ACEs Questionnaires

 

The Original ACEs Study and Questionnaire

There are several questionnaires available that can be used to determine the level of trauma a person has experienced.  However, the first ACEs questionnaire was developed as a result of the Centers for Disease Control-Kaiser Permanente Adverse Childhood Experiences Study, (Can you add the link to the study here? It’s the first one in the Research section) one of the largest investigations ever conducted to assess connections between chronic stress caused by early adversity and later-life health. The study, based at Kaiser Permanente’s San Diego Health Appraisal Clinic, was undertaken in a primary care setting to determine the long-term impact of abuse, neglect, and household dysfunction during childhood on disease risk factors and incidence, quality of life, health care utilization, and mortality.

From 1995 to 1997, health appraisals were conducted with over 17,000 Health Maintenance Organization members from Southern California. This involved completion of a physical exam, a standardized medical questionnaire that included demographic and biopsychosocial information, as well as a review of previous medical diagnoses and family medical history by a healthcare provider. The CDC continues ongoing surveillance of ACEs by assessing the medical status of the study participants via periodic updates of morbidity and mortality data.

How the Questionnaire is Scored

The study leads, Dr. Robert Anda, a medical epidemiologist at CDC, and Dr. Vincent Felitti, chief of Kaiser Permanente’s Department of Preventive Medicine, developed a scoring system for ACEs. Each type of adverse childhood experience counted as one point. If a person had none of the events in her or his background, the ACE score was zero. If someone was verbally abused during his or her childhood but no other types of childhood trauma occurred, this counted as one point on the ACE questionnaire. The number of times that abuse, neglect, or household dysfunction occurred did not increase the score. There is only one point given for each of ACE, for a maximum total of 10.

ACEs and Poor Health Outcomes

In the original ACEs study, those with four categories of ACEs had a 240 percent greater risk of hepatitis, were 390 percent more likely to have a chronic obstructive pulmonary disease (emphysema or chronic bronchitis), and a 240 percent higher risk of a sexually transmitted disease than those who had a score of 0. In addition, study participants were twice as likely to be smokers, seven times more likely to be alcoholic, ten times more likely to have injected street than those who had a score of 0. In addition, study participants with a high ACE score (a 4 or more) were more likely to have experienced more depression, more marriages, and more work absences.

Why Do People Complete the ACEs Questionnaire?

The information obtained from completing the ACEs Questionnaire could help you and your provider better understand how to work together to support your health and well-being. 

Providers who screen for ACEs and toxic stress and are able to offer targeted, evidence-based interventions can improve the efficacy and efficiency of health care, better support individual and family health and well-being, and reduce long-term health costs. However, when a provider asks that the questionnaire be completed at the time of a clinical assessment, it is highly recommended that there be ready access to a therapist should one be needed to address any issues that might arise from revisiting childhood trauma. 

The questionnaire is a self-administered instrument and so should be completed by the individual seeking services without intervention from staff. For example, the provider should not reframe any of the questions or give explanation regarding the intent of any question. The only assistance that staff may provide is with regard to literacy or vision challenges.

A Reminder

A high proportion of the population has at least one ACE in their history. However, no matter how many ACEs a person has, it’s important to understand that experiences in childhood are just one part of a person’s life story. There are many ways to heal from childhood trauma throughout one’s life. It is also important to understand that the ACEs Questionnaire doesn’t tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. ACEs are not destiny. 

The ACEs Questionnaire can be completed below.

Other ACEs Questionnaires

The Family Health History and Health Appraisal Questionnaires are used to collect information on child abuse and neglect, household challenges, and other socio-behavioral factors in the original CDC-Kaiser ACE Study.

  • Family Health History Questionnaire

Male Version
Female Version

  • Health Appraisal Questionnaire

Male Version
Female Version

The questionnaires are not copyrighted, and there are no fees for their use. If any of the questionnaires are used in your research, the Centers for Disease Control and Prevention requests that a copy of any subsequent article(s) is provided.  Please send to dvpinquiries@cdc.gov.

The Behavioral Risk Factor Surveillance System ACE module was adapted from the original CDC-Kaiser ACE Study and is used to collect information on child abuse and neglect and household challenges.