Downloadable Fillable Questionaire for Adults
The Adverse Childhood Experience (ACE) Questionnaire is a tool used to assess the impact of childhood trauma on adult health and well-being. It consists of a series of questions that focus on various types of abuse, neglect, and household dysfunction experienced before the age of 18. Below is a list of the questions typically included in the ACE Questionnaire.
Questions
Before your 18th birthday... Did have enough to eat, had to wear dirty clothes, and had no one to protect you?
Before your 18th birthday...Did you lose a parent through divorce, abandonment, death, or other reason?
Before your 18th birthday...Did you live with anyone who was depressed, mentally ill, or attempted suicide?
Before your 18th birthday...Did you live with anyone who had a problem with drinking or using drugs, including prescription drugs?
Before your 18th birthday...Did your parents or adults in your home ever hit, punch, beat, or threaten to harm each other?
Before your 18th birthday...Did you live with anyone who went to jail or prison?
Before your 18th birthday...Did a parent or adult in your home ever swear at you, insult you, or put you down?
Before your 18th birthday...Did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way?
Before your 18th birthday...Did you feel that no one in your family loved you or thought you were special?
Before your 18th birthday...Did you experience unwanted sexual contact (such as fondling or oral/anal/vaginal intercourse/penetration)?
Scoring
Each "yes" response counts as one point. The total score indicates the level of adverse experiences you faced during childhood. Higher scores are associated with a greater risk for various health issues and behavioral problems in adulthood. Download your fillable questionaire below.
Conclusion
The ACE Questionnaire is a valuable tool for understanding the long-term effects of childhood adversity on adult health. It can facilitate discussions about trauma and inform treatment and support strategies in your therapy sessions.
With love,
Shelley
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