Trauma & stress · 10 items · 0–10 · Felitti VJ, Anda RF, Nordenberg D, et al. (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 Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8
A 10-item retrospective screen counting categories of adverse childhood experiences before age 18, from the CDC-Kaiser Adverse Childhood Experiences Study.
While you were growing up, during your first 18 years of life:
No0
Yes1
Score
01Did a parent or other adult in the household often or very 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?
-
02Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?
-
03Did 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 attempt or actually have oral, anal, or vaginal intercourse with you?
-
04Did you often or very 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?
-
05Did you often or very 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?
-
06Were your parents ever separated or divorced?
-
07Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her? Or sometimes, often, or very 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?
-
08Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
-
09Was a household member depressed or mentally ill, or did a household member attempt suicide?
-
10Did a household member go to prison?
-
0-3score item↑↓moveScored locally - nothing leaves this page
0 of 10
0 / 10
ACE0 / 10
While you were growing up, during your first 18 years of life:
Scored locally - nothing leaves this page
01Did a parent or other adult in the household often or very 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?
02Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?
03Did 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 attempt or actually have oral, anal, or vaginal intercourse with you?
04Did you often or very 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?
05Did you often or very 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?
06Were your parents ever separated or divorced?
07Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her? Or sometimes, often, or very 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?
08Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
09Was a household member depressed or mentally ill, or did a household member attempt suicide?
The ACE Questionnaire counts exposure to ten categories of childhood adversity occurring before the age of 18: three forms of abuse (emotional, physical, sexual), two forms of neglect (emotional, physical), and five forms of household dysfunction (a mother treated violently, household substance misuse, household mental illness, parental separation or divorce, and an incarcerated household member). Each category is answered yes or no, and the total score is simply the number of categories endorsed, from 0 to 10.
It is an exposure index, not a symptom scale. The score reflects how many types of adversity a person reports from their childhood - it says nothing about frequency, duration or severity within a category, and it does not measure current mental state. A high score signals elevated statistical risk of adult health problems at the population level; it is not a diagnosis and does not predict outcomes for any individual.
02 - Origin & purpose
Where it comes from.
The questionnaire comes from the CDC-Kaiser Permanente Adverse Childhood Experiences Study, conducted at Kaiser Permanente's San Diego Health Appraisal Clinic in two survey waves between 1995 and 1997, with more than 17,000 adult health-plan members participating. Felitti and colleagues published the landmark findings in 1998: a graded, dose-response relationship between the number of adversity categories and adult health risks, with respondents reporting four or more categories showing four- to twelve-fold increases in risk for alcoholism, drug abuse, depression and suicide attempt compared with those reporting none.
The instrument was designed for epidemiological research, but it has since been adopted widely in trauma-informed care as a conversation opener and population-surveillance tool. A 2017 systematic review and meta-analysis of 37 studies confirmed associations between multiple ACEs and a broad range of outcomes, with the strongest associations for substance misuse, mental illness and violence. Notably, the original study authors have cautioned against using the score as an individual-level screening or prediction tool.
03 - Scoring & cutoffs
How scoring works.
Scoring is a simple count of 'yes' answers across the ten categories, giving a total from 0 to 10. There is no diagnostic cutoff. A score of 4 or more is the most widely cited risk marker, drawn from the original study's finding of sharply elevated health risks at that level, and many services treat it as a prompt for further conversation rather than a threshold for action. Two people with the same score can have profoundly different histories - a single category can range from one incident to years of sustained harm - so the score should always be interpreted alongside the person's account, current symptoms and functioning.
Score
Severity
Interpretation
0–0
No reported ACEs
About one third of the original study population reported no adverse childhood experiences.
1–3
One or more categories of adversity
Risk of adverse health outcomes rises with the count in a graded, dose-response fashion.
4–10
Four or more categories
In the original study this group (about 13% of respondents) showed markedly elevated risks, for example 4- to 12-fold increases for alcoholism, drug abuse, depression and suicide attempt compared with a score of 0 (Felitti et al. 1998).
The bands below are descriptive research groupings, not validated clinical cutoffs. The ACE score counts categories of exposure, not severity, frequency or timing. It is a population-research tool; it does not diagnose anything or predict outcomes for an individual, and a high score should open a conversation, not close one.
04 - Validation evidence
How well it performs.
The ACE score's evidence base is epidemiological rather than psychometric in the traditional sense: its strength lies in the robustness of the dose-response association, replicated across dozens of cohorts internationally. Internal consistency is adequate for a count of heterogeneous exposures, and test-retest studies show good agreement over time, though retrospective reports do shift somewhat between administrations.
α ≈ 0.70-0.76
INTERNAL CONSISTENCY
κ = 0.46-0.86
TEST-RETEST RELIABILITY
17,337 adults
ORIGINAL COHORT
4-12x risk
DOSE-RESPONSE
05 - How it compares
How it compares to the alternatives.
Instrument
Items
Time
When to reach for it
CTQ
28
~10 min
Licensed (Pearson). Reach for it when you need graded severity across maltreatment dimensions rather than a category count.
Reach for it when dissociative symptoms are the clinical question.
06 - When to use it
Right tool, wrong tool.
Reach for it when
-Opening a structured conversation about childhood adversity in a trauma-informed intake
-Population-level surveillance, service planning and research on adversity exposure
-Understanding cumulative adversity burden as context for case formulation
-Settings that need a brief, free, public-domain measure requiring no licence
Reach for something else when
-Diagnosing PTSD or any other condition - use the PCL-5 or a clinical interview instead
-Predicting an individual's future health outcomes from their score
-Measuring severity, frequency or timing of maltreatment - the CTQ covers graded severity
-Tracking change over time - the score reflects historical events and should not move
-Standalone screening without capacity for follow-up conversation and support
07 - Confidence & precision
Reading the score with care.
Standard error of measurement and minimal clinically important difference are not meaningful concepts for the ACE score: it is a retrospective count of exposure categories, not a severity measure, and it is not designed to detect change. Repeat administrations can differ - test-retest kappas of 0.46-0.86 mean some category answers shift between occasions - so treat the score as an approximate index of reported adversity rather than a precise quantity.
08 - Limitations
What it cannot tell you.
- Retrospective self-report is subject to recall bias in both directions; reports can change between administrations
- All ten categories carry equal weight, though their impact is plainly unequal
- Captures nothing about frequency, duration, developmental timing or perceived severity
- Omits significant adversities including community violence, poverty, bullying, discrimination and peer victimisation
- Not validated as an individual screening or prediction tool - the original authors explicitly caution against this use
- Risk of deterministic misinterpretation: a high score is not destiny, and resilience factors are not measured
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