Adverse Childhood Experiences Test (ACE)

What Is the Adverse Childhood Experiences (ACE) Questionnaire?

The Adverse Childhood Experiences (ACE) Questionnaire is a 10-item screening tool developed from the landmark CDC-Kaiser Permanente study (Felitti et al., 1998), one of the largest investigations of childhood abuse, neglect, and household dysfunction and their relationship to later-life health and well-being.

How It Works

Each item is answered as Yes (1) or No (0):

• Yes = you experienced that category of adversity during your first 18 years
• No = you did not

The 10 ACE Categories

The questionnaire covers three domains with 10 categories:

Abuse (3 categories): 1. Emotional abuse 2. Physical abuse 3. Sexual abuse

Household Challenges (4 categories): 4. Mother treated violently 5. Household substance abuse 6. Household mental illness 7. Parental separation or divorce 8. Incarcerated household member

Neglect (2 categories): 9. Emotional neglect 10. Physical neglect

Key Research Findings

The original ACE study (Felitti et al., 1998, n=17,337) found that:

• Nearly two-thirds (64%) of participants reported at least one ACE
• 12.5% reported an ACE score of 4 or higher
• There is a strong graded relationship between ACE score and adult health risk behaviors and diseases
• Individuals with ACE scores ≥ 4 had 4-12 times increased risk for alcoholism, drug abuse, depression, and suicide attempts
• Higher ACE scores are associated with increased risk of heart disease, cancer, chronic lung disease, and liver disease

Clinical Use

The ACE is used for:

• Risk screening in primary care and mental health settings
• Population health surveillance
• Research on the effects of childhood adversity
• Trauma-informed care planning

Reliability & Validity

• Internal consistency: Cronbach’s α = .88 (original sample)
• Test-retest reliability: κ = .64 (moderate-to-substantial agreement over one year)
• Construct validity: ACE scores show consistent dose-response relationships with numerous health outcomes across diverse populations
• Cross-cultural validation: ACE has been validated in multiple countries and languages

Disclaimer

This questionnaire is a screening tool, not a diagnostic instrument. A high ACE score does not mean you will develop health problems — it indicates increased statistical risk. Many individuals with high ACE scores lead healthy, successful lives. If this questionnaire raises distressing feelings, please consider speaking with a mental health professional.