Adverse Childhood Experience (ACE) Questionnaire

Man at desk completes written testThe Adverse Childhood Experience (ACE) Questionnaire is a 10-item self-report measure developed for the ACE study to identify childhood experiences of abuse and neglect. The study posits that childhood trauma and stress early in life, apart from potentially impairing social, emotional, and cognitive development, indicates a higher risk of developing health problems in adulthood.

Development of the ACE Questionnaire

The ACE study originated in 1985 in Dr. Vincent Felitti’s obesity clinic in California. Felitti was frustrated that a number of the people in his program dropped out, even though they were successfully losing weight. Upon reviewing the history of the people who dropped out, Felitti found that many people in his clinic had a background of adverse childhood experiences, such as physical or sexual abuse. He began to wonder if obesity might be, for some people, an unconscious defense that lingered as a result of adverse childhood experiences.

Researchers found that weight gain was indeed the way some of those who had experienced childhood abuse had attempted to protect themselves, whether consciously or unconsciously, from further incidences of abuse, and that they left Felitti’s program due to feelings of anxiety that followed their weight loss.

Following the results of this study, the Centers for Disease Control and Prevention, which was exploring the psychosocial origins of various public health concerns such as alcohol abuse, obesity, and nicotine use, paired up with Kaiser Permanente to develop one of the largest epidemiological studies in the United States. The ACE Study aimed to identify the childhood trauma experiences of more than 17,000 adult participants, who underwent a physical examination and completed the ACE Questionnaire, in order to determine whether there truly was a link between adverse experiences in childhood and health concerns, both physical and mental, later in life.

Findings of the Study

The study found that nearly 40% of participants had been exposed to two or more of the different categories, and 12.5% reported exposure to at least four categories. In other words, the study showed that adverse childhood experiences were more common than had previously been recognized or acknowledged by research and medical findings. The study also identified a direct link between the ACE score and adult chronic illness, as well as emotional and social issues such as depression, domestic violence, and suicide.

For example, an individual with an ACE score of four or higher was 260% more likely to have chronic obstructive pulmonary disease than someone with a score of 0, 240% more likely to contract hepatitis, 460% more likely to experience depression, and 1,220% more likely to attempt suicide.

Using the ACE Questionnaire

The questionnaire helps researchers and mental health professionals identify childhood abuse and neglect and family dysfunction such as domestic violence, incarceration, and alcohol and drug issues.

The survey consists of ten questions. Each affirmative answer is assigned one point. At the end of the questionnaire, the points are totaled for a score out of ten, which is known as the ACE score.

Some sample questions:

  • Did a parent or other adult in the household often push, grab, slap, or throw something at you?
  • Was a household member depressed or mentally ill or did a household member attempt suicide?
  • Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?

The questionnaire has many different applications and may be administered by clinicians to better understand the trauma history of people who are experiencing:

  • Domestic violence
  • Drug and alcohol issues
  • Incarceration
  • Mental health conditions and suicidal thoughts
  • Chronic health conditions

How the ACE Questionnaire Relates to Physical and Mental Health

The questionnaire identifies major risk factors that may lead to the development of health and social issues among people in the United States. Besides suggesting that an individual may be more likely to experience health issues later in life, this questionnaire also shows how childhood trauma affects the mortality rate: The life expectancy of an individual with an ACE score of six or more may be reduced by up to 20 years.

Because the ACE Study suggests that there is a significant link between adverse childhood experiences and chronic disease in adulthood, including heart disease, lung cancer, diabetes, and autoimmune diseases, the questionnaire may be able to help those who have a high ACE score become more informed about their increased risk factor for health issues. It could also encourage them to seek treatment or therapy if they have not already done so.  Additionally, the study highlights how these childhood experiences influence the possible development of mental health issues in adulthood and may serve to assist mental health professionals in better understanding certain mental health concerns.

The connection between adverse childhood experiences, social issues, and adult mental and physical health might also be used to help inform programs and health policies that support prevention of these issues and recovery from them.

To find out your own ACE score or learn more about the ACE Questionnaire, please visit acestudy.org.

References:

  1. Center for Disease and Prevention. (2003). ACE Reporter: Origins and Essence of the Study. San Diego.
  2. Dong, M, Anda, R.., Felitti, V.J., Dube, S.R., Williamson, D.F., Thompson, T.J., Loo, C.M., and Giles, W.H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse and Neglect, 28 (7), 771–784.
  3. Felitti, V.J., Anda, R.F., Nordenberg, D, Williamson, D.F., Spitz A.M., Edwards, V.K., Koss, M.P., and Marks, J.S., (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, vol 14 (4), 245-258.
  4. Injury Prevention and Control: Division of Violence Prevention. (2014, May 13). Retrieved from http://www.cdc.gov/violenceprevention/acestudy.
  5. Storrs, C. (2009, October 7). Is Life Expectancy Reduced by a Traumatic Childhood? Retrieved from http://www.scientificamerican.com/article/childhood-adverse-event-life-expectancy-abuse-mortality.

Last Updated: 01-16-2018

  • 17 comments
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  • Art V.

    Art V.

    April 18th, 2015 at 7:17 PM

    mom used to lash out at us… Unpredictable rages. I’d be very interested in your questionnaire and how it’s affecting me know as a 51-year-old man.

  • GoodTherapy.org Team

    GoodTherapy.org Team

    April 20th, 2015 at 10:03 AM

    Thank you for your comment. We are glad you found our page. The broken link to the Ace Study web page has been fixed, and a direct link to the questionnaire was added. We hope these are helpful to you.

  • uswa b.

    uswa b.

    March 27th, 2016 at 8:00 AM

    sir plz tell me about the reversed scored items of the scale ? i am using this scale in my research and i am in need of knowing the reversed scored item plz reply me

  • Catherine

    Catherine

    May 8th, 2017 at 3:17 PM

    I have struggled my whole life. When you score 10 out of 10 on the test, you realize why.

  • Pectopatron

    Pectopatron

    July 5th, 2017 at 6:45 AM

    Hi! I am suffering from PTSD and I realized that it caused by the ACEs. This article helps me so much to understanding about my childhood event, my PTSD, and my horrible story in my life. I write my story pectopatron.wordpress.com here, because I think words is one of the best and inexpensive therapy. Thank you for helping other people :)

  • Twinkle

    Twinkle

    September 1st, 2017 at 1:53 AM

    Is this test ACEs is a standardised test, having a manual? And from where to buy the test?

  • kathleen

    kathleen

    September 25th, 2017 at 6:42 PM

    I was one of these abused and neglected children growing up with a dysfunctional family. Although I am now living a fulfilling, productive and satisfying life it has taken years of healing and help. Thank God for others who care and are put in our path along life’s often rocky way.

  • JSalsa

    JSalsa

    October 18th, 2017 at 9:52 AM

    I know of someone who has problems maintaining personal relationships, lies a lot and often insist on serial intimacy. It is known that his father was sexually and physically abusive…can now understand ACE..

  • Amanda

    Amanda

    February 8th, 2018 at 8:22 PM

    Didn’t know to much about this but I scored a ten and I ain’t to sure how to look at it and see what it means to be exactly???

  • Kathryn

    Kathryn

    March 11th, 2018 at 4:49 PM

    I am 47 and scored a 5. My parents excuse is ‘they did the best they could’ and I am just bent on being unhappy. What do I do next wrt this study?

  • Ing H

    Ing H

    March 12th, 2018 at 11:01 AM

    So where do I go from here and how can I change my perception? scored nine out of ten

  • Sharon M,

    Sharon M,

    March 12th, 2018 at 5:21 PM

    I scored 9. No one went to prison. I am 72 and carry alot of baggage. Been through whole bunch of self help stuff. Adult Children of Alcoholics which made me cry alot and was a trigger that made me angry! Others in my family stuffed it! There were 5 of us.Everything applies to us as far as health issues. My oldest brother passed at 73. He caught ALL of the Hell from aunts uncle granny and parents. My next brother and I married 4 times. Next after me was the pet! She managed to live under the roof of our parents for 20 plus years. Example (she got a piano and lessons as a child ). I was 6 years older and was chosen to play in the high school band. I got a flutiphone.LOL! Her fingers were longer and she took typing lessons. I got my last whooping with a belt at 18. I was grown and working. No one told me that I could leave. So I was forced to get married to the only boyfriend that I was allowed to have from age 15. My parents never allowed me to date even though other young men’s parents asked permission. NONE WERE EVER ACCEPTED! I did exactly what the control freaks wanted. I was 26 and when my husband was cheating. I got divorced! I was FREE and men liked me! I was wild and didnt marry for 10 years. My baby sister got her last whooping at 17 and married shortly after. She was married twice. She is 12 years younger than me. Let me tell you about our parents who fought each other with knives/guns or whatever was their weapon of choice scissors/rocks etc. They would split and get back together for more than 50 year. We didnt all live together til I was 7 years old! My brothers lived with Dad’s mom and I was left with my mom’s mom. I was born 9 months and ONE DAY after they got married! Dad was married before and had my 2 brothers. He was a Baptist deacon and a 33 degree Mason. The pillar of the community later in life and during the time we were screwed up! People who know me always tell me that I
    am strong. I guess no one ever knew me at all. What I am is bitter! HELP ME JESUS. I’m still here 9 questions later. None of my school teachers were worth a darn either. I was in grade 3 when school teacher, Ida Mae Mulllins grabbed me by the hair for walking between her and another teacher! Today we have ACE . I have to ask, Does Anyone Give a Damned!! I doubt it! That’s why a little 3 year old girl’s babysitter has put her in the hospital in Cincinnati today! She is brain dead and not expected to live! BTW I was molested by the landlord at age 7.

  • Meghan

    Meghan

    March 14th, 2018 at 12:08 PM

    I am a grad student researching trauma, how do you obtain permission to use the ACE study or others like the Childhood Experiences of care and abuse questionnaire?

  • catherine

    catherine

    April 16th, 2018 at 7:13 AM

    I have offered for many years to use my childhood to study the effects of child abuse later in life. If you ever want to please feel free to contact me

  • Lee

    Lee

    April 13th, 2018 at 10:01 PM

    It frustrates me that the questionnaire only addresses spousal abuse by fathers, but not by mothers. My mother was abusive towards my father and the only time he ever pushed even was if she was coming towards one of us kids.

  • Heidi

    Heidi

    April 17th, 2018 at 3:48 PM

    Its really about experiencing interpersonal violence in your home.

  • Fran

    Fran

    May 10th, 2018 at 10:23 PM

    I’m a 67-year-old, African American, cis-gendered woman. Back in the early 60’s, I was one of 100 black children sent to integrate schools in the New York neighborhood called Bensonhurst. Today I’m a member of an organization that brings together people of different races who want to heal racism. I don’t recall where I found out about the ACES study but just now when I took the test, I scored an 8. I was abused as a child, including sexual abuse, and survived by becoming a multiple personality. I lived as a multiple until I was 50 years old. I have also been diagnosed with PTSD, depression and agoraphobia. I’m now looking at my past in terms of the affects of racism. Has anyone done an ACES study that asks questions about the abuses of racism? Is anyone interested in designing such a study? I’ve also suffered from obesity most of my life. Back in 2011, I joined Weight Watchers and ended up losing 70 pounds. I kept it off until 2016 when a fall resulted in a fractured hip and hip replacement surgery. I slowly lost control of my eating after that and have gained back 25 of those 70 pounds. I know now that the accident was a trigger for feelings that I was no longer safe. I’ve been in therapy most of my life so I’m not looking for a therapist. I am, however, interested in understanding the wounds from racism. I’d appreciate being pointed in the direction of any studies about that.

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