Measuring Adverse Childhood Experiences in Young Children: A Portuguese Caregiver-Report Study Comparing Conventional, Expanded, and Reduced ACE Scores

Background/Objectives: Adverse childhood experiences (ACEs) are associated with child socio-emotional difficulties, but when using parents’ reports, it remains unclear which scoring approaches are most informative about younger children. This study evaluated a Portuguese caregiver-report ACE assessment derived from the Finkelhor/Turner framework in a community sample of children aged 2–10 years. Methods: Caregivers provided reports on ACE exposure and socio-emotional adjustment for 341 children. Three ACE scores were compared: an approximate original ACE score, a full ACE pool score, and an adapted reduced caregiver-report score. Associations with socio-emotional adjustment were examined using correlations, adjusted regressions, ROC analyses, domain models, and latent class analysis. Results: Higher ACE exposure was associated with greater difficulties and lower prosocial behavior. The nine-item approximate original ACE score, which did not include emotional neglect, showed the strongest overall predictive and discriminative performance for caregiver-reported SDQ outcomes in this Portuguese sample. This finding should therefore be interpreted as evidence regarding the available approximation of conventional ACE indicators rather than the complete original ACE inventory. Among the two expanded ACE scoring approaches, however, the adapted reduced score consistently outperformed the full ACE pool, supporting a more parsimonious approach. ROC analyses indicated acceptable discrimination for elevated total difficulties, with the approximate original score showing the highest area under the curve (AUC); however, positive predictive values were low across all three scores, indicating limited stand-alone screening utility at the individual level. Domain analyses highlighted economic stressors, maltreatment, and family disorder as salient predictors. Latent class analysis identified low adversity, moderate family/economic adversity, and high polyadversity profiles. Both adversity-exposed classes showed poorer socio-emotional adjustment than the low-adversity class. Conclusions: Findings support the relevance of caregiver-report ACE assessment for understanding socio-emotional adjustment in young children, while also highlighting the need for developmentally sensitive, culturally adapted, and outcome-validated scoring approaches. More extensive ACE pools were not necessarily more informative than shorter empirically or theoretically grounded scores.