Adverse Childhood Experiences Questionnaire

The Adverse Childhood Experiences Questionnaire (ACE-Q) is a foundational clinical tool developed to measure early adversity and its cumulative impact on…

Questions: 10
Duration: 5 min
Original title: ACE-Q — Adverse Childhood Experiences Questionnaire
Adaptation: Adverse Childhood Experiences Questionnaire
Authors: Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S.
Created: 1998

The Adverse Childhood Experiences Questionnaire (ACE-Q) is a foundational clinical tool developed to measure early adversity and its cumulative impact on health. Originally created through a landmark public health study, this 10-item instrument systematically captures exposure to abuse, neglect, and severe household dysfunction occurring before the age of 18. By transforming complex early traumas into a standardized metric, it provides clinicians with a clear framework for discussing the developmental origins of presenting symptoms.

In adult clinical practice, the ACE-Q is invaluable for contextualizing chronic mental health presentations, treatment-resistant conditions, and complex somatic complaints. Identifying a high burden of early adversity allows practitioners to formulate cases through a trauma-informed lens, shifting the focus from symptom suppression to addressing underlying early maladaptive schemas and a dysregulated autonomic nervous system. It serves as an essential, validated baseline measure for adults entering trauma therapy or comprehensive psychiatric care.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

5/ 10

A 10-item retrospective self-report questionnaire assessing exposure, prior to age 18, to ten categories of potentially traumatic experiences divided into two domains: abuse/neglect (emotional, physical, and sexual abuse; emotional and physical neglect) and household dysfunction (domestic violence against the mother, a household member with addiction, mental disorder, or history of suicide attempt, parental separation/divorce, incarceration of a household member). Developed as part of the CDC-Kaiser study (Felitti et al., 1998), it documents the cumulative impact of early adversity on adult physical and mental health, demonstrating a robust dose-response relationship between the ACE score and health outcomes.

0–3

Clinical threshold not met

4–10

Clinically significant

From this threshold onwards, the general long-term health consequences become most pronounced, marking a drastic increase in the risks of mental and behavioral disorders.

cliniquemixed · pathology: child welfare system adolescents · Hungary · n = 240 · 2023 · Oláh et al. (2023)

010

M = 3.16 ± 2.27

For information

ComparisonACE-Q score of 0 vs ACE-Q score of 4

A massive increase in the relative risk of developing addictive behaviors, depressive states, and suicidal behaviors is observed in individuals with a score of 4 compared to those with a score of 0.

ComparisonVictims of bullying vs Non-victims

Higher ACE scores are significantly associated with a higher likelihood of being a victim of bullying.

Oláh et al. (2023)View the study ↗

Scoring

Sum (number of Yes responses), total score ranging from 0 to 10, each item is scored 0 or 1.

Abuse and neglect

2/ 5

Exposure to emotional, physical, and sexual abuse, as well as experiences of emotional and physical neglect during childhood.

items 1, 2, 3, 4, 5

Household dysfunction

3/ 5

Various forms of family dysfunction including domestic violence, parental separation/divorce, and household members with substance abuse problems, mental illness, or involvement in the criminal justice system.

items 6, 7, 8, 9, 10

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What the test measures

The ACE-Q captures the cumulative burden of traumatic events and chronic stressors experienced during the critical developmental window of childhood and adolescence. It evaluates ten specific domains of early adversity across two broad clinical categories.

Psychological Maltreatment: Exposure to persistent verbal hostility, humiliation, and emotional neglect.
Physical Abuse: Instances of direct physical harm, ranging from slapping to severe physical injury.
Sexual Abuse: Any non-consensual sexual contact or coercion by an older individual.
Physical Neglect: The failure of caregivers to provide essential medical care, nutrition, or safety.
Domestic Violence: Vicarious trauma stemming from witnessing severe physical aggression toward a maternal figure.
Household Dysfunction: Instability introduced by parental separation, severe parental mental illness, substance use disorders, or the incarceration of a household member.

This instrument is designed for use with adult populations to retrospectively assess developmental trauma and its potential influence on current psychological and physiological health.

When and why to use it

Clinicians utilize the ACE-Q during initial intakes and specialized trauma evaluations to systematically uncover developmental adversity that patients might otherwise omit or normalize.

Intake Formulation: To identify the early origins of emotional dysregulation and schema coping styles, ensuring treatment targets the root vulnerability rather than just surface symptoms.
Trauma Assessment: To map the breadth of childhood adversity prior to exploring common reactions to trauma or initiating deeper reprocessing work.
Treatment Resistance: To contextualize persistent difficulties like chronic dissociation, somatization, or rigid automatic behaviors that fail to respond to standard cognitive interventions.
Complex Presentations: To support the differential diagnosis process when conceptualizing complex PTSD versus personality disorders or treatment-refractory depression.

Administering a validated measure like the ACE-Q depersonalizes the disclosure of abuse, providing a structured, normalized format that often feels safer for patients than an open-ended clinical interview.

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The questions

The following questions ask about experiences you may have had during the first 18 years of your life. For each question, answer Yes or No based on your own experience.
1. Before you were 18, did a parent or other adult in your 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 you might be physically hurt?
Evaluates the patient's early exposure to psychological maltreatment and chronic emotional hostility.
- No
- Yes
2. Before you were 18, did a parent or other adult in your household often, or very often, push, grab, slap, or throw something at you? Or did they ever hit you so hard that you had marks or were injured?
Assesses the presence and severity of direct physical abuse inflicted by caregivers within the home environment.
- No
- Yes
3. Before you were 18, did an adult or a person at least 5 years older than you ever touch or fondle you in a sexual way, or ask you to touch them in a sexual way? Or did they attempt to have or have oral, anal, or vaginal intercourse with you?
Probes for instances of sexual abuse or coercive sexual contact perpetrated by an older individual during childhood.
- No
- Yes
4. Before you were 18, did you often, or very often, feel that no one in your family loved you or thought you were important or special? Or that your family members didn't look out for each other, feel close to each other, or support each other?
Captures the subjective experience of emotional neglect, focusing on the absence of familial warmth and supportive bonds.
- No
- Yes
5. Before you were 18, did you often, or very often, feel that you didn't have enough to eat, had to wear dirty clothes, or had no one to protect you? Or were your parents too drunk or high on drugs to take care of you or take you to the doctor if you needed to go?
Screens for physical neglect, identifying significant failures by caregivers to provide basic safety, nutrition, and medical care.
- No
- Yes
6. Before you were 18, were your biological parents ever separated or divorced?
Identifies structural family disruptions and the early loss of a stable, unified parental dyad.
- No
- Yes
7. Before you were 18, was your mother (or stepmother) often, or very often, pushed, grabbed, or slapped, or did she have something thrown at her? Or, sometimes, often, or very often, was she kicked, bitten, hit with a fist or with a hard object, or beaten repeatedly for several minutes, or threatened with a knife or a gun?
Measures the child's vicarious exposure to domestic violence and chronic physical aggression directed at a maternal figure.
- No
- Yes
8. Before you were 18, did you live with anyone who was a problem drinker, an alcoholic, or who used street drugs?
Highlights household dysfunction characterized by severe substance use disorders, which often destabilize early caregiving.
- No
- Yes
9. Before you were 18, was a household member depressed or mentally ill, or did a household member attempt suicide?
Determines if the patient's early environment was impacted by untreated severe mental illness or suicidal crises in family members.
- No
- Yes
10. Before you were 18, did a household member go to prison?
Accounts for the psychosocial stress and systemic disruption associated with the incarceration of a household member.
- No
- Yes