ACE Score Calculator

Adverse Childhood Experiences Assessment — Based on the CDC-Kaiser Permanente Study

✓ Validated Tool ⚗ CDC Research 🔒 100% Private
17,000+ Original Study Participants
4+ ACEs Linked to Increased Health Risks
10 Assessment Questions
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Abuse (Questions 1–5)

Q1. Did a parent or other adult in the household 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?

Q2. Did a parent or other adult in the household often push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?

Q3. 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?

Q4. Did you 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?

Q5. Did you 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?

Household Dysfunction (Questions 6–10)

Q6. Were your parents ever separated or divorced?

Q7. Was your mother or stepmother often pushed, grabbed, slapped, or had something thrown at her? Or sometimes or often kicked, bitten, hit with a fist, or hit with something hard? Or ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

Q8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

Q9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

Q10. Did a household member go to prison?

What Are Adverse Childhood Experiences?

Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in childhood (0–17 years). The ACE questionnaire measures three categories of adversity:

  • Abuse: Emotional abuse, physical abuse, and sexual abuse
  • Neglect: Emotional neglect and physical neglect
  • Household Dysfunction: Parental separation/divorce, domestic violence, substance abuse in the household, mental illness in the household, and incarceration of a household member

The original ACE study was conducted by the CDC and Kaiser Permanente from 1995 to 1997. Led by Dr. Vincent Felitti and Dr. Robert Anda, it surveyed over 17,000 adults about their childhood experiences and current health status. This landmark study revealed a powerful relationship between childhood adversity and adult health outcomes.

Prevalence: According to CDC data, about 61% of adults report having experienced at least one ACE, and approximately 16% report having experienced four or more ACEs. ACEs are common across all populations regardless of income, education level, or ethnicity.

How ACEs Affect Health

Research has established a dose-response relationship between ACEs and negative health outcomes — meaning the more ACEs a person has, the greater the risk for adverse effects. This relationship holds across a wide range of conditions:

  • Heart disease: Adults with 4+ ACEs have up to a 2x increased risk of heart disease
  • Depression: The risk of depression increases significantly with each additional ACE; those with 4+ ACEs have a 4.6x greater risk of depression
  • Substance abuse: People with 5+ ACEs are 7–10x more likely to report illicit drug use and addiction
  • Reduced lifespan: People with 6+ ACEs have an average life expectancy nearly 20 years shorter than those with none
  • Other conditions: Increased risk of diabetes, cancer, chronic lung disease, liver disease, autoimmune disorders, and sexually transmitted infections

The biological mechanism involves chronic activation of the stress response system (toxic stress), which disrupts brain development, immune function, and metabolic regulation during critical developmental periods.

Building Resilience After Adversity

An ACE score is not a destiny. Many people with high ACE scores lead healthy, fulfilling lives. Resilience — the ability to thrive despite adversity — can be cultivated at any age.

Protective Factors:

  • Having at least one stable, supportive adult relationship during childhood
  • Developing a sense of mastery and self-efficacy
  • Building strong executive function and self-regulation skills
  • Having a supportive faith or cultural community

Evidence-Based Therapies:

  • Cognitive Behavioral Therapy (CBT): Helps identify and change negative thought patterns
  • EMDR (Eye Movement Desensitization and Reprocessing): Specifically designed for trauma processing
  • Somatic Experiencing: Body-based approach to healing trauma
  • Dialectical Behavior Therapy (DBT): Combines CBT with mindfulness and distress tolerance skills

Community Resources: Support groups, community health centers, employee assistance programs (EAPs), and peer counseling networks can all serve as valuable sources of connection and healing.

When and How to Get Help

Consider reaching out to a professional if you:

  • Feel overwhelmed by memories of past experiences
  • Notice patterns in your relationships that concern you
  • Struggle with anxiety, depression, or substance use
  • Want to break cycles of adversity for yourself or your children
  • Experience difficulty managing stress or emotions

Types of Professionals:

  • Licensed Clinical Psychologist (PhD/PsyD): Specializes in assessment and therapy for trauma
  • Licensed Clinical Social Worker (LCSW): Provides therapy and connects you with community resources
  • Psychiatrist (MD): Can prescribe medication if needed alongside therapy
  • Licensed Professional Counselor (LPC): Provides individual and group counseling

National Resources:

  • 988 Suicide & Crisis Lifeline: Call or text 988 (24/7)
  • Crisis Text Line: Text HOME to 741741 (24/7)
  • SAMHSA Helpline: 1-800-662-4357 (free referrals, 24/7)
  • National Child Abuse Hotline: 1-800-422-4453 (24/7)
  • Psychology Today Therapist Finder: psychologytoday.com — search by specialty, insurance, and location

Frequently Asked Questions

The ACE score is a count of the number of Adverse Childhood Experiences a person has experienced before the age of 18. It is based on the 10-item questionnaire developed for the CDC-Kaiser Permanente Adverse Childhood Experiences Study, which surveyed over 17,000 adults. The score ranges from 0 to 10, with each "Yes" answer adding one point. Higher scores indicate a greater number of adverse experiences during childhood.

A high ACE score indicates that a person experienced multiple forms of adversity during childhood. Research shows a dose-response relationship between ACE scores and health risks — the higher the score, the greater the statistical risk for certain health and social problems. However, it is important to understand that ACE scores represent correlation, not causation. A high score does not guarantee negative health outcomes, and many people with high ACE scores live healthy, fulfilling lives, especially with appropriate support and resilience-building practices.

No — ACE scores measure past experiences that have already occurred and cannot be undone. Your ACE score will remain the same because it reflects events from your childhood. However, what can change is how those experiences affect your life going forward. Through therapy, supportive relationships, healthy coping strategies, and resilience-building practices, people can significantly reduce the impact of adverse childhood experiences on their health and well-being.

The ACE questionnaire has been validated through the landmark CDC-Kaiser Permanente study involving over 17,000 participants and has since been replicated in numerous studies worldwide. It is recognized as a reliable screening tool by the CDC, the World Health Organization, and the American Academy of Pediatrics. While no self-report instrument is perfect — as responses rely on memory and willingness to disclose — the ACE questionnaire has strong research support for identifying childhood adversity and its association with health outcomes.

Yes, sharing your ACE score with your healthcare provider can help inform your care. Many healthcare systems are adopting trauma-informed care practices, and knowing your ACE history can help your provider better understand your health risks, recommend appropriate screenings, and connect you with mental health resources. You don't need to share specific details of your experiences — simply sharing your score can be a valuable starting point for the conversation.

It is completely normal to feel emotional after reflecting on difficult childhood experiences. If you are feeling overwhelmed, please reach out for support. You can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 (available 24/7), or text HOME to 741741 to reach the Crisis Text Line. The SAMHSA National Helpline (1-800-662-4357) provides free referrals 24 hours a day. Remember: taking this assessment takes courage, and reaching out for help is a sign of strength.

Medical Disclaimer

This ACE Score Calculator is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. The ACE questionnaire is a screening tool, not a clinical diagnostic instrument. Your results should be interpreted in the context of a comprehensive assessment by a qualified healthcare professional. If you are experiencing a mental health crisis, please contact the 988 Suicide & Crisis Lifeline (call or text 988) or go to your nearest emergency department. All calculations are performed in your browser — no personal data is stored on our servers or shared with any third party.

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References

  1. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245-258.
  2. Centers for Disease Control and Prevention. Adverse Childhood Experiences (ACEs). CDC Violence Prevention. Available at: cdc.gov/violenceprevention/aces.
  3. Hughes K, Bellis MA, Hardcastle KA, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356-e366.
  4. Merrick MT, Ford DC, Ports KA, et al. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. MMWR Morb Mortal Wkly Rep. 2019;68(44):999-1005.
  5. Bethell CD, Gombojav N, Whitaker RC. Family resilience and connection promote flourishing among US children, even amid adversity. JAMA Pediatrics. 2019;173(11):e193007.