ACE Questionnaire PDF: The Ten Questions and How to Score Them
The ACE questionnaire is a ten-question yes or no form that records how many types of adversity an adult experienced before the age of 18. This page carries the ten questions to print or fill in by hand, with the scoring, the findings behind the score and a plain account of what the number counts and what it cannot tell you.
Reviewed byMichael Callans, MSWThe ten questions
- 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?
- 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?
- 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?
- 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?
- 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?
- Were your parents ever separated or divorced?
- 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?
- Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
- Was a household member depressed or mentally ill, or did a household member attempt suicide?
- Did a household member go to prison?
How to answer
Think about your first 18 years of life and mark Yes or No for each question, following its wording about how often an experience occurred. Where a question gives alternatives joined by 'or', answer Yes if either applies. You may pause or leave a question unanswered if you do not wish to respond.
The two response options: Yes, No.
How to score it
- Give each Yes answer 1 point and each No answer 0 points. Count each of the ten questions once, even if several experiences within it apply.
- Add the ten question scores to obtain an ACE score from 0 to 10. This counts categories of experience, not the number of incidents. There are no separate diagnostic subscale cutoffs.
- If an answer is missing or uncertain, leave the score incomplete and discuss it with a clinician; do not count that answer as No. This missing-answer safeguard is an editorial instruction, not a validated replacement scoring rule.
What the score means
A score of 0 means none of these ten categories was reported. Scores of 1 to 3 mean one to three categories were reported; scores of 4 to 10 mean four to ten categories were reported.
Research has associated higher ACE counts with higher rates of some health problems across groups of people, often comparing four or more ACEs with none. Four is not a diagnostic cutoff, and there are no official mild, moderate or severe diagnoses attached to these ranges. The score does not establish the severity of an experience or predict an individual's future. A clinician considers what happened, how it affects you now and what support you have; concerns deserve attention at any score.
Source and permission
Source: CDC and Kaiser Permanente, Adverse Childhood Experiences Study questionnaires. Questionnaire content is in the public domain. Use of these materials by Psychology.com does not imply endorsement of Psychology.com, its products or services by CDC, ATSDR, HHS or the United States Government. Source questionnaires are also available free at https://www.cdc.gov/aces/communication-resources/index.html.
Foundational citation: Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14(4):245-258. doi:10.1016/S0749-3797(98)00017-8.
Ten-category study: Dong M, Anda RF, Felitti VJ, et al. The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect. 2004;28(7):771-784. doi:10.1016/j.chiabu.2004.01.008.
Reproduced from public-domain CDC-Kaiser questionnaire content with source credit, unchanged substantive content, a non-endorsement disclaimer and acknowledgment that CDC provides the source questionnaires free of charge.
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About this tool
The ACE questionnaire PDF on this page is the ten-question version of the Adverse Childhood Experiences questionnaire, the form used to work out an ACE score. Ten questions, each answered Yes or No, each asking whether a particular kind of adversity was present before the age of 18. Three cover abuse, two cover neglect, and five cover what the researchers called household dysfunction: parental separation or divorce, violence toward a mother or stepmother, a household member with a drinking or drug problem, a household member who was depressed or mentally ill or attempted suicide, and a household member who went to prison. Each Yes adds a point, so the score runs from 0 to 10.
The questions come from the Adverse Childhood Experiences Study, run jointly by Kaiser Permanente in San Diego and the CDC. Felitti, Anda and colleagues mailed a questionnaire to 13,494 adults who had completed a standardized medical evaluation at a large health plan, and 9,508 of them, just over 70 percent, replied. The 1998 report in the American Journal of Preventive Medicine studied seven categories of adverse experience. Dong, Anda, Felitti and colleagues later worked with the ten-category version in Child Abuse and Neglect in 2004, which added emotional neglect, physical neglect and parental separation or divorce to the original seven.
The headline finding was a graded relationship. More than half of the respondents reported at least one category of adversity and a quarter reported two or more, and as the number of categories went up, so did the reported rates of many adult health problems, including ischemic heart disease, cancer, chronic lung disease, skeletal fractures and liver disease. Comparing people reporting four or more categories with people reporting none, the 1998 paper found risks four to twelve times higher for alcoholism, drug abuse, depression and attempted suicide, two to four times higher for smoking and poor self-rated health, and about one and a half times higher for physical inactivity and severe obesity.
Those numbers describe groups of thousands of people, and this is the point at which an ACE score is most often misread. A relative risk measured across a large sample does not forecast one person's health, and a score of 4 does not mean a particular outcome is coming. Robert Anda, one of the study's authors, co-wrote a commentary in 2020 on the merits, limits and misapplications of the ACE score, arguing that a measure built for population-level research is not well suited to screening individuals or making decisions about them. Reading your own number is reasonable. Treating it as a prediction is not.
It is equally worth being clear about what the score counts. It counts categories of exposure, nothing else. One question answered Yes scores the same single point whether something happened once or for a decade, and whether it was severe or mild. The form never asks how old you were, how long it lasted, who did it, whether anyone intervened, or whether you had one steady adult in your corner through all of it. Two people with a 3 can have had entirely different childhoods, and the same ACE score can sit behind a settled adult life and a very difficult one.
The ten questions also leave out whole kinds of adversity: community violence, bullying, racism, poverty, homelessness, foster care, immigration detention, serious illness or hospital trauma, the death of a parent, and a parent's severe physical illness. A person can have a 0 and have had a hard start. The original sample was mostly insured, middle-class patients at one health plan in one city, which shaped what the questionnaire noticed, and all of it was recalled decades later, with the usual gaps and softening that memory introduces.
What the score leaves out most importantly is everything that came afterward. The counterpart research looks at positive childhood experiences, the supportive adults, safe places and belonging that sit alongside adversity rather than canceling it out. Bethell and colleagues reported in JAMA Pediatrics in 2019 that adults who recalled more positive childhood experiences had lower odds of depression and poor mental health and better social and emotional support, and that this held across levels of adversity. The counterpart questionnaire is at Positive Childhood Experiences (PCEs) Test, and it is worth answering next if you have just scored a 4 or a 7.
Used well, this sheet is a way to say something difficult in ten lines. Many people find it easier to hand a clinician a completed form than to narrate a childhood out loud, and a therapist can then ask about the specific items rather than opening with a blank page. A score does not set the treatment: that depends on what is happening now, which symptoms are present, and what you want to change. Trauma-focused therapies have good evidence behind them, and none of them require a particular number on this form to begin.
Answering these questions can stir things up, sometimes hours later rather than at the time, so pick a moment with some room around it and stop if you need to. You are allowed to leave a question blank. If you would rather answer on screen and have the total worked out for you, the interactive versions are at ACE Test and Childhood Trauma Test, which asks about some experiences this ten-item form does not cover.
References
- Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14(4):245-258. doi:10.1016/S0749-3797(98)00017-8
- Dong M, Anda RF, Felitti VJ, et al. The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect. 2004;28(7):771-784. doi:10.1016/j.chiabu.2004.01.008
- Anda RF, Porter LE, Brown DW. Inside the adverse childhood experience score: strengths, limitations, and misapplications. American Journal of Preventive Medicine. 2020;59(2):293-295.
- Bethell CD, Jones J, Gombojav N, Linkenbach J, Sege R. Positive childhood experiences and adult mental and relational health in a statewide sample: associations across adverse childhood experiences levels. JAMA Pediatrics. 2019;173(11):e193007. doi:10.1001/jamapediatrics.2019.3007
- Centers for Disease Control and Prevention. Adverse Childhood Experiences (ACEs): communication resources. Accessed November 2026. https://www.cdc.gov/aces/communication-resources/index.html
Cite this source
Psychology.com. (2026, November 6). ACE Questionnaire PDF. Psychology.com. https://psychology.com/tools/ace-questionnaire-pdf
ACE Questionnaire PDF FAQ
Is the ACE questionnaire PDF free to download?
Yes. The ACE questionnaire content is in the public domain, and the CDC provides the source questionnaires free of charge from its own site, so there is nothing to buy and no permission to request. Reproducing it carries two obligations: credit the source, and keep a non-endorsement note, because using public-domain federal material does not imply that the CDC, HHS or the United States Government endorses the site reprinting it. Both appear on this sheet. The item wording should be left as published, since the scoring assumes those exact ten questions.
How do I calculate my ACE score?
Your ACE score is simply the number of the ten questions you answered Yes to, so it runs from 0 to 10. Each numbered question counts once, even when it describes several experiences joined by the word or, and even when something happened many times. That is the whole method: no weighting, no subscales, no reverse-scored items. If you left a question blank or genuinely cannot remember, do not record it as a No. Note that the score is incomplete, and raise the uncertainty with a clinician if you are discussing the form with one.
What does an ACE score of 4 or more mean?
Four or more is the comparison group the ACE research uses most often, not a diagnostic threshold. In the 1998 study, adults reporting four or more categories had substantially higher rates of several health problems than adults reporting none, with the largest differences for alcoholism, drug use, depression and attempted suicide. Those figures describe thousands of people at once. For any one person, a 4 means four kinds of adversity were present before 18, which is worth taking seriously and worth talking about, and it does not predict how your health or your life will go.
Can you have a low ACE score and still be affected by your childhood?
Yes, and this is the most important limit of the ACE questionnaire. The ten questions miss whole categories of hardship: community violence, bullying, racism, poverty, homelessness, foster care, a parent's death or serious illness, medical trauma, and growing up with an emotionally volatile parent who never hit anyone. A score of 0 or 1 can sit behind a genuinely difficult childhood. The number also says nothing about severity or duration, so a single category that lasted ten years scores one point. If something still weighs on you, the score is not the thing to argue with.
Does a high ACE score mean I will have health problems?
No. The ACE score was built for population research, and the findings are group-level associations rather than individual forecasts. Robert Anda, one of the original study's authors, co-wrote a 2020 commentary warning specifically against misapplying the score to individuals, including using it to screen or to make decisions about particular people. Risk measured across thousands of adults does not transfer to one adult's future. What the research does support is that early adversity is worth attention, and that attention is available in the form of treatment, not prediction.
What about the good things that happened in my childhood?
The ACE questionnaire does not ask, which is why a second body of research exists on positive childhood experiences. Bethell and colleagues reported in 2019 that adults recalling more of these experiences, such as feeling able to talk to family about feelings, feeling supported by friends, and having a sense of belonging, had lower odds of depression and poor mental health and better social and emotional support, and that this pattern held at every level of adversity. Protective experiences do not erase what happened, and they belong in any honest account of a childhood alongside the ten questions here.
Should I take my ACE score to a therapist?
It is a useful thing to bring. Many people find a completed ACE questionnaire easier to hand over than a story told out loud, and it gives a therapist specific items to ask about rather than a blank page at the first appointment. What it will not do is set the treatment, which depends on what is happening in your life now and which symptoms are present rather than on a number from decades ago. If you would rather not share the individual answers, saying how many there were, or simply that your childhood was hard, is enough to start.