If you recently took an Adverse Childhood Experiences questionnaire, you probably want to know where you stand. The ACE score measures childhood trauma exposure on a scale from 0 to 10. Each “yes” answer adds one point.
But here is the thing most people get wrong: a higher score does not mean you are broken. It means you faced more adversity growing up, and understanding that number gives you power to protect your health going forward.
What the ACE Score Actually Measures
The ACE questionnaire asks about 10 specific types of childhood adversity experienced before age 18. These fall into three categories: abuse, neglect, and household dysfunction.
Abuse includes physical, emotional, and sexual abuse. Neglect covers both physical and emotional neglect. Household dysfunction includes domestic violence, substance abuse in the home, mental illness in a family member, parental separation or divorce, and having an incarcerated household member.
Each category you experienced counts as one point. Your total is your ACE score.
ACE Score Ranges and What They Mean
Score of 0: No Reported ACEs
About 36% of adults report an ACE score of zero. This means none of the 10 adverse experiences were present during childhood. A score of zero is associated with the lowest baseline risk for ACE-related health conditions.
Keep in mind that the ACE questionnaire does not capture every form of childhood stress. Poverty, bullying, racism, and community violence are not included in the original 10 questions.
Score of 1 to 3: Low to Moderate Exposure
Roughly 38% of adults fall into this range. A score in this bracket is common and indicates some childhood adversity. Research shows the health risks at this level are elevated compared to a score of zero, but the increases are modest.
People with scores of 1 to 3 may have a slightly higher risk of depression, smoking, or heavy drinking. However, many people in this range live healthy lives with no significant health consequences, especially when protective factors are present.
Score of 4 to 6: Significant Exposure
This is where the research gets serious. An ACE score of 4 or higher is the threshold used in the original CDC-Kaiser study to flag substantially elevated health risks.
Compared to someone with zero ACEs, a person with 4 or more ACEs is:
- 4.6 times more likely to experience depression
- 12.2 times more likely to attempt suicide
- 7.4 times more likely to develop alcoholism
- 2.2 times more likely to develop heart disease
- 1.9 times more likely to develop cancer
These are statistical averages, not guarantees. Many individuals with scores in this range do not develop these conditions.
Score of 7 to 10: High Exposure
About 6% of adults report scores in this range. A score this high indicates pervasive childhood adversity across multiple categories. The health risks are the most elevated, and the likelihood of chronic conditions increases further with each additional ACE point.
People with scores of 7 or above often experienced overlapping forms of trauma. For example, substance abuse in the home frequently co-occurs with domestic violence, neglect, and parental separation.
Why Your ACE Score Is Not Your Destiny
A high ACE score tells you about risk. It does not tell you about certainty. This distinction matters enormously.
Researchers have identified several resilience factors that can buffer the effects of childhood adversity:
- Stable relationships: Having at least one safe, supportive adult during childhood dramatically reduces long-term harm
- Community connections: Belonging to a faith community, sports team, or neighborhood group provides protective social bonds
- Emotional regulation skills: Learning to manage stress through therapy, mindfulness, or other practices rewires the brain’s stress response
- Physical activity: Regular exercise reduces cortisol and inflammation, two biological pathways through which ACEs cause disease
- Mental health treatment: Trauma-informed therapy, particularly EMDR and cognitive behavioral therapy, has strong evidence for healing ACE-related wounds
What to Do After Learning Your ACE Score
Knowing your score is the first step. Here is what comes next, depending on where you fall.
If Your Score Is 0 to 3
Stay informed. Maintain healthy habits, build strong relationships, and know that you are not immune to stress-related health issues just because your childhood was relatively stable. Annual checkups and basic stress management go a long way.
If Your Score Is 4 or Higher
Talk to your doctor. Mention your ACE score at your next visit. Many physicians now screen for ACEs because the research connecting childhood trauma to adult disease is so strong. Your doctor may recommend more frequent screening for conditions like depression, diabetes, or cardiovascular disease.
Consider therapy if you have not already. You do not need to be in crisis to benefit from working with a therapist trained in trauma-informed care.
For Everyone
Remember that ACEs are common. Over 60% of adults have at least one. This is not a rare or shameful thing. The purpose of the ACE score is to inform, not to label.
Limitations of the ACE Score
The ACE questionnaire has real limitations. It does not account for the severity, frequency, or duration of each experience. It does not include poverty, racism, bullying, or community violence. It does not measure resilience factors or positive childhood experiences.
A score of 4 where each experience happened once is very different from a score of 4 where each experience was ongoing for years. The questionnaire cannot capture that nuance.
Despite these limitations, the ACE score remains one of the most studied and validated tools in public health for understanding the link between childhood adversity and adult health outcomes.
Frequently Asked Questions
Is an ACE score of 4 bad?
A score of 4 or higher is associated with significantly increased health risks. It is not “bad” in a moral sense, but it does mean you should be proactive about your physical and mental health. Talk to your healthcare provider about what this means for your specific situation.
Can my ACE score change?
Your ACE score itself does not change because it measures past experiences. However, your health trajectory can absolutely change through resilience-building activities, therapy, healthy relationships, and medical care.
Should I tell my doctor my ACE score?
Yes. The American Academy of Pediatrics and many medical organizations now recommend ACE screening. Sharing your score helps your doctor understand your health risks and tailor preventive care accordingly.
