ACE
Adverse Childhood Experiences questionnaire
Ten-item screen for childhood exposure to abuse, neglect, and household dysfunction — predicts adult health outcomes at the population level.
What it measures
Yes/no items across three domains: abuse (emotional, physical, sexual), neglect (emotional, physical), and household dysfunction (domestic violence, substance use, mental illness, parental separation, incarcerated household member). Score is the count.
Scoring and bands
Cutoffs
A score of ≥4 is the most-cited threshold for elevated risk, drawn from the original Felitti studies. Risk is dose-response — higher scores correlate with more outcomes — and the ACE was designed as a population measure, not an individual prognostic tool.
How to talk about the score
Pre-frame the questions before administering. 'These are sensitive questions about childhood. You don't have to share details — just yes/no — and we can talk about what comes up.' Hold space after, regardless of score.
Limitations
- Designed for population research, not individual prediction
- Treats categories as equivalent (one yes = one yes regardless of severity, frequency, or duration)
- Omits significant adversities (community violence, racism, poverty, foster-care experiences)
- Can re-traumatize if administered without care
- Resilience and protective factors not captured
Best used for
- Trauma-informed intake when administered with care
- Psychoeducation about adversity-health links
- Opening a conversation, not closing one
FAQ
Should I use the ACE on intake?
Only with informed consent and a clinical follow-through plan. Many clinicians prefer to defer the ACE until alliance is established and the client opts in.
Is a high ACE score deterministic?
No. It's a population-level risk indicator, not an individual prognosis. Many people with high ACE scores live well; protective factors and adult resources matter enormously.