Adverse Childhood Experience Questionnaire For Adults

Our relationships and experiences-even those in childhood can affect our health and well being. Difficult childhood experiences are very common. This information will help you and your provider better understand how to work together to support your health and well-being.  

Instructions: Below is a list of 10 categories of Adverse Childhood Experiences (ACES). From the list below, please count on your fingers for each ACE category that you have experienced prior to your 18th birthday. Then, please add up the number of categories of ACES you experienced to get your final score.

1. Did you feel that you didn't have enough to eat, had to wear dirty clothes, or had no one

 to protect or take care of you?

2. Did you lose a parent through divorce, abandonment, death, or other reason?

3. Did you live with anyone who was depressed, mentally ill, or attempted suicide?

4. Did you live with anyone who had a problem with drinking or using drugs, including 

prescription drugs?

5. Did your parents or adults in your home ever hit, punch, beat, or threaten to harm each 

other?

6. Did you live with anyone who went to jail or prison?

7. Did a parent or adult in your home ever swear at you, insult you, or put you down?

8. Did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way?

9. Did you feel that no one in your family loved you or thought you were special?

10. Did you experience unwanted sexual contact (such as fondling or oral/anal/vaginal intercourse/penetration)?

Your ACE score is the total number of checked responses 

Do you believe that these experiences have affected your health?   

Experiences in childhood are just one part of a person's life story. There are many ways to heal throughout one's life. 

If you scored 3+ on this ACE Survey, you may benefit from the REPAIR Program.