Psychometric Validation And Factor Structure Of The Romanian Version Of The Adverse Childhood Experiences – International Questionnaire (ACE-IQ) In Clinical And Non-Clinical Sample - Info and Reading Options

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Study Objective and Design The primary objective of this research is to conduct the psychometric and factorial validation of the Romanian version of the Adverse Childhood Experiences – International Questionnaire (ACE-IQ) for the assessment of adverse childhood experiences (ACEs) in two samples (clinical and non-clinical) of adult participants (aged 18 and above) from Romania. The study design is primarily cross-sectional, with a longitudinal component to evaluate test–retest reliability one month after the initial administration. Data are collected predominantly through face-to-face administration, complemented by an electronic (online) clinical screening. For participants residing outside Bucharest and/or unable to travel, full or partial online data collection is also available, with strict confidentiality measures in place. Throughout the study, trauma-informed care (TIC) principles are applied, ensuring participant safety and empowerment. Translation Process The translation of the ACE-IQ into Romanian was carried out exclusively by specialists, without the use of software or artificial intelligence. The team included: (i) two initial translators (RM & DV), clinical psychologists and psychotherapists with expertise in psychotraumatology; (ii) a linguistic expert (AV), a specialized translator responsible for reconciliation; (iii) two back-translators (AF & AA), clinical psychologists with expertise in psychotraumatology and therapeutic interventions for children from vulnerable backgrounds, respectively; and (iv) an expert committee consisting of the entire research team, including the two initial translators, two additional researchers (CN, with expertise in psychometric validation, and TG, with expertise in psychotraumatology), as well as an additional clinician (GS) with expertise in psychotraumatology. Together with the linguist and the back-translators, this committee contributed to the development of both the pilot and final versions of the instrument. For certain auxiliary materials (i.e., scoring guide, question-by-question guide, and interviewer manual), the initial translation was performed by a single researcher (RM), followed by linguistic review (AV) to ensure coherence. For another auxiliary material (i.e., data coding questionnaire), the pilot and final versions of the instrument were used, with only the coding categories added. During the validation stages, all auxiliary materials were updated to integrate first the pilot items and, subsequently, the final version. Translation Design The linguistic and cultural adaptation of the instrument followed the recommendations of the International Test Commission (ITC, 2017). A forward–backward translation design with stepwise validation was employed to ensure semantic, conceptual, and cultural equivalence between the original and Romanian versions. This approach reduces translation errors, supports score comparability across versions, and facilitates interpretation in different cultural contexts. Step 1: Construct Analysis. The research team (RM, CN, DV, TG) evaluated the extent to which the constructs measured by the instrument were relevant and equivalent in Romanian culture, based on a literature review concerning both the conceptual validity of the ACE-IQ and its cultural specificity. Epidemiological data on the prevalence of ACEs in Romania and culturally specific factors influencing item comprehension were also reviewed. This analysis confirmed that the instrument could be adapted to the Romanian context with minor cultural adjustments. Step 2: Forward Translation. Two researchers (RM & DV), both clinical psychologists and psychotherapists specialized in psychotraumatology, independently produced two forward translations of the instrument (English → Romanian), without access to each other’s version. The process followed ITC (2017) recommendations on independent multiple translation and relied on standardized guidelines developed by one of the researchers (CN), experienced in test adaptation. These included the use of key terms, avoidance of stigmatizing formulations, and preference for accessible language. At this stage, the interviewer's manual was also translated by RM and reviewed by the linguist (AV). Step 3: Reconciliation. The linguist (AV), a professional translator without prior knowledge of the instrument, compared the two forward translations and produced a reconciled version. To improve terminological consistency, the research team developed a glossary of terms and definitions for ACE-IQ constructs. The reconciled version ensured fidelity to the original, linguistic clarity, accessibility, and cultural sensitivity. Step 4: Back-Translation. Two clinical psychologists fluent in English and Romanian independently back-translated the reconciled version into English. AF specialized in psychotraumatology, while AA specialized in therapeutic interventions with children from vulnerable communities. Both translators were blinded to the original version and to each other’s translation. The purpose was to identify semantic and conceptual inconsistencies between the reconciled Romanian version and the original. Step 5: Expert Committee Review. The expert committee—comprising the research team (RM, CN, DV, TG), the linguist (AV), the back-translators (AF, AA), and an additional psychotraumatology clinician (GS)—reviewed the pilot version of the instrument. Items were assessed for clarity, cultural relevance, and sensitivity. Adjustments included reformulation into second-person singular to ensure a familiar and direct tone that promotes self-disclosure, harmonization of expressions with the original meaning, and adaptation to the Romanian cultural context. At this stage, additional auxiliary materials (data coding questionnaire, scoring guide, and question-by-question guide) were translated by RM and reviewed by AV. Pilot Study (Completed Phase) A pilot study was conducted prior to the full-scale validation to ensure the linguistic equivalence and cultural relevance of the Romanian version. Eighteen participants (N = 9 clinical; N = 9 non-clinical) were recruited, and the instrument was administered by licensed clinical psychologists in two formats: face-to-face interviews (N = 9; clinical [N = 5], non-clinical [N = 4]) and online self-report (N = 9; clinical [N = 4], non-clinical [N = 5]). Following administration, all participants completed cognitive interviews (face-to-face or online, depending on administration mode) that explored item clarity, fluency, emotional discomfort, cultural and socioeconomic relevance, sensitivity of wording, and suggestions for improvement. Based on this feedback, the research team revised the instrument and finalized the Romanian version of the ACE-IQ, together with the auxiliary materials. Final Testing (Ongoing Phase) Following the completion of the pilot stage, the finalized Romanian version of the ACE-IQ is currently being administered in clinical and non-clinical samples, through both face-to-face and online formats. The aim of this ongoing phase is to evaluate the psychometric properties and factorial structure of the Romanian ACE-IQ, as well as its test–retest reliability. Participants and Recruitment Participants are being recruited both online (via e-mail and social media) and face-to-face (through outreach by the research team in collaborating institutions, including universities, psychotherapy and clinical assessment practices, and the University of Bucharest Clinic). Recruitment follows a staged process aligned with TIC principles: Stage I. Potential participants are informed about the research team, study aims, methodology, and the voluntary nature of participation. Stage II. Detailed information is provided regarding confidentiality, its limits, potential risks, prevention and intervention strategies, and the right to withdraw without negative consequences. Written informed consent is obtained at this stage. Stage III. Participants declare the presence or absence of a psychological diagnosis. Those with a valid diagnosis (based on at least one structured clinical interview by a psychiatrist or licensed clinical psychologist, according to DSM-5 criteria) are assigned to the clinical sample. Those without or with a non-validatable diagnosis undergo an online clinical screening. If relevant symptoms are identified (e.g., daily dysfunction, low well-being, significant difficulties, or risk), participants are referred for a full clinical psychological evaluation, conducted face-to-face (for residents of Bucharest/able to travel) or online (for others). Participants without clinically significant symptoms are allocated to the non-clinical sample. Stage IV. Participants undergoing a clinical evaluation receive the final results and are assigned either to the clinical sample (if DSM-5 psychopathology is present) or to the non-clinical sample (if no diagnosis is identified). Informed Consent Given the sensitivity of the topic (ACEs), informed consent is obtained at multiple stages, in accordance with TIC principles. Written consent is first collected at Stage II of recruitment, after participants are fully informed about study aims, methodology, and the voluntary nature of participation. At Stage III, prior to online screening, electronic consent is requested within the survey platform. At Stage IV, before clinical psychological evaluation, a specific written consent form is signed. Finally, before the administration of the ACE-IQ and additional mental health instruments, written consent is again obtained. For participants randomly selected for retesting, consent is renewed at the second administration. For those residing outside Bucharest or unable to travel, signed consent forms may be scanned and submitted electronically.

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