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Adverse Childhood Experiences (ACE)
Measuring Mobility Toolkit > Measure Selector > Adverse Childhood Experiences (ACE)
Adverse Childhood Experiences (ACE)
Factor: Being Valued in Community
Age: Teen, Adult
Duration: Less than 3 minutes
Reading Level: 6th-8th grade
What
Developed by Felitti and colleagues (1998), the Adverse Childhood Experiences (ACE) Scale includes 17 items that measure childhood exposure to trauma such as psychological, physical, or sexual abuse, neglect, mental illness, domestic violence, divorce, and having a parent in prison. Higher scores on this scale mean that the respondent has gone through more types of childhood trauma.
Who
Researchers have used the Adverse Childhood Experiences Scale with adults of all ages, including White, Black, Hispanic, and Asian respondents from different socioeconomic backgrounds (Felitti et al., 1998). Additionally, the National Crittenton Foundation (2016) tested the ACE Scale with a group of White, Black, Latinx, Native American, and multiracial respondents that included older children and teens (ages 10 to 18).
How
INSTRUCTIONS
Respondents answer 17 yes or no questions about their childhood (e.g., “While you were growing up during your first 18 years of life, did you live with anyone who was a problem drinker or alcoholic?”). The ACE Scale contains two subscales. The Childhood Abuse subscale contains eight questions about exposure to psychological, physical abuse, and sexual abuse. The Exposure to Household Dysfunction subscale includes nine questions about exposure to substance abuse, mental illness, domestic abuse, and criminal behavior in the household. Researchers score the ACE Scale by summing the number of items for which respondents answered “yes.”
RESPONSE FORMAT
Yes/No
Instructions: Please circle your answer below.
1. While you were growing up during your first 18 years of life, did a parent or other adult in the household
a. Often or very often swear at, insult, or put you down?
b. Often or very often act in a way that made you afraid that you would be physically hurt?
2. While you were growing up during your first 18 years of life, did a parent or other adult in the household
a. Often or very often push, grab, shove, or slap you?
b. Often or very often hit you so hard that you had marks or were injured?
3. While you were growing up during your first 18 years of life, did an adult or person at least five years older ever
a. Touch or fondle you in a sexual way?
b. Have you touch their body in a sexual way?
c. Attempt oral, anal, or vaginal intercourse with you?
d. Actually have oral, anal, or vaginal intercourse with you?
4. While you were growing up during your first 18 years of life, did you
a. Live with anyone who was a problem drinker or alcoholic?
b. Live with anyone who used street drugs?
5. While you were growing up during your first 18 years of life,
a. Was a household member depressed or mentally ill?
b. Did a household member attempt suicide?
6. While you were growing up during your first 18 years of life, was your mother (or stepmother)
a. Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her?
b. Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?
c. Ever repeatedly hit over at least a few minutes?
d. Ever threatened with, or hurt by, a knife or gun?
7. While you were growing up during your first 18 years of life,
a. Did a household member go to prison?
Why It Matters
Researchers have found that high ACE scores are related to chronic disease (Felitti et al., 1998; Anda et al., 2008; Brown, Thacker, & Cohen, 2013) worse health-related quality of life (Barile, Edwards, Dhingra, & Thompson, 2015; Corso, Edwards, Fang, & Mercy, 2008), depression (Anda et al., 2002; Chapman et al., 2004), suicide attempts (Felitti et al., 1998), obesity (Felitti et al., 1998), poor work performance, being absent from work, and financial problems (Anda et al., 2004). Research has also found a relationship between high ACE scores and many leading causes of death (e.g., heart disease, stroke, cancer; Felitti et al., 1998).
HEADS UP
Although studies suggest a link between adverse childhood experiences and poor health (Hughes et al., 2017), researchers do not know whether exposure to trauma directly causes worse health or some other factor causes both.
This questionnaire contains potentially upsetting material. Researchers should consider preparing a list of support resources that respondents can use if they become upset.
SEE ALSO
References
Anda, R. F., Brown, D. W., Dube, S. R., Bremner, J. D., Felitti, V. J., & Giles, W. H. (2008). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive Medicine, 34(5), 396–403.
Anda, R. F., Whitfield, C. L., Felitti, V. J., Chapman, D., Edwards, V. J., Dube, S. R., & Williamson, D. F. (2002). Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatric Services, 53(8), 1001–1009.
Anda, R., Fleisher, V. I., Felitti, V., Edwards, V. J., Whitfield, C. L., Dube, S. R., & Williamson, D. F. (2004). Childhood abuse, household dysfunction, and indicators of impaired adult worker performance. The Permanente Journal, 8(1), 30–38.
Barile, J. P., Edwards, V. J., Dhingra, S. S., & Thompson, W. W. (2015). Associations among county-level social determinants of health, child maltreatment, and emotional support on health-related quality of life in adulthood. Psychology of Violence, 5(2), 183–191.
Brown, M. J., Thacker, L. R., & Cohen, S. A. (2013). Association between adverse childhood experiences and diagnosis of cancer. PLoS ONE, 8(6), e65524.
Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225.
Corso, P. S., Edwards, V. J., Fang, X., & Mercy, J. A. (2008). Health-related quality of life among adults who experienced maltreatment during childhood. American Journal of Public Health, 98(6), 1094–1100.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258.
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton. C., … Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. Lancet Public Health, 2, e356-66.
National Crittenton Foundation. (2016). Beyond ACE: Summary findings from the Crittenton Family of Agencies 2014-2015 administration of the Adverse Childhood Experiences (ACE) Survey.
