Adverse Childhood Experience ( ACE ) Questionnaire : Finding your ACE Score
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 ? 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 …
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 five years older than you ever …
Touch or fondle you or have you touch their body in a sexual way ? or 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 ? 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 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 . 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 ? or Sometimes or 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 ra hbr 10 24 06 fects health across a lifetime .” Video Podcast retrieved from https :// www . ted . com / talks / nadine _ burke _ harris _ how _ childhood _ trauma _ affects _ health _ across _ a _ lifetime ? language = en .
• Center for Disease Control and Prevention website . “ Adverse Childhood Experiences ,” www . cdc . gov / violenceprevention / acestudy .
• Dong , M ., Anda , R . F ., Felitti , V . J ., Williamson , D . F ., Dube , S . R ., Brown , D . W . and Giles , W . H . ( 2005 ). “ Childhood residential mobility and multiple health risks during adolescence and adulthood : the hidden role of adverse childhood experiences .” Archives of pediatrics and adolescent medicine , 159 ( 12 ), 1104-1110 .
• Downey , L . ( 2012 ). “ Calmer classrooms : A guide to working with traumatised children .” Child Safety Commission , Victoria , Australia .
• Felitti , V . ( speaker ). ( 2015 , October ). Bigthink . “ How childhood trauma can make you a sick adult .” Video retrieved from http :// bigthink . com / experts / vincentfelitti .
• Cole , S . et al . ( 2013 ). “ Helping Traumatized Children Learn , Vol . 2 .” Massachusetts Advocates for Children and Harvard Law School .
• Trauma and Learning Policy Initiative , Harvard Law School , Education Law Clinic ( 2016 , September ). Advocacy strategies , including providing support to schools to become trauma-sensitive environments .
• Van der Kolk , B . ( 2014 ). “ The body keeps the score .” New York : Viking .
• Wolpow , R ., Johnson , M . M . and Hertel , R . ( 2009 ). “ The heart of learning and teaching .” Washington State Office of Superintendent of Public Instruction .
Shawn Nealy-Oparah and Tovi C . Scruggs-Hussein are colleagues at Partners in School Innovation , adjunct professors at Mills College , where they co-teach a course on traumainformed leadership , and facilitators of transformational leadership with an SEL focus . Scruggs-Hussein also serves as ACSA ' s Region 6 state equity rep .
16 Leadership