Adverse Childhood Experience (ACE) Questionnaire

Ten yes-or-no questions about abuse, neglect, and household challenges before age 18. The score counts how many of the ten categories you answered yes to, from 0 to 10. It is not a diagnosis or a prediction of your health. Read more.

While you were growing up, during your first 18 years of life:

0 of 10

1. Did a parent or other adult in the 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 that you might be physically hurt?

Yes No

2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

Yes No

3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?

Yes No

4. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?

Yes No

5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

Yes No

6. Were your parents ever separated or divorced?

Yes No

7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit at least a few minutes or threatened with a gun or knife?

Yes No

8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

Yes No

9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

Yes No

10. Did a household member go to prison?

Yes No

Notes for yourself (optional)

Only you see these. They are saved only if you create an account and save this result, and providers you later share your results with can read saved notes.

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Source: Finding Your ACE Score (ACE Score Calculator, 2006), which condenses the CDC-Kaiser Permanente Adverse Childhood Experiences Study questionnaires into ten questions. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med. 1998;14(4):245-258. If you hold the rights to a questionnaire on Survey Doctor, please contact us.