What are the 10 ACE categories?

The original 10 ACEs: (1) emotional abuse — parent frequently insulted, humiliated, or threatened you; (2) physical abuse — parent hit, kicked, or physically harmed you; (3) sexual abuse — someone at least 5 years older than you touched sexually or attempted / did sexual acts; (4) emotional neglect — no one in family made you feel important or loved; (5) physical neglect — not enough food, dirty clothes, no one to protect you; (6) mother treated violently — witnessed physical violence toward mother; (7) parental separation or divorce; (8) household substance abuse — someone in household was a problem drinker or drug user; (9) household mental illness — someone in household was depressed or mentally ill or attempted suicide; (10) household incarceration — household member went to prison.

What was the ACE Study?

The CDC-Kaiser ACE Study was led by Vincent Felitti and Robert Anda between 1995-1997 and published in 1998 in the American Journal of Preventive Medicine. It surveyed 17,000+ Kaiser Permanente patients about childhood adversity and correlated results with adult health outcomes. Findings established a strong dose-response relationship — each additional ACE category increased adult risk of depression, anxiety, PTSD, substance use, cardiovascular disease, cancer, and premature death.

What does my ACE score mean?

ACE 0-1: below-average risk but not risk-free. ACE 2-3: moderately elevated risk. ACE 4+: substantially elevated risk for adult mental and physical health problems. ACE 6+: very high risk with shortened life expectancy (~20 years shorter than ACE 0 in the original study). BUT: score is not destiny. Many adults with high ACE scores recover well, particularly with therapeutic support and stable adult relationships.

Is ACE score deterministic?

No. Correlations are strong at population level but any individual with a high ACE score may recover well — protective factors matter substantially. Protective factors include stable trusted adult relationships in childhood or adulthood, therapy, self-compassion practice, meaningful work / community, and post-traumatic growth. The ACE score tells you about elevated risk; therapy and support tell you about actual trajectory.

Yes — well documented. EMDR, TF-CBT, Somatic Experiencing, and Compassion-Focused Therapy all have strong evidence for adult recovery from childhood adversity. Recovery is real and lasting for most people who engage with treatment. The older narrative that "you just have to live with it" is outdated.

What are the limitations of the ACE score?

The original 10 ACEs don't capture: community violence, racism, poverty, chronic illness in the family, migration/refugee experience, bullying, or many other childhood adversities that also increase adult risk. Expanded ACE tools exist (Philadelphia ACEs, WHO ACE-International) that add these dimensions. The simple 0-10 score is useful but not exhaustive.

What should I do with a high ACE score?

Book with a trauma-focused clinician. Bring the score to the intake — it shortens the assessment. Trauma-focused therapy (EMDR, TF-CBT, Somatic Experiencing) has strong evidence for adult recovery. If you also have PTSD symptoms currently, take the [ITQ](/assessments/itq) alongside.

Assessments

ACE Test — Adverse Childhood Experiences Score (Free Childhood Trauma Screener)

Take the ACE questionnaire — 10 questions about childhood adversity that predict adult mental and physical health. Free explanation and CHILDAFF alternative in the Mindtalk app.

Important safety information

The ACE (explained) → CHILDAFF alternative includes a question about thoughts of self-harm (question 9). If you have had any such thoughts recently, please reach out for support before or instead of taking this assessment — you do not need to take a test to deserve help.

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Take the ACE (explained) → CHILDAFF alternative (3 min)See related assessments

Quick answer

The ACE (Adverse Childhood Experiences) questionnaire is a 10-item screener asking about childhood adversity experienced before age 18. It emerged from the landmark CDC-Kaiser ACE Study led by Vincent Felitti and Robert Anda in the late 1990s — which established that childhood adversity substantially predicts adult mental and physical health outcomes. Your ACE score is simply the count (0-10) of categories you endorse: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, mother treated violently, parental separation or divorce, household substance abuse, household mental illness, and household incarceration. ACE 4+ substantially elevates adult risk of depression, anxiety, PTSD, substance use, cardiovascular disease, and shorter lifespan. This is not deterministic — many adults with high ACE scores recover well — but the effect is real and treatable.

The 10 ACEs

Your ACE score is the count of categories you experienced before age 18:

Emotional abuse — parent frequently insulted, humiliated, or threatened you
Physical abuse — parent hit, kicked, or physically harmed you
Sexual abuse — someone at least 5 years older than you touched sexually or attempted / did sexual acts
Emotional neglect — no one in family made you feel important or loved
Physical neglect — not enough food, dirty clothes, no one to protect you
Mother treated violently — witnessed physical violence toward mother
Parental separation or divorce
Household substance abuse — someone in household was a problem drinker or drug user
Household mental illness — someone in household was depressed, mentally ill, or attempted suicide
Household incarceration — household member went to prison

What ACE scores predict

The CDC-Kaiser ACE Study (Felitti & Anda, 1998) established a dose-response relationship:

ACE score	Adult risk elevation
0-1	Below-average risk baseline
2-3	Moderately elevated risk
4+	Substantially elevated risk for depression, anxiety, PTSD, substance use, cardiovascular disease
6+	Very high risk; associated with ~20-year shorter life expectancy in original sample

Score is not destiny. Population-level correlations don't determine individual outcomes. Many adults with high ACE scores recover well — particularly with therapeutic support, stable adult relationships, meaningful work, and self-compassion practice.

Limitations of the original ACE

The original 10 categories don't capture:

Community violence
Racism and discrimination
Poverty
Chronic illness in the family
Migration or refugee experience
Bullying
Many other childhood adversities that also elevate adult risk

Expanded tools (Philadelphia ACEs, WHO ACE-International) address some of these. The simple 0-10 score is useful but not exhaustive.

What to do with a high ACE

Book with a trauma-focused clinician. Bring the score to intake — it shortens the assessment.

Take related assessments:

ITQ — current PTSD and Complex PTSD symptoms
Trauma Self-Insight hub — self-understanding
PHQ-9 and GAD-7 — current mental health

Consider trauma-focused therapy:

EMDR — strong RCT evidence for adult PTSD and complex trauma
TF-CBT — trauma-focused CBT
Somatic Experiencing — body-focused
Compassion-Focused Therapy — for shame-driven patterns
Schema Therapy — for early-maladaptive schemas

Post-traumatic growth

Not all adults with high ACE scores experience only adverse outcomes. Post-traumatic growth — meaning-making, resilience, deep empathy, wisdom — is well-documented. Trauma changes people; sometimes the change includes strength alongside vulnerability.

How to take the ACE (explained) → CHILDAFF alternative

1
Take CHILDAFF in the Mindtalk app
Tap "Take the ACE Test" to open CHILDAFF — the Mindtalk-hosted childhood-impact screener.
2
Answer 10 questions about childhood experiences
For each category, indicate whether you experienced that type of adversity before age 18.
3
Get your ACE-equivalent score and interpretation
Receive a score with interpretation and personalised next-step recommendation.

Take the ACE (explained) → CHILDAFF alternative (3 min)

Frequently Asked Questions

What are the 10 ACE categories?: The original 10 ACEs: (1) emotional abuse — parent frequently insulted, humiliated, or threatened you; (2) physical abuse — parent hit, kicked, or physically harmed you; (3) sexual abuse — someone at least 5 years older than you touched sexually or attempted / did sexual acts; (4) emotional neglect — no one in family made you feel important or loved; (5) physical neglect — not enough food, dirty clothes, no one to protect you; (6) mother treated violently — witnessed physical violence toward mother; (7) parental separation or divorce; (8) household substance abuse — someone in household was a problem drinker or drug user; (9) household mental illness — someone in household was depressed or mentally ill or attempted suicide; (10) household incarceration — household member went to prison.
What was the ACE Study?: The CDC-Kaiser ACE Study was led by Vincent Felitti and Robert Anda between 1995-1997 and published in 1998 in the American Journal of Preventive Medicine. It surveyed 17,000+ Kaiser Permanente patients about childhood adversity and correlated results with adult health outcomes. Findings established a strong dose-response relationship — each additional ACE category increased adult risk of depression, anxiety, PTSD, substance use, cardiovascular disease, cancer, and premature death.
What does my ACE score mean?: ACE 0-1: below-average risk but not risk-free. ACE 2-3: moderately elevated risk. ACE 4+: substantially elevated risk for adult mental and physical health problems. ACE 6+: very high risk with shortened life expectancy (~20 years shorter than ACE 0 in the original study). BUT: score is not destiny. Many adults with high ACE scores recover well, particularly with therapeutic support and stable adult relationships.
Is ACE score deterministic?: No. Correlations are strong at population level but any individual with a high ACE score may recover well — protective factors matter substantially. Protective factors include stable trusted adult relationships in childhood or adulthood, therapy, self-compassion practice, meaningful work / community, and post-traumatic growth. The ACE score tells you about elevated risk; therapy and support tell you about actual trajectory.
Is trauma treatable?: Yes — well documented. EMDR, TF-CBT, Somatic Experiencing, and Compassion-Focused Therapy all have strong evidence for adult recovery from childhood adversity. Recovery is real and lasting for most people who engage with treatment. The older narrative that "you just have to live with it" is outdated.
What are the limitations of the ACE score?: The original 10 ACEs don't capture: community violence, racism, poverty, chronic illness in the family, migration/refugee experience, bullying, or many other childhood adversities that also increase adult risk. Expanded ACE tools exist (Philadelphia ACEs, WHO ACE-International) that add these dimensions. The simple 0-10 score is useful but not exhaustive.
What should I do with a high ACE score?: Book with a trauma-focused clinician. Bring the score to the intake — it shortens the assessment. Trauma-focused therapy (EMDR, TF-CBT, Somatic Experiencing) has strong evidence for adult recovery. If you also have PTSD symptoms currently, take the [ITQ](/assessments/itq) alongside.

Need a clinician's read on your results?

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