One Test You Don't Want to ACE: Adverse Childhood Experience

Acing a test typically entails scoring high, but with the ACE quiz, the lower the score, the better.

ACE, which stands for Adverse Childhood Experience, explores a span of traumatic childhood experiences as risk predictors for mental and physical problems in adulthood. The quiz examines adverse situations that include issues such as physical and emotional neglect or violence, substance abuse, mental illness and parental separation or divorce. 

A score from 0 to 10 rates the likelihood respondents have of suffering from psychological disorders such as depression, from chronic diseases such as coronary heart disease and cancer and from life skills challenges that can result in unemployment and even incarceration. 

Lucky — and few — are the respondents who score a zero, for their childhood had no trauma. About two-thirds of adults who have taken the quiz report scoring at least one adverse childhood experience, and the majority of respondents had more than one. A score of four or more places the individual at high risk for toxic stress physiology.

The test has existed since 1995, when its foundational study was conducted by the Centers for Disease Control and Kaiser Permanente health care company. A group of patients insured through Kaiser Permanente — 17,000 participants — were quizzed on their childhood and current health status and behaviors. The results found a direct link between childhood trauma and toxic stress, what the National Scientific Council on the Developing Child calls the overactivation of stress responses on a child’s brain and his or her immune, metabolic and cardiovascular systems. This constant wear-and-tear can lead to adult onset of emotional, mental and physical issues. 

All children need to feel is that they belong and are loved. When children live in a traumatic environment like a household with substance abuse problems or where violence is routine, they will try to develop unhealthy coping skills that will make them feel they belong. 

“These skills help them survive, but bring a lot of anxiety because the child is constantly anticipating what could happen next,” said licensed mental health counselor Kristin Woodling of Pamper Your Mind in Satellite Beach. “We honor these coping skills, but we need to let the person see they don’t need to live with this anxiety.”

The ACE test does not measure childhood stressors outside the household, from poverty and discrimination to isolation and lack of services, as well as adult risk factors such as drug use and unhealthy lifestyle. Individual resilience is also not gauged, even though some individuals may be more resilient than others to the same negative experiences, possibly because they are genetically predisposed to do so. 

The quiz also does not explore the opportunity for positive experiences and people in the child’s life to cancel out long-term effects of early trauma. For example, a teacher who mentored the child or a relative that offered positive guidance could mitigate future problems. 

Ultimately, individuals with high ACE scores can live happy, healthy and productive lives, while, conversely, those with low ACE scores can struggle in adulthood. Screening based on the ACE quiz serves merely as a starting point for mental health professionals for trauma-informed care, even if the test is not formally taken.

“I’m always listening for that sort of thing, because these questions are indicative of whether or not someone had trauma in their background,” said Lori Burke, a certified clinical hypnotherapist practicing in Viera.

Burke adds that while the questions in the quiz do provide important information about the childhood of the men and women she helps, it is only part of the story.

“You also have to be cognizant of whether they had some nurturing parent or grandparent helping them,” she said. 

ACE test participants also need to understand the quiz is simply a tool to raise awareness of potential impact of adverse experiences and it is not intended for self-diagnosis. A high ACE score does not mean the person is damaged beyond repair. 

“People tend to start labeling themselves when they hear a diagnosis,” Burke added. 

Knowing that you have scored high in the quiz can be beneficial if it serves to direct you to professional therapy or to coping mind/body practices such as yoga, meditation, physical exercise, spending time in nature and mindfulness training. 

“These instrumental tools are more effective when in a crisis situation, not as a cookie-cutter,” Woodling said.

Take the ACE Quiz

Add one to the total of all affirmative answers for the following 10 questions. The total number is your ACE score.

Before your 18th birthday:

Did a parent or other adult in the household often or very often

a) Swear at you, insult you, put you down, or humiliate you or 

b) Act in a way that made you afraid that you might be physically hurt?

Did a parent or other adult in the household often or very often 

a) Push, grab, slap, or throw something at you or 

b) Ever hit you so hard that you had marks or were injured?

Did an adult or person at least 5 years older than you ever 

a) Touch or fondle you or have you touch their body in a sexual way or 

b) Attempt or actually have oral, anal, or vaginal intercourse with you?

Did you often or very often feel that 

a) No one in your family loved you or thought you were important or special or 

b) Your family didn’t look out for each other, feel close to each other, or support each other?

Did you often or very often feel that

a) You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you or 

b) Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

Were your parents ever separated or divorced?

Was your parent/caregiver

a) Often or very often pushed, grabbed, slapped or had something thrown at him/her or 

b) Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard or 

c) Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

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

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

Did a household member go to prison?