Your ACE score is the number of ten kinds of childhood adversity you reported, from 0 to 10. Large studies link 4 or more ACEs to higher rates of depression, alcohol and drug problems, and heart disease. The score describes your past. It does not diagnose a condition or predict your own health.
The quick answer
The ACE questionnaire, sometimes called the ACE test, asks ten yes-or-no questions about your life before age 18. Each yes adds one point. Survey Doctor shows the total as a number, without a group label. Research most often compares people with 4 or more against people with none.
| Your score | What it means | Share of US adults | What research has found |
|---|---|---|---|
| 0 | None of the ten categories reported | About 36% | The comparison group in most studies |
| 1 to 3 | Some adversity reported | About 47% | Rates of many health problems rise with each added ACE |
| 4 to 10 | Four or more categories reported | About 17% | The group with the strongest links to later health problems |
The shares come from a CDC analysis of 264,882 adults surveyed from 2011 to 2020 (Swedo et al., 2023). That survey counted eight categories rather than ten, so treat the shares as approximate.
A higher score means more kinds of adversity were reported. The answers are only yes or no. Some questions ask whether something happened often, but none asks how long it went on or how severe it was.
What the ten questions cover
Survey Doctor's form uses the ten questions of the widely used 2006 ACE Score Calculator. That form is based on the original CDC-Kaiser ACE Study questionnaires. The ACE questionnaire page explains the form in more detail.
| Type | Categories |
|---|---|
| Abuse | Emotional abuse, physical abuse, sexual abuse |
| Neglect | Emotional neglect, physical neglect |
| Household difficulty | Violence toward your mother or stepmother, a household member who was a problem drinker or used street drugs, a household member with mental illness, a household member who went to prison, parents' separation or divorce |
A score of 0 means only that none of these ten were reported. The list leaves out many hard experiences. Examples include bullying, poverty, racism, community violence, serious illness and the death of a parent.
What research links to 4 or more ACEs
Four or more is the usual high-exposure group in ACE research. The CDC's 2023 analysis used that cutoff because so much research links it to poorer health and life outcomes.
The original CDC-Kaiser ACE Study surveyed 9,508 adults (Felitti et al., American Journal of Preventive Medicine, 1998). It counted seven categories and compared people with 4 or more against people with none. Those with 4 or more had 4 to 12 times the odds of alcoholism, drug misuse, depression and suicide attempts. Their odds of smoking and poor self-rated health were 2 to 4 times higher. The more categories people reported, the more often they had heart disease, cancer, chronic lung disease and liver disease.
A 2017 review in The Lancet Public Health pooled 37 studies with 253,719 adults (Hughes et al., 2017). People with 4 or more ACEs had higher odds of all 23 health outcomes it studied.
| Odds compared with 0 ACEs | Outcomes |
|---|---|
| Less than 2 times | Physical inactivity, overweight or obesity, diabetes |
| 2 to 3 times | Smoking, heavy drinking, poor self-rated health, cancer, heart and lung disease |
| More than 3 to 6 times | Sexual risk taking, mental health problems, problem drinking |
| More than 7 times | Problem drug use, violence as a victim or perpetrator, suicide attempts |
Odds compare two groups, so they do not tell you how many people were affected. The authors note that a big rise in odds for a rare problem can mean few extra cases. For almost half the outcomes, results varied widely between studies.
If you need help now. In the US, Call 988 or text 988. Call 911 if you are in immediate danger. Outside the US, contact your local emergency number or find support in your country.
What those links look like in real numbers
A 2015 survey of 6,188 Wisconsin adults gives plain percentages (Bethell et al., JAMA Pediatrics, 2019). The table counts adults who had ever been diagnosed with depression. It also counts those with 14 or more poor mental health days in the past month.
| ACEs reported | Adults with depression or frequent poor mental health |
|---|---|
| 0 | 12% |
| 1 | 20% |
| 2 to 3 | 29% |
| 4 or more | 42% |
The rate rose at each step. Even so, about 58% of adults with 4 or more ACEs met neither measure.
What these studies cannot tell you
Every finding above comes from large groups of people. The findings show which problems are more common in a group, but they cannot forecast what happens to one person. Two people with the same score can have very different lives. An ACE score is not a diagnosis, and it does not measure how you are doing today.
The studies used their own questions, some with seven or eight categories. All of them relied on adults remembering their childhood. They show links, and they cannot prove that ACEs caused the problems. Survey Doctor uses the 2006 ten-question form, not the studies' own questions. Its scores have not been tested against these findings.
What does an ACE score of 7 mean?
A score of 7 means you reported seven of the ten categories. Most of the studies above stop at "4 or more", so a 7 falls in their highest group. They give no separate figure for 7. They also do not show whether a 7 carries more risk than a 4.
You may have read that 6 or more ACEs can shorten life by about 20 years. That figure comes from a follow-up of 17,337 adults in the CDC-Kaiser study (Brown et al., 2009). Deaths were tracked from the mid-1990s to the end of 2006. Of the 1,539 people who died, those with 6 or more ACEs died at an average age of 60.6. Those with no ACEs died at an average age of 79.1.
These ages describe only the people who died during the study. They are not a life expectancy for everyone with 6 or more ACEs. After adjusting for other factors, 6 or more ACEs carried 1.7 times the risk of dying at 75 or younger. The authors also found that the risk did not climb steadily with each added ACE.
A 7 does tell you that you reported adversity in many parts of your childhood. That is a good reason to tell your doctor about your history. Mention anything that worries you now, such as sleep, mood, drinking or smoking. The score cannot show which experiences happened, how severe they were, who helped you, or how you are now.
Positive childhood experiences also count
The same Wisconsin study asked adults about seven positive experiences from childhood:
- being able to talk with family about feelings
- feeling that family stood by you during hard times
- enjoying community traditions
- feeling you belonged at high school
- feeling supported by friends
- having at least two adults besides your parents who took a real interest in you
- feeling safe and protected by an adult at home
Among adults with 4 or more ACEs, those with more positive experiences reported less depression and poor mental health. The rate was 60% with 0 to 2 positive experiences, 37% with 3 to 5, and 21% with 6 to 7. This was a one-time survey, so it shows a link rather than proof of cause. When you talk with a professional, mention the support you had as well as the adversity.
What to do with your score
Start with how you are now. Talk to a professional if your past is affecting your sleep, mood, drinking, relationships, work or sense of safety. You do not need a high score to ask for help. A high score alone does not mean you need treatment.
A primary care doctor is a good first step. You can also look for a licensed therapist who works with trauma. You decide how much to share, and you do not have to describe what happened in detail.
It helps to bring:
- your score, and any categories you are comfortable naming
- what is bothering you now, and how long it has been going on
- changes in sleep, mood, appetite, drinking or drug use
- your health conditions and a list of the medicines you take
- what you want from the visit, such as support, a referral or a physical health check
Your ACE score will not go down as you heal, because it asks about events before age 18. To track how you are doing now, use a questionnaire about current symptoms. The PHQ-9 asks about depression, and the PC-PTSD-5 score guide explains a short screen for current trauma symptoms.