[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"assessment-childhood-trauma-test":3,"all-assessments-nav":476,"related-assessments-query":1155},{"id":4,"title":5,"body":6,"category":435,"categoryTitle":436,"clinicalCitations":437,"copyright":435,"description":450,"disclaimer":435,"downloadLink":435,"extension":451,"faqs":452,"featured":465,"i18nReady":465,"icon":435,"interpreter":435,"lastReviewed":466,"meta":467,"navigation":468,"path":469,"permissionsNote":435,"published":465,"recommendedFrequency":435,"relatedCodes":435,"relatedConditions":435,"reviewedBy":435,"seo":470,"slug":471,"stem":472,"summary":473,"takeaways":435,"timeline":435,"type":474,"usedToDiagnose":435,"__hash__":475},"assessments\u002Fassessments\u002Fchildhood-trauma-test.md","Childhood Trauma Test (ACE Score)",{"type":7,"value":8,"toc":421},"minimark",[9,13,18,21,24,27,31,34,38,41,46,49,93,100,104,107,112,162,167,203,208,277,280,284,287,367,370,374,377,380,414,418],[10,11,12],"p",{},"The ACE Score (0–10) measures exposure to 10 categories of childhood adversity including abuse, neglect, and household dysfunction. ACE scores ≥4 are associated with significantly elevated risk for depression, PTSD, substance use, and chronic disease, with a graded dose-response relationship established across multiple large-cohort studies.",[14,15,17],"h2",{"id":16},"what-is-a-childhood-trauma-test","What is a Childhood Trauma Test?",[10,19,20],{},"A childhood trauma test screens for adverse childhood experiences\n(ACEs), traumatic events or chronic stressors occurring before age 18 that are\nassociated with lasting physical and mental health consequences. The landmark\nACE Study, conducted by Kaiser Permanente and the CDC (Felitti\net al., 1998), enrolled 9,508 adult respondents and established the dose-response\nrelationship between ACE scores and health outcomes across the lifespan.",[10,22,23],{},"The current CDC-Kaiser ACE questionnaire assesses 10 categories across three\ndomains: abuse (emotional, physical, sexual), neglect\n(emotional, physical), and household dysfunction (domestic violence,\nsubstance abuse, mental illness, parental separation\u002Fdivorce, incarcerated household\nmember). Each endorsed category counts as 1 point, yielding a total ACE Score from\n0 to 10.",[10,25,26],{},"The ACE score is a population-level risk indicator, not a personal prognosis. Adults with a score of 4 or more show markedly elevated risk for a range of mental and physical health conditions, but resilience factors — including supportive relationships, community resources, and evidence-based treatment — substantially mitigate the impact of childhood adversity.",[14,28,30],{"id":29},"ace-score-screener","ACE Score Screener",[10,32,33],{},"ACE Study: Felitti et al. (1998). This screener is for educational awareness only and does not constitute clinical assessment. If childhood trauma is affecting your wellbeing, speak with a trauma-informed therapist. Crisis support: 988 Suicide & Crisis Lifeline.",[14,35,37],{"id":36},"ace-score-risk-reference","ACE Score Risk Reference",[10,39,40],{},"From the CDC-Kaiser ACE Study (Felitti et al., 1998) and subsequent research. ACE scores are a population-level risk indicator; resilience, support systems, and treatment substantially modify individual outcomes.",[42,43,45],"h3",{"id":44},"score-interpretation","Score Interpretation",[10,47,48],{},"The ACE questionnaire yields a score from 0 to 10. Each point represents one category of adversity endorsed. The original 1998 study found a graded relationship between ACE score and adult risk outcomes — higher scores corresponded to increasingly elevated risk across multiple health domains. The widely cited ≥4 threshold is the point at which the original study reported the most marked elevation in risk for depression, alcoholism, drug abuse, and suicide attempt.",[50,51,52,65],"table",{},[53,54,55],"thead",{},[56,57,58,62],"tr",{},[59,60,61],"th",{},"ACE Score",[59,63,64],{},"Population Risk Profile",[66,67,68,77,85],"tbody",{},[56,69,70,74],{},[71,72,73],"td",{},"0",[71,75,76],{},"Baseline reference group in the original ACE Study",[56,78,79,82],{},[71,80,81],{},"1–3",[71,83,84],{},"Graded elevation in risk begins; each additional point increases likelihood of adverse health outcomes (Felitti et al., 1998)",[56,86,87,90],{},[71,88,89],{},"≥4",[71,91,92],{},"4- to 12-fold increased risk for alcoholism, drug abuse, depression, and suicide attempt; 2- to 4-fold for smoking and poor self-rated health; graded relationship with ischemic heart disease, cancer, and other chronic diseases (Felitti et al., 1998)",[10,94,95,99],{},[96,97,98],"strong",{},"Important:"," These figures are derived from epidemiological cohort studies and represent group-level probabilities. They do not predict outcomes for any individual. Many people with high ACE scores live healthy, fulfilling lives, particularly with access to supportive relationships and trauma-informed care.",[42,101,103],{"id":102},"ace-categories-10-total","ACE Categories (10 Total)",[10,105,106],{},"The 10-item CDC-Kaiser ACE questionnaire covers adversity across three domains. One point is assigned if any item in a category was present before age 18.",[10,108,109],{},[96,110,111],{},"Abuse (3 categories)",[50,113,114,127],{},[53,115,116],{},[56,117,118,121,124],{},[59,119,120],{},"#",[59,122,123],{},"Category",[59,125,126],{},"Example experiences covered",[66,128,129,140,151],{},[56,130,131,134,137],{},[71,132,133],{},"1",[71,135,136],{},"Emotional abuse",[71,138,139],{},"Repeated humiliation, threats, or belittling by an adult in the household",[56,141,142,145,148],{},[71,143,144],{},"2",[71,146,147],{},"Physical abuse",[71,149,150],{},"Being hit, beaten, or kicked hard enough to leave marks",[56,152,153,156,159],{},[71,154,155],{},"3",[71,157,158],{},"Sexual abuse",[71,160,161],{},"Sexual contact or behaviour by an adult or person ≥5 years older",[10,163,164],{},[96,165,166],{},"Neglect (2 categories)",[50,168,169,179],{},[53,170,171],{},[56,172,173,175,177],{},[59,174,120],{},[59,176,123],{},[59,178,126],{},[66,180,181,192],{},[56,182,183,186,189],{},[71,184,185],{},"4",[71,187,188],{},"Emotional neglect",[71,190,191],{},"Not feeling loved, important, or protected by family",[56,193,194,197,200],{},[71,195,196],{},"5",[71,198,199],{},"Physical neglect",[71,201,202],{},"Lack of sufficient food, clothing, medical care, or supervision",[10,204,205],{},[96,206,207],{},"Household Dysfunction (5 categories)",[50,209,210,220],{},[53,211,212],{},[56,213,214,216,218],{},[59,215,120],{},[59,217,123],{},[59,219,126],{},[66,221,222,233,244,255,266],{},[56,223,224,227,230],{},[71,225,226],{},"6",[71,228,229],{},"Domestic violence",[71,231,232],{},"Witnessing a mother or stepmother being physically hurt by a partner",[56,234,235,238,241],{},[71,236,237],{},"7",[71,239,240],{},"Household substance abuse",[71,242,243],{},"Living with someone who was a problem drinker, used street drugs, or was alcoholic",[56,245,246,249,252],{},[71,247,248],{},"8",[71,250,251],{},"Household mental illness",[71,253,254],{},"Living with someone who was depressed, mentally ill, or attempted suicide",[56,256,257,260,263],{},[71,258,259],{},"9",[71,261,262],{},"Parental separation or divorce",[71,264,265],{},"Parents ever separated or divorced",[56,267,268,271,274],{},[71,269,270],{},"10",[71,272,273],{},"Incarcerated household member",[71,275,276],{},"A household member ever sent to prison",[10,278,279],{},"Note: The original 1998 paper by Felitti and colleagues used seven categories (range 0–7). The 10-category version is the expanded CDC-Kaiser standard that became the widely used public-health instrument.",[42,281,283],{"id":282},"health-outcomes-by-ace-score","Health Outcomes by ACE Score",[10,285,286],{},"Cumulative risk across domains from the original ACE Study and subsequent research.",[50,288,289,302],{},[53,290,291],{},[56,292,293,296,299],{},[59,294,295],{},"Outcome Domain",[59,297,298],{},"ACE Score ≥4 vs score 0",[59,300,301],{},"Source",[66,303,304,315,325,335,345,356],{},[56,305,306,309,312],{},[71,307,308],{},"Alcoholism, drug abuse, depression, suicide attempt (group)",[71,310,311],{},"4- to 12-fold increased risk",[71,313,314],{},"Felitti et al., 1998",[56,316,317,320,323],{},[71,318,319],{},"Smoking, poor self-rated health, ≥50 sexual partners, sexually transmitted disease (group)",[71,321,322],{},"2- to 4-fold increased risk",[71,324,314],{},[56,326,327,330,333],{},[71,328,329],{},"Physical inactivity, severe obesity (group)",[71,331,332],{},"1.4- to 1.6-fold increased risk",[71,334,314],{},[56,336,337,340,343],{},[71,338,339],{},"Ischemic heart disease, cancer, chronic lung disease, skeletal fractures, liver disease",[71,341,342],{},"Graded relationship; no summary multiplier reported in abstract",[71,344,314],{},[56,346,347,350,353],{},[71,348,349],{},"Multimorbidity (two or more chronic conditions)",[71,351,352],{},"Each additional ACE associated with ~13% increased odds",[71,354,355],{},"Senaratne et al., 2024",[56,357,358,361,364],{},[71,359,360],{},"18 health\u002Fbehavioural outcomes across multiple domains",[71,362,363],{},"Dose-response graded relationship; mean comorbidity count tripled across ACE score range",[71,365,366],{},"Anda et al., 2006",[10,368,369],{},"The dose-response relationship holds across mental health, substance use, sexual health, and chronic physical disease domains. Anda et al. (2006) confirmed this pattern in a cohort of 17,337 HMO members across 18 distinct outcome measures; the mean number of co-occurring adverse outcomes tripled across the ACE score range.",[42,371,373],{"id":372},"childhood-trauma-assessment-tools","Childhood Trauma Assessment Tools",[10,375,376],{},"ACE scores measure exposure, not destiny. Research consistently shows that trauma-focused therapy (EMDR, CPT, TF-CBT, somatic approaches), stable supportive relationships, and community connection substantially reduce the long-term impact of childhood adversity. Many adults with high ACE scores live healthy, fulfilling lives. If you recognize these experiences in yourself, connecting with a trauma-informed therapist is one of the most effective steps you can take.",[10,378,379],{},"Beyond the ACE questionnaire, clinicians use a range of validated instruments to assess specific trauma-related outcomes:",[381,382,383,390,396,402,408],"ul",{},[384,385,386,389],"li",{},[96,387,388],{},"PCL-5 (PTSD Checklist for DSM-5)"," — 20-item self-report screen for PTSD symptom severity",[384,391,392,395],{},[96,393,394],{},"PHQ-9 (Patient Health Questionnaire-9)"," — depression severity monitoring commonly paired with ACE-informed care",[384,397,398,401],{},[96,399,400],{},"GAD-7 (Generalized Anxiety Disorder-7)"," — anxiety severity screen frequently used alongside trauma assessment",[384,403,404,407],{},[96,405,406],{},"AUDIT (Alcohol Use Disorders Identification Test)"," — substance use screening relevant given elevated risk at ACE ≥4",[384,409,410,413],{},[96,411,412],{},"CTQ (Childhood Trauma Questionnaire)"," — a 28-item retrospective self-report assessing five types of childhood maltreatment with more dimensional detail than the ACE screener",[14,415,417],{"id":416},"trauma-informed-outcome-monitoring","Trauma-Informed Outcome Monitoring",[10,419,420],{},"PCL-5, PHQ-9, GAD-7, and ACE-informed care pathways, integrated trauma outcome monitoring for community mental health, primary care, and specialty behavioural health programs.",{"title":422,"searchDepth":423,"depth":423,"links":424},"",3,[425,427,428,434],{"id":16,"depth":426,"text":17},2,{"id":29,"depth":426,"text":30},{"id":36,"depth":426,"text":37,"children":429},[430,431,432,433],{"id":44,"depth":423,"text":45},{"id":102,"depth":423,"text":103},{"id":282,"depth":423,"text":283},{"id":372,"depth":423,"text":373},{"id":416,"depth":426,"text":417},null,"Trauma & ACEs Assessment",[438,441,444,447],{"text":439,"link":440},"Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245-58.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F9635069\u002F",{"text":442,"link":443},"Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, Dube SR, Giles WH. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006;256(3):174-86.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F16311898\u002F",{"text":445,"link":446},"Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry. 2003;160(8):1453-60.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F12900308\u002F",{"text":448,"link":449},"Senaratne DNS, Thakkar B, Smith BH, Hales TG, Marryat L, Colvin LA. The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis. BMC Med. 2024;22(1):315.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F39143489\u002F","The 10-category ACE (Adverse Childhood Experiences) screener. ACE score ≥4 associated with significantly elevated risk for depression, PTSD, substance...","md",[453,456,459,462],{"question":454,"answer":455},"What does an ACE score of 4 or higher mean?","An ACE score of 4 or more indicates exposure to four or more categories of adverse childhood experience. In the original ACE Study, adults at this threshold had 4- to 12-fold increased risk for alcoholism, drug abuse, depression, and suicide attempt compared to those with a score of 0. The score is a population-level risk indicator, not a personal diagnosis or prognosis — resilience factors and evidence-based treatment substantially modify individual outcomes.",{"question":457,"answer":458},"Is the ACE questionnaire self-report or clinician-administered?","The standard ACE questionnaire is a self-report tool. It was designed for large-scale epidemiological surveys and can be completed in about five minutes. It is not a clinical diagnostic instrument; a trauma-informed clinician is needed to contextualize results, explore individual history, and guide treatment decisions.",{"question":460,"answer":461},"Can the ACE score diagnose PTSD or depression?","No. The ACE score measures cumulative exposure to adversity categories, not current symptom severity. PTSD, depression, and other trauma-related conditions require separate validated diagnostic tools (such as the PCL-5 for PTSD or the PHQ-9 for depression) and clinical assessment. A high ACE score warrants further evaluation, not a diagnosis.",{"question":463,"answer":464},"How many items are on the ACE questionnaire and what does it cover?","The current CDC-Kaiser 10-item ACE questionnaire assigns one point for each category of adversity experienced before age 18, across three domains: abuse (emotional, physical, sexual), neglect (emotional, physical), and household dysfunction (domestic violence, substance abuse, mental illness, parental separation or incarceration). The score ranges from 0 to 10. The original 1998 study by Felitti and colleagues used seven categories; the questionnaire was later expanded to ten.",false,"2026-06-03",{},true,"\u002Fassessments\u002Fchildhood-trauma-test",{"title":5,"description":450},"childhood-trauma-test","assessments\u002Fchildhood-trauma-test","The 10-category ACE (Adverse Childhood Experiences) screener. ACE score ≥4 associated with significantly elevated risk for depression, PTSD, substance use, and chronic disease. Felitti et al. (1998).","assessment","Wemhd5OSXNyQnzhWaClhBN_I-qyi61ILe8jMzJsJJxM",[477,481,486,490,494,499,504,508,513,518,523,528,533,538,542,546,551,556,561,565,569,574,579,584,588,592,596,601,605,610,615,620,625,630,634,638,643,647,651,655,659,663,668,673,677,678,683,688,693,698,702,706,711,715,719,724,728,733,737,742,746,750,754,759,764,768,773,778,782,786,790,794,799,803,807,811,815,819,824,829,833,837,841,845,849,854,858,862,866,871,875,880,885,889,893,897,901,905,910,915,919,923,927,931,935,939,943,947,951,956,960,964,968,972,976,981,985,990,994,998,1003,1007,1011,1015,1019,1023,1028,1032,1036,1041,1045,1049,1053,1057,1061,1065,1069,1074,1079,1084,1089,1093,1097,1101,1105,1109,1113,1117,1121,1126,1130,1134,1138,1142,1146,1151],{"title":61,"slug":478,"path":479,"categoryTitle":480},"aces","\u002Fassessments\u002Faces","Trauma & PTSD",{"title":482,"slug":483,"path":484,"categoryTitle":485},"ADHD Clinical Outcome Scale, Self-Report (ACOS-SR)","acos-sr","\u002Fassessments\u002Facos-sr","ADHD & 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