Childhood Trauma Questionnaire

The Childhood Trauma Questionnaire (CTQ) is a standardized self-report instrument that measures a person’s history of childhood abuse and neglect. It scores five dimensions: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Most practices use the 28-item short form (CTQ-SF), which takes about five minutes and includes three items that flag possible under-reporting.

Each subscale produces a raw score from 5 to 25, which you read against published severity bands from none/minimal to severe-to-extreme. Therapists, psychiatrists, and researchers use the scores at intake, in PTSD assessment, and to track outcomes. The CTQ itself is licensed through Pearson, so the free worksheet below helps you record and interpret scores without reproducing any items.

Key takeaways

The CTQ-SF has 28 items rated on a 5-point scale: 25 cover five maltreatment subscales, and three form a Minimization/Denial validity scale.

Each subscale scores 5 to 25 and has its own severity cut-points, so the same raw score can mean different severity on different subscales.

Internal consistency is good on most subscales (Cronbach’s alpha usually above 0.70), but Physical Neglect often scores lower, at about 0.61 in the 2003 validation.

The CTQ is licensed through Pearson. Its items revisit traumatic memories, so arrange consent and grounding support before a patient starts.

Practice management software like Pabau lets licensed practices send the CTQ-SF as a secure digital form and keep scores in the patient record.

What is the Childhood Trauma Questionnaire?

The CTQ is a retrospective self-report instrument that measures the severity of five types of childhood maltreatment. Respondents rate each item, 70 in the original and 28 in the short form, from 1 (never true) to 5 (very often true). They report on their own early-life experiences, and the answers become scores you can compare across patients and over time.

That makes the CTQ useful in trauma-informed care workflows, where a patient’s history shapes safety planning and treatment goals. Bernstein and Fink’s 1998 manual, published by The Psychological Corporation, standardized how the CTQ is scored and set its severity norms. The CTQ has since been translated into 30+ languages and validated across 50+ peer-reviewed studies in PubMed Central.

Original CTQ vs CTQ-SF: which version should your practice use?

Use the CTQ-SF, the 28-item short form that is also called the CTQ-28. It is an abbreviated version of the original 70-item CTQ, which Bernstein and colleagues published in 1994. In 2003, Bernstein et al. used factor analysis to reduce the original to 25 clinical items, five per subscale. They then added three Minimization/Denial items that flag possible under-reporting. Both versions measure the same five types of maltreatment on the same 5-point Likert scale.

Most practices and research teams choose the CTQ-SF. It covers the same five dimensions with 42 fewer items, so patients finish it faster and tire less. The Minimization/Denial items also help you judge whether an unusually low score is credible. That brevity suits high-volume mental health practice workflows. You will mainly meet the 70-item original when reading older studies that report scores from it.

The five subscales explained

The CTQ-SF measures maltreatment across five empirically derived dimensions, each with five items rated on the 5-point scale. A three-item validity scale sits alongside them:

• Emotional Abuse (EA): Five items assessing verbal attacks, humiliation, and psychological intimidation, such as name-calling by family members.
• Physical Abuse (PA): Five items capturing physical harm and dangerous discipline, such as being hit or shoved by a family member.
• Sexual Abuse (SA): Five items measuring unwanted sexual contact or exposure (administered sensitively with trauma-informed protocol).
• Emotional Neglect (EN): Five items assessing lack of emotional support, empathy, and psychological attunement. Some items in this subscale are reverse-scored.
• Physical Neglect (PN): Five items evaluating insufficient food, clothing, medical care, or supervision.
• Minimization/Denial (validity scale): Three items flagging defensive responding or distorted recall. Any positive score suggests the respondent may be under-reporting trauma.

Each subscale yields a raw score (sum of items). Severity is then interpreted against published thresholds.

How to score the questionnaire

Scoring the CTQ-SF takes five steps:

1. Sum the item responses (1 to 5 per item) within each subscale to get five raw scores between 5 and 25. Reverse-score the positively worded items first, including several in Emotional Neglect.
2. Compare each raw score with that subscale’s published cut-scores in the table below. Each subscale has its own thresholds.
3. Score the three Minimization/Denial items separately. Each counts as 1 only when answered “very often true,” and a total of 1 or more suggests possible under-reporting.
4. Interpret each subscale in the context of the clinical presentation. A patient may score high on emotional neglect but low on physical abuse, which gives a nuanced maltreatment profile.
5. Document the scores and your interpretation in the patient record.

Secure digital forms keep the subscale scores, the validity flag, and your interpretation together in one record. Paper charts work too, as long as they get the usual HIPAA safeguards.

Severity thresholds by subscale

These cut-scores come from the Bernstein and Fink 1998 manual. Check a recent validation study for population-specific norms, because thresholds can vary by demographic group.

Because each subscale has its own bands, the same raw score can land in different severity categories. A score of 10 is moderate-to-severe for physical abuse, sexual abuse, and physical neglect. On emotional abuse and emotional neglect, the same 10 is only low-to-moderate. The chart below lines the bands up so you can see where each one shifts.

Psychometric properties and reliability

Validation studies support the CTQ’s reliability across clinical and community samples. Internal consistency (Cronbach’s alpha) typically exceeds 0.70 on four of the five subscales, in samples of 200 to 3,000 participants. Physical Neglect is the exception. Its alpha was about 0.61 in Bernstein et al.’s 2003 validation, and it often falls below 0.70 in community samples. Interpret that subscale with more caution.

Test-retest reliability holds over several months. The original validation studies retested respondents after 1.6 to 5.6 months, about 3.6 months on average. They reported intraclass correlations of roughly 0.79 to 0.86, which fits a measure of past experiences that shouldn’t change between administrations.

Construct validity is supported by strong correlations with other trauma and adverse experience measures. The CTQ also separates trauma-affected groups from comparison groups. Studies in French-, German-, Spanish-, and Portuguese-speaking cohorts confirm the same factor structure outside English-speaking samples.

How clinicians use the CTQ

Mental health practitioners build the CTQ into clinical workflows for three main purposes:

• Intake screening: A single CTQ-SF administration at the first appointment establishes baseline trauma history and informs safety planning.
• PTSD and complex trauma assessment: CTQ severity scores correlate with post-traumatic stress disorder diagnosis and treatment response. They help guide treatment intensity and modality selection (trauma-focused CBT, EMDR, somatic therapies).
• Research and outcome measurement: Researchers use the CTQ as a standardized predictor variable (maltreatment severity). It features in longitudinal studies of resilience, attachment outcomes, and adult mental health trajectories.

Safe administration starts with informed consent and a safety plan agreed before the patient begins. Keep grounding techniques ready, because CTQ items address traumatic content directly and can trigger emotional activation partway through.

How the CTQ differs from the ACE Questionnaire

The CTQ is often confused with the Adverse Childhood Experiences (ACE) Questionnaire, a related but distinct screening tool. The ACE Questionnaire came out of CDC research in the 1990s. It asks yes/no questions about 10 categories of childhood adversity, covering abuse, neglect, and household dysfunction, and yields a single 0-10 score.

The CTQ, by contrast, rates five specific maltreatment types on a 5-point scale and produces five separate severity scores. That granularity suits individual clinical assessment. The ACE is epidemiological and better suited to population screening.

Licensing the CTQ and its alternatives

The CTQ is a proprietary instrument published by Pearson and registered with the APA PsycNET test registry. Clinical and research users must obtain a license through Pearson, and fees vary by volume and organization type. The 28-item CTQ-SF item set can’t be reproduced in print or digital form without a license agreement.

That’s why the free Pabau worksheet on this page contains no CTQ-SF items. It’s a companion for recording scores from your licensed Pearson forms.

The main free alternative is the CDC’s public-domain ACE Questionnaire, which suits population-level screening. The Early Trauma Inventory (ETI) covers similar ground to the CTQ. It is also copyrighted, though, so you need permission from its publisher before using it.

For researchers with limited budgets, some universities hold standing CTQ site licenses through their library or psychology department. Confirm licensing status with your compliance officer before you administer any of these instruments.

How Pabau supports trauma-informed CTQ administration

Many mental health practices still hand patients a paper questionnaire, tally the subscales by hand, and scan the sheet into the chart. That takes time, and it leaves sensitive trauma history on paper at the front desk.

For therapy and counseling practices, practice management software like Pabau turns a licensed CTQ-SF into a secure digital intake form. Responses land in encrypted, HIPAA-compliant patient records, so only authorized clinicians can see them.

Where your trauma-informed protocol allows remote completion, patients can fill in the form through the Client Portal before the session. You then spend the appointment discussing the results rather than waiting while the patient completes paperwork.

Pabau Scribe, our AI scribe, drafts the session note as you talk the results through with the patient. That keeps your attention on the person in the room, which is a core principle of trauma-informed care.

Run trauma assessments with less paperwork

Send licensed instruments like the CTQ-SF as secure digital forms and keep scores in HIPAA-compliant patient records. Pabau Scribe drafts the session note while you talk.

Book a demo

Conclusion

Start with the CTQ-SF unless you need to compare against older studies that used the 70-item original. Read each subscale against its own cut-points rather than one overall threshold. Give Physical Neglect scores extra scrutiny, since that subscale is the least reliable of the five.

Before the first administration, secure a Pearson license and agree a safety plan with the patient. Then use the free worksheet above to record the scores, the Minimization/Denial flag, and your follow-up notes in one place.

Book a demo to see how Pabau keeps CTQ-SF results, session notes, and follow-up appointments together in one secure patient record.

Continue your research

Need a platform built around therapy workflows? Therapy practice management software brings intake forms, session notes, and scheduling for counseling practices into one system.

Screening for PTSD symptoms after a high CTQ score? The PCL-5 template measures current PTSD symptoms against the DSM-5 criteria.

Assessing complex PTSD as well? The International Trauma Questionnaire screens for PTSD and complex PTSD using ICD-11 criteria.

Seeing dissociative symptoms alongside trauma history? The Dissociative Experiences Scale measures how often patients experience dissociation in daily life.

Choosing an EHR for trauma-informed care? The best EHR software for mental health compares the leading options for therapy and psychiatry practices.

Frequently asked questions