It happened in a basement in San Diego back in the late 90s. Dr. Vincent Felitti was actually trying to figure out why people were dropping out of an obesity clinic, not trying to rewrite the history of modern medicine. But what he stumbled onto—and what eventually became the ACE adverse childhood experiences questionnaire—basically changed how we look at every single chronic illness from heart disease to depression.
It’s a simple list. Ten questions. That's it.
Honestly, it’s almost too simple for how much weight it carries. You’ve probably seen it floating around social media or in a therapist's waiting room. The test asks about things that happened before you turned 18. Things like: Did a parent scream at you? Was there enough food? Did someone go to jail? Were you hit? It’s blunt. It doesn't use medical jargon. It just asks if your childhood was safe or if it was a bit of a war zone.
But here’s the kicker: your score isn’t just a "vibe" check. It’s a predictor. Felitti and his colleague Dr. Robert Anda found that the more "Yes" answers you have, the higher your risk for things that seem totally unrelated, like autoimmune diseases or even broken bones. It turns out the body really does keep the score.
The Science of a High Score
When we talk about the ACE adverse childhood experiences questionnaire, we aren't just talking about "bad memories." We are talking about biology.
Think about it this way. If you’re a kid and your house is constantly stressful, your brain is marinating in cortisol and adrenaline. All the time. Every day. This isn't just a temporary feeling. It’s a structural change. The amygdala, which is basically the brain’s smoke detector, gets enlarged and hyper-reactive. Meanwhile, the prefrontal cortex—the part that helps you think logically and calm down—kind of goes offline.
Dr. Nadine Burke Harris, the former Surgeon General of California, has spent years screaming this from the rooftops. She explains that when that stress response stays "on" for years, it creates systemic inflammation. Your immune system starts attacking things it shouldn't. Your heart works harder than it has to. By the time you’re 40 or 50, that high ACE score manifests as a physical breakdown.
The original study looked at over 17,000 Kaiser Permanente patients. These weren't "at-risk" kids in the traditional sense; most were middle-class, educated people with health insurance. And yet, the data was staggering. If you had an ACE score of 4 or higher, your risk of chronic obstructive pulmonary disease (COPD) increased by 390 percent. Your risk of hepatitis went up 240 percent. It’s not just about "lifestyle choices" or "bad habits." It’s about how your cells were programmed when you were five years old.
Why the ACE Adverse Childhood Experiences Questionnaire Isn't a Destiny
It’s easy to get freaked out.
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If you take the test and realize you’ve got a 6 or a 7, it feels like a death sentence. It’s not. Let's be very clear: the questionnaire is a population health tool, not a crystal ball for your individual life.
One thing people often overlook is resilience. Two kids can grow up in the same house with the same ACE score, but if one of them had a grandmother who loved them unconditionally or a teacher who saw their potential, their biological outcome might be completely different. These are called Positive Childhood Experiences (PCEs). They act like a buffer. They’re the shock absorbers for the soul.
Also, the 10 questions are kinda limited.
The original ACE adverse childhood experiences questionnaire doesn't ask about poverty. It doesn't ask about racism, community violence, or bullying. It focuses almost entirely on what happened inside the home. Modern researchers are starting to realize we need a "Version 2.0" because kids today face stresses that Dr. Felitti wasn't even looking for in 1998. If you grew up in a war zone but had perfect parents, your score would be a zero, which obviously doesn't tell the whole story.
Misconceptions that drive me crazy
People think a score of 0 means you’re "fine." That’s not how humans work. You can have a zero and still have trauma from a car accident or a natural disaster. On the flip side, people think a high score means you’re "broken."
Neuroplasticity is real. The brain can heal.
We see this in people who start mindfulness practices, EMDR therapy, or even just consistent exercise later in life. You can actually lower those inflammatory markers. You can "down-regulate" that hyper-active nervous system. It takes work, sure, but the score you had at 18 doesn't have to be the score that defines you at 60.
How to actually use this information
So, you’ve got the questionnaire in front of you. What now?
First, don't take it alone if you’re currently in a dark place. These questions can be "triggering"—and I know that word gets overused, but here it’s literal. Thinking about childhood neglect or abuse can send your nervous system right back into that fight-or-flight mode.
What the 10 questions usually look like:
- Abuse: Physical, emotional, or sexual.
- Neglect: Both physical (not enough food/clean clothes) and emotional (no one felt close to you).
- Household Dysfunction: Divorce, domestic violence, substance abuse in the home, mental illness in the home, or an incarcerated relative.
Each "yes" is one point.
If you’re a clinician, you use this to understand why a patient might be "non-compliant." Maybe they aren't "lazy"; maybe their nervous system is so fried they can’t focus on a complex diet plan. If you’re an individual, you use this to find some self-compassion. It’s a lot easier to stop shaming yourself for having anxiety when you realize your brain was literally trained to be anxious for survival.
The Criticism: It’s Not Perfect
We have to talk about the flaws.
The ACE adverse childhood experiences questionnaire has been criticized for being too "white and middle class." When you look at the Philadelphia ACE Study, researchers found that adding questions about "witnessing violence" or "living in foster care" changed the scores significantly for urban populations.
There's also the "Weighting Problem." In the current system, every "yes" is equal. But is a parent’s divorce (1 point) the same as chronic sexual abuse (1 point)? Most people would say no. The questionnaire doesn't account for the frequency or the intensity of the trauma. It just checks the box.
Because of this, you shouldn't use your score as a competition or a label. It’s a conversation starter. Nothing more.
Moving Toward Healing and Action
If you find yourself staring at a high score, there are specific, evidence-based steps to take. This isn't just "self-care" fluff; it's about biological intervention.
- Sleep is a non-negotiable. Sleep deprivation mimics the stress of an ACE. You need 7-9 hours to let your brain's "glymphatic system" wash out the metabolic waste.
- Move your body. Exercise helps "burn off" the excess cortisol that a high ACE score leaves in your system.
- Check your gut. There is a massive link between childhood trauma and gut health (the gut-brain axis). Anti-inflammatory diets actually help stabilize mood.
- Find a trauma-informed therapist. Standard talk therapy is great, but for ACE-related issues, things like Somatic Experiencing or Internal Family Systems (IFS) tend to work better because they address the body's physical "stuckness."
- Build "Social Buffers." Isolation is a neurotoxin. Healthy, safe adult relationships can actually help rewire the neural pathways that were damaged in childhood.
The ACE adverse childhood experiences questionnaire was never meant to be a trap. It was meant to be a map.
It showed us that what happens to us as children isn't something we just "get over." It gets under our skin. It gets into our DNA. But once you have the map, you can finally figure out where you're going. You stop asking "What is wrong with me?" and start asking "What happened to me?"
That shift in perspective is where the actual healing begins. Honestly, it’s the only way forward.
Practical Next Steps
- Locate a trauma-informed provider: Use directories like Psychology Today and filter for "Trauma-Informed" or "EMDR."
- Practice grounding: When you feel your ACE-related "alarm" going off, use the 5-4-3-2-1 technique (5 things you see, 4 you feel, 3 you hear, 2 you smell, 1 you taste) to bring your prefrontal cortex back online.
- Read more: Pick up The Deepest Well by Dr. Nadine Burke Harris or The Body Keeps the Score by Bessel van der Kolk for a deeper dive into the biology of these scores.
- Advocate for screening: Talk to your primary care physician about ACEs. Many doctors still aren't trained in this, and bringing it up can change the trajectory of your medical care.