This is a much-shortened version of the ACE Study questionnaire that 17,337 adults filled out at Kaiser Permanente in San Diego. The original questionnaire, which is on the CDC ACE Study site, has more than 200 questions.

Tthe ACE Study shows a direct link between child trauma and diabetes, heart disease, lung cancer, and a host of other chronic illnesses that people get when they're adults. The higher a person's ACE score, the higher risk of chronic disease when they're an adult.

There are 10 types of trauma measured in the ACE Study. Five are personal -- physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to the family: a parent who's an alcoholic, a mother who's a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma counts as one. So a person who's been physically abused, with one alcoholic parent, and a mother who was beaten up has an ACE score of three.

What’s My ACE Score?

Prior to your 18th birthday:

1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?

   Yes
   No If Yes, enter 1 __

2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

   Yes
   No

   If Yes, enter 1 __

3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?

   Yes
   No

   If Yes, enter 1 __

4. Did you often or very 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?

   Yes
   No

   If Yes, enter 1 __

5. Did you often or very 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?

   Yes
   No

   If Yes, enter 1 __

6. Was a biological parent ever lost to you through divorce, abandonment, or other reason ?
   

   Yes
   No

   If Yes, enter 1 __

7. Was your mother or stepmother:
   Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

   Yes
   No

   If Yes, enter 1 __

8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

   Yes
   No

   If Yes, enter 1 __

9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

   Yes
   No

   If Yes, enter 1 __

10. Did a household member go to prison?

    Yes
    No

    If Yes, enter 1 __

Now add up your “Yes” answers: _ This is your ACE Score