Name: Flavia Garcia Pereira
Type: PhD thesis
Publication date: 05/02/2021

Namesort descending Role
Maria Carmen Moldes Viana Advisor *

Examining board:

Namesort descending Role
Angelica Espinosa Barbosa Miranda Internal Examiner *
Maria Angelica Carvalho Andrade Internal Examiner *
Maria Carmen Moldes Viana Advisor *
Michael Eduardo Reichenheim External Examiner *
Sandhi Maria Barreto External Examiner *

Summary: Introduction: Adverse Childhood Experiences have often been reported in several
sociodemographic and cultural contexts. However, the divergence among the methods
used to evaluate these experiences has made it difficult to compare data among
countries. In order to standardize its assessment and to facilitate strategies for
prevention and management, the World Health Organization and the Center for
Disease Control and Prevention developed the instrument named “Adverse Childhood
Experiences International Questionnaire”. Objectives: 1) To identify, through an
review of the literature, the instruments commonly used in the assessment of childhood
adverse experiences in epidemiological research conducted over the past ten years
and to compar their characteristics. 2) To produce a Portuguese-Brazilian version of
the Adverse Childhood Experiences International Questionnaire, through the process
of semantic equivalence. Methods: To identify scientific articles, esarches were
performed in the Latin American and Caribbean Health Sciences Information System
and the Medical Literature Analysis and Retrieval System Online. The Health Sciences
Descriptors used, combined with Boolean operators, were: “child neglect OR life
change events OR child abuse, adult survivors OR adult survivors of child abuse OR
adult survivors of childhood trauma OR adult survivors, child abuse AND
questionnaire”. The semantic equivalence of the instrument was performed in five
phases: 1) obtaining two forward translations of the original instrument into Brazilian
Portuguese and developing a combined version; 2) obtaining two retranslations of the
combined version into English; 3) evaluation of the instrument items by a committee of
experts, concerning: correspondence of the translation with the original version,
relevance/importance, clarity, vocabulary, objectivity, applicability to the Brazilian
context and regarding the instructional sequencing of the items; 4) preparation of a
synthesis version of the retranslations and the first version of the Portuguese-Brazilian
questionnaire; 5) performing two pre-tests to assess acceptability, understanding and
emotional impact through face-to-face interviews, and obtaining the final version of the
adapted questionnaire. Results: 1) Thirty-eight instruments were identified in the 253
scientific articles analyzed. The most commonly used instruments were described:
Childhood Trauma Questionnaire, Childhood Experience of Care and Abuse, Adverse
Childhood Experiences Questionnaire, Child Abuse and Trauma Scale, Early Trauma


Inventory Self Report, and Adverse Childhood Experiences International
Questionnaire. The instruments analyzed differed regarding psychometric properties,
age for application, and number of adverse experiences assessed. Considering the
instruments evaluated, two have a Brazilian Portuguese version available. 2) The
adapted version of the Childhood Experiences International Questionnaire produced
demonstrated to be of easy application and to comprehension, and obtained a good
semantic equivalence when compared to the original version. Conclusion: Several
instruments assessing the exposure to childhood adverse experiences have been
used, assessing different parameters and dimensions, impairing the comparability of
results. The provision of an international questionnaire adapted to the Brazilian context
can contribute to the expansion and standardization of epidemiological research in
Brazil. Its psychometric properties still have to be further evaluated.

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