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What is the ACE Study and Why Is It Important to Me?

The ACE Study is one of the largest scientific research studies of its kind, with over 17,000 mostly middle income Americans participating.  The focus was to analyze the relationship between childhood trauma and the risk for physical and mental illness in adulthood.

Over the course of a decade, the results demonstrated a strong, graded relationship between the level of traumatic stress in childhood and poor physical, mental and behavioral outcomes later in life.

The ACE Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente.

Co-principal Investigators : Robert F. Anda, MD, MS, Centers for Disease Control and Prevention;

                 Vincent J. Felitti, MD, Kaiser Permanente, San Diego.


What is an Adverse Childhood Experience / ACE?

Growing up experiencing any of the following conditions in the household prior to age 18:

1.         Recurrent physical abuse

2.         Recurrent emotional abuse

3.         Contact sexual abuse

4.         An alcohol and/or drug abuser in the household

5.         An incarcerated household member

6.         Family member who is chronically depressed, mentally ill, institutionalized, or suicidal

7.         Mother is treated violently

8.         One or no parents

9.         Physical neglect

10.       Emotional neglect


The ACE Score

The ACE Study used a simple scoring method to determine the extent of each study participant’s exposure to childhood trauma.  Exposure to one category (not incident) of ACE, qualifies as one point.

When the points are added up, the ACE Score is determined.

An ACE Score of 0 (zero) would mean that the person reported no exposure to any of the categories of trauma listed as ACEs above.

An ACE Score of 10 would mean that the person reported exposure to all of the categories of trauma listed above.

The ACE Score is referred to throughout all of the peer-reviewed publications about the ACE Study findings.


What’s YOUR ACE Score?

Help me calculate my ACE Score:

The ACE Study is based upon data collected from over 17,000 adult participants, and no new study participants are being accepted.  However, you might like to know your own ACE Score, so that the information you read about the Study is more meaningful to you.

Please visit the Centers for Disease Control and Prevention website to learn how your score may affect you and your health:


How does fear impact childhood?

The key concept underlying the ACE Study is that stressful or traumatic childhood experiences can result in social, emotional, and cognitive impairments.  Examples: Increased risk of unhealthy behaviors, risk of violence or re-victimization, disease, disability and “early death.”

Breakthroughs in neurobiology demonstrate that fear-based childhoods disrupt neurodevelopment, and can actually alter normal brain structure and function.

Fear during infancy and early childhood has a cumulative impact on childhood development.  Results of the ACE Study link the exploding rates in America’s physical, mental, and social pathologies with our national failure to strengthen our families and protect our children.


What increased health risks are associated with an ACE?

The young brain is especially vulnerable to stress. When prolonged stress occurs during infancy and childhood, the stress hormone cortisol is released throughout the young brain and body.  These stress hormones compromise normal brain development and the immature immune and nervous systems.  The ACE Study demonstrates that early stress is a strong factor for developing the following national health problems.

  • Cardiovascular disease
  • Cancer
  • Heart attacks
  • High blood pressure
  • Stroke
  • Diabetes
  • Weight gain(especially abdominal fat)
  • Exhaustion
  • Reduced Growth Hormone Levels
  • Compromised immune function
  • Bone loss

A decade of rigorous research demonstrates that sustained stress in childhood results in overproduction of cortisols, with profound, lifelong impacts on the brain and body.


How does the ACE score affect social well being?

Within the 17,000 middle-class, ethnically diverse American adults tested, it was found that the compulsive use of nicotine, alcohol, and injected street drugs increased proportionally, in a strong, graded, dose-response manner with the level of adverse life experiences reported during childhood.


The ACE Study results are disturbing to some because they imply that the basic causes of addictions are to be found in our personal histories, not in drug dealers or dangerous chemicals. 

This finding is at odds with current concepts, including those of biological psychiatry, drug-treatment programs, and drug-eradication programs. The results of the ACE Study strongly suggest that billions of dollars are spent everywhere except on  the solution.

The prevalence of adverse childhood experiences and their long-term effects are clearly a major determinant of the health and social well-being of the nation. This is true whether looked at from the standpoint of social costs, the economics of health care, the quality of human existence, the focus of medical treatment, or the effects of public policy.

The ACE Study demonstrates dramatically that if we engage America in the protection and nurturing of its children, these serious and prevalent health and social problems will be significantly reduced.


Where can I find more information on the ACE Study? 



Adverse Childhood Experience (ACE) Questionnaire

Finding your ACE Score ra hbr 10 24 06

While you were growing up, during your first 18 years of life:

1. Did a parent or other adult in the household often

Swear at you, insult you, put you down, or humiliate you?


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

Push, grab, slap, or throw something at you?


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?


Try to or actually have oral, anal, or vaginal sex with you?

                          Yes No                                                                      If yes enter 1 ________

4. Did you often feel that …

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


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 feel that …

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


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. Were your parents ever separated or divorced?

                             Yes No                                                                   If yes enter 1 ________

7. Was your mother or stepmother:

Often pushed, grabbed, slapped, or had something thrown at her?


Sometimes or often kicked, bitten, hit with a fist, or hit with something hard?


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 

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