiles, differing in their frequency of intra-familial adversity. The ability to draw this distinction is dependent on the quantitative nature of the Y-VACS. In quantifying traumatic experience though a finer lens, we are hopeful that the YVACs will be used along with behavioral, neuroimaging, and genotypic data to help facilitate a better understanding of the relationship between traumatic experiences and phenotypic presentations. Table 1. Person correlation values between parent- and child- reports on Y-VACS total score and intra- and extra-familial subscores. * p <.05, ** p <.01 Currently, the gold standard of adversity assessment is the The Adverse Childhood Experiences (ACE) survey. The ACEs is a ten item questionnaire that assesses exposure to a variety of traumatic experiences. Each item on the ACEs is scored categorically (i.e. 0 and 1 rating scale) and the scores range from 0-10. To date, much has been learned from the ACEs. Research indicates that children who have experienced four or more ACEs are more likely to have substance abuse problems, sexually transmitted diseases, and be on anti- depressants in adulthood 1. Research also indicates that children across all socioeconomic strata experience ACEs 2. Despite its many advantages, the ACEs has some limitations including that it only queries for intra-familial adversity. In addition, given its categorical scoring, two children who have endured markedly different experiences can receive identical ACE scores. To address these limitations, we have developed the Yale-Vermont Adversity in Childhood Scale (Y-VACS). This new measure improves on the ACE survey by including extra-familial experiences and relying on multiple informants. The Y-VACS suite of instruments consists of a child self-report (Y-VACS SR ) 3, parent-report (Y-VACS PR ) 3, adult self-report on childhood experiences (Y-VACS ASR ) 3, and a clinician rating (Y-VACS CR ) 4. Each of these scales includes a frequency and severity rating for each experience, thereby making the Y-VACS a more quantitative and comprehensive measure than the ACE survey. Y-VACS scores range from 0-100, allowing for a high level of distinction among children and adolescents who would receive comparable ACE scores. In capturing the heterogeneity in child adversity, the Y-VACS will enhance our understanding of the relationship between traumatic experiences and phenotypic presentations. References 1 Heckman, J. (2008). Schools, Skills and Synapses Economic Inquiry. 46(3): 289. 2 Bethel, C. (2013). Presentation at 2011-12 NSCH (HRSA/MCHB/CDC). 3 Hudziak, J.J. & Kaufman, J. (2014). 4 Kaufman, J. & Hudziak, J. J. (2014). All authors have no disclosures relevant to this work. 4. Parent and child report correlations 1. ACES and Y-VACS Frequency Distributions 4. LCA of Y-VACS items LCA of the Y-VACS CR was used to identify profiles within this 20-item scale. Three items were excluded due to exceedingly low frequency. 2. Dimensional versus categorical measurement Figure 3. Range of Y-VACS total scores for each ACE score ClassLLBIC(LL)LMREntropy Model 11 class-2915.576005.360.97 Model 22 class-2646.395559.230.000.98 Table 2. Fit statistics for LCA models Figure 4. Patterns of item endorsement for two-class model