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The ACE Quiz: A Tool for Identifying Childhood Trauma



The decreasing stigma surrounding discussions about mental health has paved the way for more nuanced and necessary discussions about its various determinants. One critical factor is the impact of adverse childhood experiences (ACEs) on both long-term mental and physical health.


This article will explore various types of ACEs and explain the many ways that experiences during childhood affect our future well-being. It will also examine the test used to identify ACEs, including its benefits and risks.


In this article:


What are adverse childhood experiences?

Adverse Childhood Experiences (ACEs), also known as childhood trauma, are traumatic events or experiences that occur in a person's life before the age of 18.


ACEs encompass a range of traumatic events and adverse circumstances, such as childhood abuse or neglect, that can impact a child's life.


What is the Adverse Childhood Experiences Test?

The Adverse Childhood Experiences test (also known as the ACE or ACEs quiz or childhood trauma test) is a questionnaire designed to assess an individual's exposure to traumatic events during their formative years. The cumulative score obtained from the ACE test serves as an indicator of the individual's level of exposure to childhood trauma.

According to the Centers for Disease Control and Prevention (CDC), 61% of adults experienced at least 1 ACE and 16% experienced at least 4 different types of ACEs during their childhood.

Contents of the ACE test

The ACE test focuses on the following 10 specific traumatic experiences.


The 10 experiences included in the ACEs test

1. Physical abuse

Physical abuse includes being repeatedly hit, pushed, grabbed, slapped, kicked, shaken, or otherwise physically hurt.


2. Emotional abuse

Emotional abuse encompasses behaviors that can cause serious mental or emotional harm to a child, including constant criticism, threats, or rejection.


3. Sexual abuse

Sexual abuse involves any sexual activity with a child, including exposure to sexually explicit material.


4. Physical neglect

Physical neglect refers to the failure of a caregiver to provide for a child's basic needs and physical health. For example, a child might be forced to wear dirty clothes or receive insufficient food or medical care.


5. Emotional neglect

Emotional neglect involves the absence of emotional support and attention necessary for a child's psychological development.


6. Household substance abuse

Household substance abuse refers to children's exposure to family members or caregivers who misuse substances such as alcohol, street drugs, or prescription medications.


A woman sits on a bed with pills in front of her

Children growing up in households with substance abuse often face a range of other challenges, including neglect, emotional or physical abuse, instability, and a lack of consistent caregiving.


7. Household mental illness

Household mental illness can include living with a parent or other adult who is depressed or mentally ill or having a household member attempt suicide.


8. Domestic violence

Domestic violence in the context of ACEs refers to children witnessing intimate partner violence or violence between parents or caregivers within the home environment.


9. Parental separation or divorce

As an ACE, parental separation or divorce refers to the disruption of the family unit due to the dissolution of the parental relationship.


A girl hugs a stuffed bunny while parents argue in the background

Children experiencing parental separation or divorce may struggle with changes in their living arrangements, potential conflicts between parents, and adjustments to new family dynamics.


10. Incarceration

Incarceration as an ACE refers to the experience of having a parent, family member, or other adult in the household in prison during a child's formative years. Children with incarcerated parents may face challenges such as financial strain, changes in living arrangements, and social stigma.


Scoring and interpreting the ACE test

The ACEs test is scored by tallying the number of different types of adverse experiences a person has encountered during their childhood. The total score represents the cumulative impact of these experiences on their well-being.


A higher ACE score is associated with an increased risk of various health conditions and challenges in adulthood.

Individuals with an ACE score of 4 or more may face a significantly heightened risk for chronic diseases.

These risks only increase as the ACE score rises. For example, an individual with an ACE score of 7 or higher has 3 times more lifetime risk of lung cancer and 3.5 times more risk of coronary artery disease.

How ACEs impact health

Research has shown that ACEs can have profound and lasting effects on a developing child and their physical, mental, and emotional well-being into adulthood.


The impacts of ACEs on health include the following issues, which are often interrelated.


1. Chronic health problems

Childhood trauma can lead to toxic stress responses in the body, which in turn can disrupt the development of the brain and other organ systems. This disruption may lead to long-term changes in the body's response to stress, immune function, and inflammation, all of which are associated with chronic disease risk.


ACEs have been linked to an increased risk for a number of chronic health conditions in adulthood, including cardiovascular diseases, autoimmune diseases such as multiple sclerosis and type 1 diabetes, asthma, coronary heart disease, pulmonary disease, and cancer.


2. Higher likelihood of mental health disorders

The emotional and psychological toll of ACEs can manifest in conditions such as depression, anxiety, substance use disorders, post-traumatic stress disorder (PTSD), and even suicidal tendencies.

Studies have found that exposure to multiple ACEs is linked to a higher risk of developing mental health disorders.

3. Greater susceptibility to substance abuse and addiction

Individuals who experienced ACEs may be more likely to engage in high-risk health behaviors as coping mechanisms. These behaviors, such as substance abuse, smoking, or overeating, can contribute to the development of chronic health conditions later in life.


Benefits of the Adverse Childhood Experiences Test

Early identification and intervention

The ACEs test helps in early identification of individuals who have experienced significant trauma during childhood.


This early detection allows healthcare providers, social workers, and other professionals to intervene and provide appropriate support, potentially mitigating the long-term impact of ACEs on an individual's health and well-being.


A girl holds a teddy bear while talking to a therapist

Tailored support in education

The ACEs assessment can be used in schools to help educators better understand the impact of childhood trauma on students.


By recognizing and addressing the root causes of negative behaviors, teachers can create more supportive and understanding environments for their students. This can lead to improved academic performance and reduced disciplinary incidents, which in turn contribute to better job prospects and overall economic stability during adulthood.


Trauma-informed healthcare

The ACEs assessment is also valuable in healthcare settings. Healthcare providers can use the results of the assessment to inform treatment plans and provide more effective care for patients who have experienced childhood trauma.

By taking high ACE scores into account, healthcare professionals can adopt a more holistic approach to treating their patients by recognizing the profound impact that early life experiences have on both physical and mental health.

This awareness allows for the integration of psychological support with traditional medical treatments, offering a comprehensive care plan that addresses both the symptoms and the underlying causes of a patient's condition.


The CDC has estimated that identifying and addressing ACEs could potentially reduce incidences of depressive disorder by 44% and chronic pulmonary disease by 27%.


Ending intergenerational trauma

By identifying individuals who have experienced ACEs, the test allows for early recognition of trauma within families. This recognition can lead to targeted interventions aimed at breaking the cycle of trauma by providing support for both children and their caregivers.


As parents or caregivers become aware of their own ACE scores, they may seek assistance to address unresolved trauma, learn healthier parenting practices, and avoid passing on trauma to the next generation.


Flaws of the Adverse Childhood Experience Test

Although the ACEs test is a valuable tool for understanding the impact of childhood trauma, it is important to acknowledge its limitations. Some of the notable concerns include the following.


1. Limited scope of trauma

The ACE test focuses on 10 specific interpersonal and household experiences that are considered traumatic. However, there may be other types of adverse childhood experiences that are not covered by the questionnaire.


For instance, broader systemic issues such as racism, poverty, and other social determinants of health can have a significant impact on an individual's development, yet these experiences may not be directly addressed within the ACE framework.


2. Potential for bias

The questionnaire might lack cultural relevance and fail to fully encompass the varied experiences of diverse cultural and socioeconomic groups. As a result, individuals from some socio-economic or cultural backgrounds might not find the ACEs questions relatable or reflective of their experiences.


3. Failure to consider positive mitigating factors

The test focuses entirely on adverse experiences and ignores any beneficial or protective factors, such as supportive relationships and access to mental health services, that could act as buffers against the effects of ACEs.



4. Oversimplification of complex experiences

The ACEs test has been criticized for its one-size-fits-all approach to assessing trauma.


ACEs can impact every child differently. By assigning equal weight to every form of traumatic event, regardless of its severity or duration, the test might not capture the complex reality of trauma and how it impacts individuals.


5. Potential misuse for diagnosis

The test is a screening tool designed to assess risk factors and guide individuals towards appropriate support and care. An individual's ACE score cannot and should not be used to diagnose a condition or predict their future mental or physical health.


6. Potential ethical issues

Certain critics have expressed concerns that the ACE quiz results could be misapplied, for instance, by attaching a stigma to individuals or households according to their ACEs ratings.


For all of these reasons, the ACEs test should be used cautiously and together with other means of assessing trauma to form a more comprehensive understanding of a person's individual experiences and well-being.


The Takeaway

The ACEs test is not about placing blame or predicting destiny; it's about empowerment and awareness. It offers individuals the chance to rewrite their own narratives and gain the awareness and tools to overcome their past trauma.


Sources:

  1. Nelson CA, Bhutta ZA, et al. Adversity in childhood is linked to mental and physical health throughout life. BMJ 2020; 371 :m3048 doi:10.1136/bmj.m3048.

  2. Lin L, Wang HH, et al. Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics. JAMA Netw Open. 2021;4(10):e2130143. doi:10.1001/jamanetworkopen.2021.30143


Bio of Reba Troxler


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