Questionnaires

Adverse Childhood Experiences Questionnaire


The Adverse Childhood Experiences study found that people who had experiences difficult or adverse experiences in childhood had a greater risk of both physical and mental health problems during adulthood.[1] The risk increases significantly for people with larger numbers of adverse experiences in their childhood. Adverse experiences include not only trauma and abuse, but also non-traumatic stressors like parental divorce and household dysfunction.[1], [2].

Adverse Childhood Experiences Study

Instructions:
Adverse Childhood Experiences - know your score! There are 10 questions, each is answered by selecting Yes or No. These questions are in English have been designed for adults (age 18 and older).[1]
Warning: These questions may cause distress. Some questions ask directly about experiences of child abuse. Check that you have a support person or helpline number available before beginning.
Download a printable version (external link) of the ACE questionnaire.

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1. Did 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?
no  yes 
2. Did 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?
no  yes 
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
Attempt or actually have oral, anal, or vaginal intercourse with you?
no  yes 
4. Did 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?
no  yes 
5. Did 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?
no  yes 
6. Were your parents ever separated or divorced?
no  yes 
7. Was 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 at least a few minutes or threatened with a gun or knife?
no  yes 
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
no  yes 
9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
no  yes 
10. Did a household member go to prison?
no  yes 

Press Calculate Result to see your score.

 

Based on a tally quiz generated by
D.K. Jordan's quiz maker

ACE Score
 
Press the Clear button to remove the results from your screen after using the tool.

ACE Scoring Explained

Questions 1-3 refer to emotional, physical and sexual abuse. Questions 4 and 5 assess emotional and physical neglect, and questions 6-10 refer to household dysfunction.[2]

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References

1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. (2014, May 13). About the Study. Retrieved June 27, 2015.
2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. (2014, May 13). Prevalence of Individual Adverse Childhood Experiences. Retrieved June 27, 2015.

Cite this page

Adverse Childhood Experiences Questionnaire Traumadissociation.com. Retrieved from .

There is no copyright for the questions, answers and scoring of the ACE study.[1] The remaining information can be copied or modified for any purpose, including commercially, provided a link back is included. License: CC BY-SA 4.0