The 'Maltreatment and Abuse Chronology of Exposure' (MACE) scale for the retrospective assessment of abuse and neglect during development

Martin H Teicher, Angelika Parigger, Martin H Teicher, Angelika Parigger

Abstract

There is increasing interest in childhood maltreatment as a potent stimulus that may alter trajectories of brain development, induce epigenetic modifications and enhance risk for medical and psychiatric disorders. Although a number of useful scales exist for retrospective assessment of abuse and neglect they have significant limitations. Moreover, they fail to provide detailed information on timing of exposure, which is critical for delineation of sensitive periods. The Maltreatment and Abuse Chronology of Exposure (MACE) scale was developed in a sample of 1051 participants using item response theory to gauge severity of exposure to ten types of maltreatment (emotional neglect, non-verbal emotional abuse, parental physical maltreatment, parental verbal abuse, peer emotional abuse, peer physical bullying, physical neglect, sexual abuse, witnessing interparental violence and witnessing violence to siblings) during each year of childhood. Items included in the subscales had acceptable psychometric properties based on infit and outfit mean square statistics, and each subscale passed Andersen's Likelihood ratio test. The MACE provides an overall severity score and multiplicity score (number of types of maltreatment experienced) with excellent test-retest reliability. Each type of maltreatment showed good reliability as did severity of exposure across each year of childhood. MACE Severity correlated 0.738 with Childhood Trauma Questionnaire (CTQ) score and MACE Multiplicity correlated 0.698 with the Adverse Childhood Experiences scale (ACE). However, MACE accounted for 2.00- and 2.07-fold more of the variance, on average, in psychiatric symptom ratings than CTQ or ACE, respectively, based on variance decomposition. Different types of maltreatment had distinct and often unique developmental patterns. The 52-item MACE, a simpler Maltreatment Abuse and Exposure Scale (MAES) that only assesses overall exposure and the original test instrument (MACE-X) with several additional items plus spreadsheets and R code for scoring are provided to facilitate use and to spur further development.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Development and Validation.
Fig 1. Development and Validation.
Flow chart enumerating the sequence of steps used to develop and validate the Maltreatment and Abuse Chronology of Exposure Scale.
Fig 2. Emotional Neglect.
Fig 2. Emotional Neglect.
Rasch analysis of emotional neglect subscale showing item characteristic curve, item information curve and test information function.
Fig 3. Test-retest Reliability.
Fig 3. Test-retest Reliability.
Bland and Altman analysis of reliability / reproducibility of test—retest scores. Red line indicates the mean difference between test and retest scores, which is close to zero. Horizontal lines indicate confidence intervals showing that test-retest difference scores fall within ± 2 points.
Fig 4. Recollected time course 1.
Fig 4. Recollected time course 1.
Recollected time course of exposure to emotional neglect, non-verbal emotional abuse, parental verbal abuse, parental physical maltreatment, peer motional abuse and peer physical bullying in males and females.
Fig 5. Recollected time course 2.
Fig 5. Recollected time course 2.
Recollected time course of exposure to physical neglect, familial and non-familial sexual abuse, witnessing interparental violence and witnessing violence to siblings in males and females.
Fig 6. Statistical Differences in Time Course…
Fig 6. Statistical Differences in Time Course Across Different Types of Abuse.
A. Heat map showing Z-score differences in time course of exposure to different types of maltreatment in females. Darker shading is indicative of more significant differences. B. Multidimensional scaling showing in 2-dimensional Euclidean space the degree of similarity or difference in time course of exposure to different types of maltreatment in females. The greater the distance between exposure types the more significant the difference. C. Heat map showing Z-score differences in time course of exposure to different types of maltreatment in males. D. Multidimensional scaling showing in 2-dimensional Euclidean space the degree of similarity or difference in time course of exposure to different types of maltreatment in males. Abbreviations: EN—emotional neglect; NVEA—parental non-verbal abuse; Phys—parental physical maltreament; PVA—parental verbal abuse; Peer_E—peer emotional abuse; Peer_P—peer physical abuse; PN—physical neglect; SexAb—sexual abuse; WIPV—witnessing interparental violence; WSibA—witnessing sibling abuse.

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