Childhood Trauma Questionnaire

Score: Emotional Abuse, Physical Abuse, Sexual Abuse, Emotional and Physical Neglect, and Minimization–Denial of Abuse.

Description: The Childhood Trauma Questionnaire is a 28-item self-report retrospective inventory intending to measure childhood or adolescent abuse and neglect. It is straightforward and easy to use. The CTQ can be administered individually or to a group. The examinee responds to 28 simple questions on a 5-point Likert scale ranging from Never True to Very Often True. The central constructs underlying the questionnaire are emotional, physical neglect and abuse, and sexual abuse. Other traumatic events that may occur during childhood, such as the death of a parent or a major illness, are not assessed. The items are written at a sixth grade reading level and reading level and intellectual functioning should be assessed before administering the scale.

Scoring: The CTQ contains five subscales, three assessing abuse (Emotional, Physical, and Sexual) and two assessing neglect (Emotional and Physical). Each subscale has five items and there is a three-item Minimization-Denial subscale to check for extreme response bias, specifically attempts by respondents to minimize their childhood abuse experiences. A 5-point frequency of occurrence scale is utilized: (1) never true, (2) rarely true, (3) sometimes true, (4) often true, and (5) very often true. Each subscale score ranges from 5 (no history of abuse or neglect) to 25 (very extreme history of abuse and neglect).

Reliability: Internal consistency coefficients are offered for all of the subsamples with generally favorable patterns reported. The three largest subsamples, the Sexual Abuse (alphas of .93 to .95) and Emotional Neglect (alphas of .88 to .92) are the most reliable. Emotional Abuse (alphas of .84 to .89) and Physical Abuse (alphas of .81 to .86) have acceptable reliabilities. The internal consistency of Physical Neglect (alphas of .63 to .78) is marginal. Test-retest reliabilities with testing over an average 3.6-month period yielded stability coefficients near .80, suggesting good consistency of responses over time.

Validity: The results of confirmatory factor analyses, which tested the goodness of fit of the five-factor CTQ subscale model for the adult substance abusers, the adolescent psychiatric inpatients, and a subsample of the HMO members, showed structural invariance across the three samples suggesting that they measured the same constructs across groups. There are good correlations between scores on the CTQ and ratings derived from semistructured interviews administered by clinicians and ratings by therapists. The correspondence of the CTQ scores with ratings of Sexual Abuse and Physical Abuse seem particularly noteworthy (typically correlations from .50 to .75).

Norms: Norms were derived from six samples. Only three had more than 300 subjects: (a) 378 mostly Black, male inpatient substance abusers; (b) 398 adolescent psychiatric inpatients; and (c) 1,225 all female, mostly White HMO members. These three subsamples comprise 2,001 of the 2,201 individuals in the CTQ norm group. The first two subsamples are from New York psychiatric facilities and the latter sample was from the Pacific Northwest. Despite using nonrepresentative samples, the authors offer "norms" for each of these subsamples. The adult substance user norms present percentile ranks derived from just 58 female respondents. Percentile ranks are also provided for adolescent psychiatric patients and are derived from just 171 males and 227 females. The distributions of scores, even in these high-risk samples, were quite skewed. The CTQ norms were also used to create the severity classification categories of (1) None or Minimal, (2) Low to Moderate, (3) Moderate to Severe, and (4) Severe to Extreme. How these classifications apply to regional groups in the U.S. is completely unknown. These categories should be used with extreme caution.

Suggested use: The stated uses of the CTQ are (a) for rapid abuse-history taking for treatment planning, (b) to encourage disclosure of childhood abuse as part of clinical assessments, and (c) for use in epidemiological and correctional studies involving childhood abuse. As a screening tool to identify individuals with a childhood history of abuse and neglect, this device may have utility.