Adverse Childhood Events Questionnaire

There are many researchers, psychiatrists, psychologists and medical professionals who have studied the link between various issues in our adult lives that occur as a result of the childhood we endured. These range from chronic pain, to all types of addictions, to a diverse range of what we consider to be mental health issues, to autoimmune issues, to chronic and terminal illnesses. The connection between our childhood and our adult life issues, is staggering!

The questionnaire below will ask you some questions about events that happened during your childhood; specifically the first 18 years of your life. The information you provide by answering these questions will allow us to better understand problems that may have occurred early in your life and
allow us to explore how those problems may be impacting the challenges you are experiencing today. Many of us grew up thinking we had a normal childhood, but often as adults living in that same dysfunctional thinking and behaviors we deal with in our own lives is a result of the trauma we lived in our childhood, so this is a crucial assessment to find out where you are on the adverse event scale.
This can be very helpful to know and learn in the success of your own healing journey.

Three Ways Trauma Affects You | Colorado Coalition Against ...

There are 10 types of childhood traumas measured in the ACE Study.

  • Five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect.
  • Five are related to other family members: 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

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?
Attempt or actually have oral, anal, or vaginal intercourse 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. Were any of your parents or other adult caregivers:
Often pushed, grabbed, slapped, or had something thrown at them?
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 _____

ACE SCORE (Total “Yes” Answers): _______ Adverse Childhood Experience (ACE)

anxiety: Children and anxiety: A cry for help

What is your ACE score?

It is never too late to heal from childhood trauma. Using a variety of techniques laid out on this website, will help to process traumatic or distressing memories and experiences from the past so that your nervous system and brain can let them go and no longer be triggered by them in the present. Working on the experiences form the past that caused you harm and chronic stress will help you to live a healthier life as a adult. Even though we cannot go back and change what happened to you as a child we can heal form the past and build resiliency now as a adult. A score of 4+ on the above questionnaire indicates that there is enough trauma in your life from childhood that it can significantly impact your daily living now in a variety of ways. All trauma is related to many types of mental, physical and spiritual dis-ease.

Start your healing process today and increase your resilience to life stressors and improve your physical and mental health. If you have tried some of these techniques and find it is not enough, you may require more 1:1 guidance.

Don’t wait. Call, email or schedule an appointment today.