Adverse Childhood Experience (ACE) Questionnaire
If you have chronic conditions or persistent challenges (either physical or emotional) that don't seem to relate to your current life situation, the root cause may lie in your early childhood experiences. We can work together to uncover these issues in a safe and supportive way so that you can gain the tools and knowledge you need to free yourself from the past and ease your symptoms.
If this seems appropriate to you, take the quiz below and bring your results to your next appointment and together we can create a plan that best suits your needs.
Finding your ACE Score
There are 10 types of childhood trauma measured in the ACE Study.
Five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect
Five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma counts as one.
There are, of course, many other types of childhood trauma — watching a sibling being abused, losing a close relative or caregiver (grandmother, mother, father, grandfather, etc.), homelessness, surviving and recovering from a severe illness or accident, witnessing a father being abused by a mother, witnessing a grandmother abusing a father, growing up in a violent neighborhood, etc.
The ACE Study included only those 10 childhood traumas because those were mentioned as most common by a group of about 300 Kaiser members; those traumas were also well studied individually in the research literature.
The most important thing to remember is that the ACE score is meant as a guideline: If you experienced other types of toxic stress over months or years, then those would likely increase your risk of health consequences.
For more information on the ACE study and how it may relate to your own healing, check out these links: Got your ACE Score? or Childhood Disrupted by Donna Jackson Nakazawa.
While you were growing up, during your first 18 years of life:
1. Did a parent or other adult in the household often ...
Swear at you, insult you, put you down, or humiliate you?
or
Act in a way that made you afraid that you might be physically hurt?
Yes No If yes enter 1 ________
2. Did a parent or other adult in the household often ...
Push, grab, slap, or throw something at you?
or
Ever hit you so hard that you had marks or were injured?
Yes No If yes enter 1 ________
3. Did an adult or person at least 5 years older than you ever...
Touch or fondle you or have you touch their body in a sexual way?
or
Try to or actually have oral, anal, or vaginal sex with you?
Yes No If yes enter 1 ________
4. Did you often feel that ...
No one in your family loved you or thought you were important or special?
or
Your family didn’t look out for each other, feel close to each other, or support each other?
Yes No If yes enter 1 ________
5. Did you often feel that ...
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?
or
Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
Yes No If yes enter 1 ________
6. Were your parents ever separated or divorced?
Yes No If yes enter 1 ________
7. Was your mother or stepmother:
Often pushed, grabbed, slapped, or had something thrown at her?
or
Sometimes or often kicked, bitten, hit with a fist, or hit with something hard?
or
Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
Yes No If yes enter 1 ________
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
Yes No If yes enter 1 ________
9. Was a household member depressed or mentally ill or did a household member attempt suicide?
Yes No If yes enter 1 ________
10. Did a household member go to prison?
Yes No If yes enter 1 ________
Now add up your “Yes” answers:_______
This is your ACE Score