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What is the ACE Questionnaire?

The 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.



What the World Health Organization (WHO) says about ACE

Adverse Childhood Experiences (ACE) refer to some of the most intensive and frequently occurring sources of stress that children may suffer early in life. Such experiences include multiple types of abuse; neglect; violence between parents or caregivers; other kinds of serious household dysfunction such as alcohol and substance abuse; and peer, community and collective violence.


So what?

It has been shown that considerable and prolonged stress in childhood has life-long consequences for a person's health and well-being. It can disrupt early brain development and compromise functioning of the nervous and immune systems. In addition because of the behaviors adopted by some people who have faced ACE's, such stress can lead to serious problems such as alcoholism, depression, eating disorders, unsafe sex, HIV/AIDS, heart disease, cancer, and other chronic diseases.


Take the ACE Questionnaire

While you were growing up, during your first 18 years of life:

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___ If Yes, enter 1 ___

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___ 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 Attempt or actually have oral, anal, or vaginal intercourse with you?

No___ If Yes, enter 1 ___

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___ If Yes, enter 1 ___

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___ If Yes, enter 1 ___

6. Were your parents ever separated or divorced?

No___ If Yes, enter 1 ___

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 over at least a few minutes or

threatened with a gun or knife?

No___ If Yes, enter 1 ___

8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

No___ If Yes, enter 1 ___

9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

No___ If Yes, enter 1 ___

10. Did a household member go to prison?

No___ If Yes, enter 1 ___

Now add up your "Yes" answers: _____ This is your ACE Score


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