ACE Calculator

What is the ACE Questionnaire?

The Adverse Childhood Experiences (ACE) Questionnaire is a ten-item retrospective screening tool that assesses exposure to adverse experiences during childhood (before age 18). Developed as part of the landmark ACE Study conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, the questionnaire covers three categories of childhood adversity: abuse (emotional, physical, sexual), neglect (emotional, physical), and household dysfunction (domestic violence, substance abuse, mental illness, parental separation, incarcerated household member).

Each item is answered with "Yes" (1) or "No" (0), producing a total score between 0 and 10. The ACE score represents a cumulative count of different types of adverse experiences, not the frequency or severity of any single experience.

The ACE Study and Its Impact

The original ACE Study, published by Felitti and colleagues in 1998, surveyed over 17,000 adults at Kaiser Permanente in San Diego. The findings revealed a striking dose-response relationship between the number of adverse childhood experiences and a wide range of negative health outcomes in adulthood.

Key findings included that ACEs are remarkably common: approximately two-thirds of participants reported at least one ACE, and more than one in five reported three or more. The study demonstrated graded relationships between ACE scores and outcomes including heart disease, cancer, chronic lung disease, liver disease, depression, substance use, and premature mortality.

The ACE Study has become one of the most cited and influential public health studies, fundamentally shifting understanding of the relationship between childhood adversity and lifelong health. It has informed trauma-informed care models worldwide and has been replicated in numerous countries, including Australia.

How ACE Scoring Works

The ACE Questionnaire uses a simple binary format. Each of the ten items asks about a specific category of adverse experience before age 18:

Yes = 1 (experienced this type of adversity) No = 0 (did not experience this type of adversity)

Total scores range from 0 to 10. The original Felitti & Anda (1998) ACE Study did not publish graduated severity bands. The widely-cited threshold anchored to the published dose-response finding is:

0–3: Below the ≥4 threshold commonly cited in the ACE Study as associated with substantially elevated health risk 4–10: At or above the ≥4 threshold (Felitti & Anda, 1998) — research shows substantially elevated risk across depression, substance use, cardiovascular disease, and other outcomes

This is a population-level statistical finding, not an individual prediction. Two individuals with the same ACE score may have had vastly different experiences.

Clinical Considerations

The ACE Questionnaire is used in clinical settings to support trauma-informed assessment and care planning. Understanding a person's ACE history can help practitioners contextualise current presentations within a developmental and relational framework.

Important considerations when using the ACE Questionnaire include:

The ACE score is a count of types of adversity, not a measure of severity. Two individuals with the same ACE score may have had vastly different experiences.

The ACE Questionnaire does not capture all forms of childhood adversity. Experiences such as bullying, racism, community violence, poverty, and foster care are not included in the original ten items.

Protective factors (such as supportive relationships, community connection, and personal resilience) are not measured by the ACE Questionnaire but significantly moderate the impact of adverse experiences.

The ACE Questionnaire asks about sensitive topics and should be administered in the context of a therapeutic relationship where appropriate support is available.

ACE Research in Australia

Australian research has confirmed and substantially extended the patterns identified in the original US ACE Study. The 2023 Australian Child Maltreatment Study (ACMS) — led by Haslam, Mathews, Pacella, Higgins, Finkelhor and colleagues at Queensland University of Technology — surveyed a nationally representative sample of 8,503 Australians aged 16 and over, providing the first nationally representative prevalence data on child maltreatment in Australia.

Key Australian findings from the ACMS include:

62.2% of Australians experienced at least one form of child maltreatment before age 18 39.4% experienced multiple forms (multi-type maltreatment) Physical abuse: 32.0%; sexual abuse: 28.5%; emotional abuse: 30.9%; neglect: 8.9%; exposure to domestic violence: 39.6% Aboriginal and Torres Strait Islander Australians report disproportionately high rates of cumulative adversity

These prevalence figures are substantially higher than the original Felitti & Anda (1998) US ACE Study findings, reflecting both the broader maltreatment definitions used in the ACMS and the methodological strengths of a nationally representative population sample.

In clinical practice, the ACE Questionnaire is used in Australian psychology, general practice, social work, and community health settings. It supports trauma-informed approaches to care and can assist practitioners in understanding the developmental context of a person's current difficulties.

Australian guidelines emphasise that ACE screening should always be accompanied by appropriate clinical response, including safety assessment, psychoeducation about trauma, and referral pathways where needed. Where culturally appropriate, alternative or supplementary trauma-screening tools developed for Aboriginal and Torres Strait Islander populations should be considered.