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This measure is a retrospective questionnaire assessing the 10 types of ACEs experienced by children, young people, and adults before the age of 18. It focuses on different forms of maltreatment and household dysfunction.
This measure is used to screen for adverse childhood experiences in the general population and is frequently applied to children and young people in the child welfare system.
0 to 64 year-olds
This measure has versions and translations in English, Spanish, French, German, Norwegian and Swedish. ACE-Q translations.
Additional information to inform measure use
This measure assesses the various adverse childhood experiences but does not quantify the individual contributions of genetics, trauma or environmental circumstances. (Anda et al., 2009; Lipina & Posner, 2012; Zarse et al., 2019).
There are other forms of the ACE-Q questionnaire. The Center for Youth Wellness (CYW) developed the CYW ACE-Q, which includes two sections: section 1 contains the original ten ACEs items, and section 2 includes supplementary items that assess additional early life stressors specific to children and young people in community clinics.
A cumulative ACE score between 0 and 10 is calculated by summing the number of ‘yes’ responses (yes=1 and no=0) for each question, reflecting the number of ACE experienced. The ACE score serves as a severity index that measures the accumulation of different types of adverse experiences, showing how many types of adversities a person has experienced in their childhood. Most adults score 1 or higher, and a score of 4 is considered clinically significant. Only a minority (5%–10%) of the general population score 4 or more (Hughes et al., 2017).
The norms, reliability and validity statistics included in each measure profile are those reported by the author(s) of the measure. It is important to note that altering, adding or removing questions from a measure voids these reported statistics, possibly making the revised tool unreliable and invalid.
The sample included 9508 patients from Kaiser Permanente’s San Diego Health Appraisal Clinic between the ages of 19 to 64+. The mean age for this sample was 56.1. (Felitti et al., 1998).
The reliability of the ACE-Q has been found to be acceptable, with Cronbach's alpha ranging from 0.64 to 0.7, indicating good internal consistency (Kovács-Tóth., 2023; Oláh et al., 2023). In a study of Hungarian adolescents in the child welfare system, Oláh et al. (2023) reported the item-total correlation, finding that most items showed moderate correlations with the cumulative ACE scores. The only exception was for ‘parental separation/divorce’ which had weak correlations with the other items and ‘sexual abuse’ that correlated with only 4 of the 10 items.
Based on the reliability results, Oláh et al. (2023) tested the concurrent criterion validity of the 10-item version and 9 item version (without parental separation/divorce) of the ACE-Q finding slightly stronger predictive potential in the 9-item version. They found significant associations between the cumulative ACE score and various symptoms including emotional, conduct, hyperactivity/inattention and overall difficulties. Additionally, the ACE score significantly increased the likelihood of being a bullying victim (Oláh et al., 2023).
Kovács-Tóth et al. (2023) also explored the internal validity, finding moderate correlations among the items. The lowest correlation was found for the ‘incarcerated household member’ item, while the ‘emotional abuse’ and ‘emotional neglect’ items showed the strongest correlations. They also found that the ACE accumulation significantly increased the odds of experiencing somatic health complaints (Kovács-Tóth et al., 2023).
