ACE Questionnaire

While you were growing up, during your first 18 years of life:*

	Yes	No
1. 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 feel afraid that you might be physically hurt?
2. 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?
3. Did an adult or person at least 5 years older than you ever ... Touch or fond you or have you touch their body in a sexual way? OR Try to or actually have oral, anal, or vaginal sex with you?
4. 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?
5. 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?
6. Were your parents ever separated or divorced?
7. 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 a least a few minutes or threatened with a gun or knife?
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
9. Was a household member depressed or mentally ill or did a household member attempt suicide?
10. Did a household member go to prison?

ACE SCORE

PROBABILITY OF OUTCOMES (GIVEN 100 AMERICAN ADULTS)

33 with 0 ACEs	51 with 1-3 ACEs	16 with 4-8 ACES
1 in 6 smokes	1 in 9 smokes	1 in 6 smokes
1 in 69 are alcoholic	1 in 9 are alcoholic	1 in 6 are alcoholic
1 in 48 uses IV drugs	1 in 43 uses IV drugs	1 in 30 uses IV drugs
1 in 14 has heart disease	1 in 7 has heart disease	1 in 6 has heart disease
1 in 96 attempts suicide	1 in 10 attempts suicide	1 in 5 attempts suicide

Chart from ACEs Iowa 360
Source: http://www.bfhd.wa.gov/ph/aces.php

An issue brief issued by Johns Hopkins Bloomberg School of Public Health in October 2017[i] looked at national and across-state data of ACE data among US children. Among the findings:

ACEs are common across all income groups and among children with both public and private insurance. Fifty-eight percent of U.S. children with ACES, however, live in homes with incomes less than 200 percent of the federal poverty level.
Black children are disproportionately represented among children with ACEs. Six in 10 have ACEs and they represent 17.4 percent of all children in the United States with ACEs.
Compared to those children with no ACEs, children three to five years old with two or more ACEs are four times more likely to have three or more of the six social and emotional challenges that can affect learning.
About two thirds of children six to 17 years old who bully, pick on, or exclude other children – or are themselves bullied, picked on or excluded – have ACEs.

Nationally, 21.7 percent children are estimated to have two or more adverse childhood experiences with individual states ranging from 15 percent to 30.6 percent. Eleven states have significantly higher numbers of children with two or more ACEs (.05) including Montana, Arizona, New Mexico, Oklahoma, Missouri, Arkansas, Louisiana, Mississippi, Alabama, Kentucky and Ohio.

To Find Out More About ACEs: https://www.canp.uscourts.gov/forms/ACEs%20Assessment.pdf
https://knowledgeworks.org/resources/ace-assessment-how-used/

Adverse Childhood Experience (ACE) Questionnaire