Adverse Childhood Experiences (ACEs) Questionnaire
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The ACEs Questionnaire is a 10-item screening tool used to assess exposure to common forms of childhood trauma before age 18. It includes experiences of abuse, neglect, and household dysfunction and has been widely linked to lifelong impacts on health, behavior, and wellbeing.
Recommended Frequency: Administer once at intake, particularly in behavioral health, trauma-informed care, or substance use treatment settings. It is not typically repeated unless clinically relevant.
About the ACEs Questionnaire
Developed as part of a landmark study by the CDC and Kaiser Permanente, the ACEs Questionnaire identifies 10 types of adverse experiences during childhood, grouped into three categories:
- Abuse (emotional, physical, sexual)
- Neglect (emotional, physical)
- Household Dysfunction (e.g., parental mental illness, substance use, incarceration, separation/divorce, domestic violence)
The total score represents how many different types of adversity were reported—not frequency or severity.
ACEs are associated with increased risk of chronic illness, mental health issues, substance use, and early mortality, but the tool itself is non-diagnostic.
Psychometric Properties
The ACEs Questionnaire is widely used in public health and research, with strong predictive validity for later-life health outcomes. However, it is not a clinical diagnostic tool and has been critiqued for lacking contextual nuance (e.g., duration, timing, severity, protective factors).
- Strong correlation with physical and mental health outcomes
- Used in population surveillance and trauma-informed care initiatives
- Internal consistency: moderate (varies by population)
Sources: Felitti et al., 1998; Anda et al., 2006
The Scale
The ACEs Questionnaire consists of 10 yes/no questions asking whether specific types of adverse events occurred during the respondent’s first 18 years of life.
Example: “Did a parent or other adult in the household often or very often swear at you, insult you, or put you down?”
Each “yes” response counts as one point toward the ACE score.
Score Range
- 0–3: Lower reported exposure
- 4 or more: Elevated risk for long-term health and psychosocial challenges
No clinical threshold exists, but a score of 4+ is often used in research and practice to indicate higher vulnerability.
| Score | Interpretation |
|---|---|
| 0–3 | Low exposure to early adversity (but not risk-free) |
| 4–6 | Moderate ACEs exposure; increased risk for long-term impact |
| 7–10 | High exposure; significant risk for emotional, relational, and physical challenges across the lifespan |
Copyright
© U.S. Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. Public domain tool.
References
- Felitti, V. J., Anda, R. F., 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
- Centers for Disease Control and Prevention. (2023). Adverse Childhood Experiences (ACEs). https://www.cdc.gov/violenceprevention/aces/index.html
Disclaimer
This summary is for informational purposes only. The ACEs Questionnaire is a screening and awareness tool, not a diagnostic instrument. HiBoop does not use this tool to guide clinical decisions. Interpretation should be done by trained professionals as part of a broader trauma-informed approach.
Permissions
The ACEs Questionnaire is in the public domain and may be freely used and reproduced without permission for non-commercial purposes.
Frequently Asked Questions
Does a high ACE score mean someone has PTSD?
No. A high ACE score indicates elevated risk, but many people with high scores do not develop PTSD or other disorders.
Should I ask about details when clients endorse traumatic experiences?
Only if clinically appropriate and the client is ready. The ACEs tool is a screen, not a full trauma history.
Can this tool be triggering?
It can be. Always introduce it with care, explain its purpose, and offer opt-outs or pacing as needed.
Is it valid for culturally diverse populations?
The original tool was normed on U.S. populations and may miss culture-specific forms of adversity. Use cultural humility and invite narrative when appropriate.
Can I use ACEs with youth?
The standard ACEs is designed for adults reflecting on childhood. A youth-report version or caregiver report (e.g., PEARLS) is recommended for clients under 12.