Fri | Feb 3, 2023

Michael Abrahams | What is your ACE score? [Part 1]

Published:Sunday | March 10, 2019 | 12:00 AM

Several years ago, I came across a study that changed my life. The results of the research prompted me to not only introspect, but to also observe more keenly the behaviour of those I interact with socially and professionally, especially the patients I manage in my practice.

The study was the landmark Adverse Childhood Experiences Study (ACE Study), and was conducted by the American health maintenance organization Kaiser Permanente and the Centers for Disease Control and Prevention, between 1995 and 1997.

The study investigated the effects of adverse childhood experiences (ACEs), in the first 18 years of the respondents’ lives.

Ten ACEs, in three categories (abuse, household challenges and neglect) were investigated:


- Emotional abuse

- Physical abuse

- Sexual abuse



- Mother treated violently

- Household substance abuse

- Mental illness in household

- Parental separation or divorce

- Criminal household member



- Emotional neglect

- Physical neglect

The study demonstrated an association of ACEs with physical, mental and social issues later in life.

Health is defined as physical, mental and social well-being. Therefore, the study indicated that childhood trauma predisposes us to poor health as we get older.

The ACE score, graded out of ten, is used to assess cumulative childhood stress, and the study found a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course.

In other words, the higher your ACE score, the more likely you are to be unwell.

As the number of ACEs increases, so do the risks for the following:

- Alcoholism and alcohol abuse

- Chronic obstructive pulmonary disease

- Depression

- Fetal death

- Health-related quality of life

- Illicit drug use

- Ischemic heart disease

- Liver disease

- Poor work performance

- Financial stress

- Risk for intimate partner violence

- Multiple sexual partners

- Sexually transmitted diseases

- Smoking

- Suicide attempts

- Unintended pregnancies

- Early initiation of smoking

- Early initiation of sexual activity

- Adolescent pregnancy

- Risk for sexual violence

- Poor academic achievement


You can find out your ACE score by completing the questionnaire below:

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 five 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 ________


Add up your “Yes” answers: _______

This is your ACE score.


Next week I will discuss the scores and what they mean.


- Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback and, or tweet @mikeyabrahams.