Summary
About the ACEs AssessmentThe ACE-Q stands for the Adverse Childhood Experiences Questionnaire.It is a 10-item, self-report screening tool designed to retrospectively assess the extent of exposure to potentially traumatic experiences occurring from birth to age 18. Purpose and UseThe ACE-Q is based on the groundbreaking Adverse Childhood Experiences (ACE) Study conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, first published in 1998.Screening Tool: It is used in public health, primary care, and integrative health settings to screen for childhood adversity, providing a rapid, quantifiable measure of a patient's risk profile.Root Cause Identification: In functional and integrative medicine, the ACE score is considered a critical antecedent (predisposing factor) that can lead to chronic activation of the stress response, contributing to a wide range of adult physical and mental health issues.Dose-Response Relationship: The central finding of the ACE Study is the "dose-response relationship"—the more types of ACEs a person experiences, the higher their risk for negative health and social outcomes later in life (e.g., chronic disease, mental illness, substance abuse, and violence). Scoring & InterpretationThe ACE-Q uses a dichotomous (Yes/No) response format. Each “Yes” answer is scored as 1 point. The “Yes” responses are summed to create a total score ranging from 0 to 10. Higher scores indicate exposure to a greater number of adverse childhood experiences, with each point representing a different type of adversity rather than the frequency or severity of any single experience. The ACE-Q items can be conceptually grouped into two categories: Abuse / Neglect (Items 1-5): Emotional, physical, and sexual abuse and emotional and physical neglectHousehold Dysfunction (Items 6-10): Household substance abuse, mental illness, incarceration, domestic violence, and parental separation/divorce For clinical interpretation, ACE-Q scores are categorized as follows, with corresponding qualitative descriptors:0 ACEs (No Reported Adversity): Indicates no exposure to the measured adverse childhood experiences. Individuals in this category typically show the lowest risk for negative health outcomes.1-3 ACEs (Low to Moderate Adversity): Indicates exposure to one or more types of adversity. Research demonstrates a modest but statistically significant elevation in risk for various health and social problems compared to individuals with no ACEs.4+ ACEs (High Adversity): Represents a clinically significant threshold where risk for negative outcomes increases substantially. This category is associated with significantly elevated risk across multiple domains of functioning and should prompt thorough clinical attention.6+ ACEs (Very High Adversity): Although not a formal categorization in all ACE literature, scores of 6 or higher represent exposure to multiple forms of serious adversity and are associated with the highest risk for severe and complex health problems. Clinical RecommendationsFor clients with clinically significant ACE-Q scores (4+), evidence-based trauma-focused interventions may be indicated, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), or Sensorimotor PsychotherapyHowever, the selection of intervention should be guided by the client’s specific symptoms, needs, and preferences rather than by the ACE score alone.