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June 2, 2023

The ACE-Q

Last updated on June 10, 2023

The Adverse Childhood Experiences Questionnaire (ACE-Q) is a self-report questionnaire designed to correlate household childhood maltreatment and the association between them and risk behaviours in later life. The test does NOT test for stressors outside the home, such as bullying and discrimination.

Basic information
Statements: 10
Duration: 2–5 minutes
Type: screening tool
Authors: Vincent Felitti et al.
Publishing year: 1988
Seminal paper: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study (Felitti et al., 1998)

Take the test here:


Dr. Natalie Engelbrecht’s rating: 5 stars for appropriate and respectful wording, 4 stars for clarity & lack of ambiguity, and 5 stars for testing accuracy.

Dr. Natalie Engelbrecht’s rating: 5 stars for appropriate and respectful wording, 4 stars for clarity & lack of ambiguity, and 5 stars for testing accuracy.


Who the test is designed for

  • Teenagers
  • Adults
  • Parents to describe their child’s experiences

Versions & translations

  • English
  • Spanish
  • French
  • German
  • Norwegian
  • Swedish

Taking the test

The ACE-Q consists of 10 statements, giving you 2 choices for each statement:

  1. Yes = 1
  2. No = 0

Note: Some of the questions may be triggering for people who experienced trauma. If that is the case, you can answer the ACE-Q collaboratively with your therapist or someone you trust or not take the test.


Scoring

  • Scoring range: 0-10
  • Most of adults score 1 or higher
  • A score of 4 is considered clinically significant
  • A minority (5%–10%) of the general population score 4 or more

Compared to those with an ACE-Q score of 0, people with a score of 4 are twice as likely to be smokers and 5 times more likely to experience depression. Further, they are 7 times more likely to become alcoholics, 10 times more likely to participate in illicit drug use, and 12 times more likely to attempt suicide.[1]Nova Psych ACE-Q


Validity

How reliable, accurate, valid, and up to date is the test?


Dr. Natalie Engelbrecht pointing to the title ‘Discussion’.

Discussion

Dr. Natalie Engelbrecht:

The ACE-Q helps a person understand whether or not they had a difficult childhood. The main problem I have with the test is the name which can be confusing to clinicians and test-takers alike. It does not consider stressors outside of the household, such as discrimination, a common experience for autistics. In addition, protective factors such as a loving, supportive parent are not considered. And lastly, individual differences, which make a person more or less sensitive to adversity, are not considered.

Still, it is an important test that has been used repeatedly in research to demonstrate that autistics experience significantly more ACEs[3] which affects their mental and physical health outcomes.[4]

My score of 7 indicates a higher risk for negative life outcomes, and I certainly had a rough childhood. I do think that my autism has been protective in some ways. For example, I have noted that autistics often stop contact with harmful parents more often than non-autistics. I suspect the reasoning behind this is due to our pragmatism. I felt that my parents were incapable of parenting lovingly, so I decided that I needed to step in and parent myself in the way a healthy parent would. Another protective factor is that I find autistics tend to find loving relationships. My clinical experience has been that we will ultimately leave destructive relationships and find people that can love us for who we are.

An ACE study of over 9,500 adults found that persons with higher ACE-Q scores experienced more childhood adversity, increasing their risk of chronic disease, mental illness, violence, becoming a victim of violence, and various other consequences.

Kendall

Even though I scored 0 on the ACE-Q, I have experience with 4.5 out of 5 of its predicted consequences. That’s not to say their conclusions aren’t accurate, but that traumatic events outside the home may also be relevant. Taking the test is very quick, and the statements are clear, direct, and easy to understand.


Dr. Natalie Engelbrecht pointing at a psychometric test.

The ACE-Q

  • Because of the questions’ sensitive nature, individuals should take the ACE Questionnaire in a confidential space.
  • Please note some of the questions may be triggering for people who experienced trauma. If that is the case, you can answer the ACE-Q collaboratively with your therapist or someone you trust or not take the test.
  • Before your 18th birthday, did any of the following things occur to you?
1. A person in the household often or very often acted in a way that made the child/teen afraid that they would be hurt (e.g., sworn at, insulted, put down, humiliated)
2. A person in the household often or very often hit, pushed, grabbed, or slapped the child/teen so hard that they had marks or were injured
3. A person touched the child/teen’s private parts or asked them to touch their private parts
4. Child/teen often or very often felt that people they lived with did not love them, look out for each other, feel close to each other, or were a source of strength and support
5. Child/teen often or very often did not have enough to eat or clean clothes to wear, and did not have someone to take care of and protect them
6. Child/teen’s parents or guardians were separated or divorced
7. Child/teen witnessed a person in the household being pushed, grabbed, hit, or physically threatened
8. Someone the child/teen lived with had a problem with drinking or used street drugs
9. Someone the child/teen lived with was depressed, mentally ill, or attempted suicide
10. Someone the child/teen lived with served time in prison


Recommended next steps

After the ACE-Q, consider taking one of the tests below.

Autism Spectrum Quotient

A simple screening test that is used as a basis
for pursuing a formal autism evaluation

CAT-Q

Measures camouflaging, and can account
for lower scores on other autism tests

Aspie Quiz

Identifies neurodivergence and
potential co-occurring conditions

Online autism tests can play an essential role in the process of self-discovery, and may inform your decision to pursue a formal diagnosis. For a formal assessment, please see a knowledgeable medical professional trained in assessing autism.


An illustration of a clipboard with a checklist or assessment.

If you are looking for an autism assessment,
have a look at the following post:

Online autism assessments

References

This article
was written by:
dr-natalie-engelbrecht

Dr. Natalie Engelbrecht ND RP is a dually licensed naturopathic doctor and registered psychotherapist, and a Canadian leader in trauma, PTSD, and integrative medicine strictly informed by scientific research.

She was diagnosed at 46, and her autism plays a significant role in who she is as a doctor, and how she interacts with and cares for her patients and clients.

Want to know more about her? Read her About me page.

Disclaimer

Although our content is generally well-researched
and substantiated, or based on personal experience,
note that it does not constitute medical advice.

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