It started with a realization about weight loss. Back in the 1980s, Dr. Vincent Felitti was running an obesity clinic for Kaiser Permanente in San Diego. He noticed something weird. People who were successfully losing massive amounts of weight were suddenly dropping out of the program. It didn't make sense. Why quit when you're finally winning? When he started actually talking to them—really listening—he found a pattern. For many of these patients, their weight was a shield. It was a physical layer of protection against a world that had hurt them when they were small. This realization eventually birthed the ACE test for childhood trauma, a simple ten-question survey that basically upended everything we thought we knew about chronic illness and "bad" habits.
Most people think of trauma as something that happens in the mind. You get scared, you feel bad, you maybe go to therapy. But the original CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study proved it's way more visceral than that. Your body remembers what your mind tries to forget.
What is the ACE Test for Childhood Trauma Anyway?
Basically, the ACE score is a tally of different types of abuse, neglect, and household dysfunction. If you went through it before your 18th birthday, it counts. The original study looked at ten specific categories. These include physical, emotional, and sexual abuse. They also look at neglect—both physical and emotional. Then there are the "household challenges" like growing up with a parent who has a mental illness, someone struggling with substance abuse, an incarcerated relative, or witnessing domestic violence against a mother or stepmother. Divorce or parental separation is the tenth one.
It's a simple 0-to-10 scale. One point for each category you experienced.
Honestly, the simplicity is what makes it so powerful and so controversial at the same time. You’re not just a person with high blood pressure or depression. You’re a person whose nervous system was calibrated in a high-stress environment. The ACE test for childhood trauma isn't a diagnostic tool in the medical sense—it’s more of a risk assessor. It tells a story about your biology. When a kid grows up in a "war zone" at home, their brain stays in fight-or-flight mode. Their cortisol levels are spiked constantly. Over years, that "weathering" wears down the heart, the immune system, and even the way DNA is expressed.
The Math of Trauma
The numbers from the original study were staggering. They surveyed over 17,000 people. These weren't "high-risk" populations in the traditional sense; most were middle-class, insured, and college-educated.
🔗 Read more: Ingestion of hydrogen peroxide: Why a common household hack is actually dangerous
It turns out trauma is everywhere.
About two-thirds of the people surveyed had at least one ACE. More than one in eight had four or more. If your score is four or higher, your risk for chronic obstructive pulmonary disease (COPD) doubles. Your risk of hepatitis or sexually transmitted infections goes up. If your score is a six or higher? Your life expectancy could be cut short by 20 years.
Twenty years. Just because of what happened before you were old enough to drive.
It sounds grim, doesn't it? Like a life sentence written in a childhood home. But experts like Dr. Nadine Burke Harris, the former Surgeon General of California, argue that the score isn't destiny. It's a map. If you know where the landmines are, you can start defusing them. She's been a massive advocate for screening kids in pediatric offices, catching that toxic stress before it turns into a heart attack at 45.
Where the ACE Score Gets It Wrong (The Nuance)
We have to be careful here. The ACE test for childhood trauma is a blunt instrument. It doesn't measure everything.
💡 You might also like: Why the EMS 20/20 Podcast is the Best Training You’re Not Getting in School
What about poverty?
What about racism?
What about living in a neighborhood where you hear gunshots every night?
The original study didn't include those "social" ACEs. If you grew up in a loving home but were bullied relentlessly at school or faced systemic oppression, your ACE score might be a zero, yet your nervous system could be just as fried as someone with a four. Researchers at the Philadelphia ACE Project have tried to fix this by adding expanded questions about community violence and discrimination.
Then there's the "Resilience" factor. Two kids can grow up in the same house, with the same alcoholic father and the same ACE score, but one thrives while the other struggles. Why? Usually, it's because the first kid had one stable, caring adult—a grandma, a teacher, a coach—who made them feel safe. Biology is complex. You can't just boil a human life down to a single integer.
Also, let's talk about the "Score Shaming" thing. Some people get their score and feel broken. They feel like they have a ticking time bomb in their chest. That’s not the point of the ACE test for childhood trauma. The point is to shift the question from "What is wrong with you?" to "What happened to you?" It’s about removing the shame from things like smoking, overeating, or drug use. Often, these aren't "bad choices"—they're coping mechanisms for a brain that’s trying to regulate itself after a lifetime of fear.
The Biological Reality of Toxic Stress
When you experience a threat, your hypothalamus sends a signal to your pituitary gland, which tells your adrenal gland to pump out adrenaline and cortisol. Your heart races. Your pupils dilate. This is great if you’re being chased by a bear. It’s terrible if the "bear" lives in the bedroom down the hall and never leaves.
📖 Related: High Protein in a Blood Test: What Most People Get Wrong
Continuous activation of the stress response—what Dr. Jack Shonkoff at Harvard calls "toxic stress"—actually changes the architecture of the developing brain. It shrinks the hippocampus (the center for learning and memory) and overdevelops the amygdala (the fear center). This is why kids with high ACE scores often get misdiagnosed with ADHD. They aren't "acting out"; they are scanning the room for threats because their brain thinks they're in danger.
Practical Ways to Move Forward
So, you took the test. Your score is high. Now what? You can't go back and give your seven-year-old self a better childhood.
First, realize that the brain is plastic. It can change. Neuroplasticity means we can rewire these pathways even in adulthood. It’s not easy, but it’s doable. Healing from a high ACE score usually requires a multi-pronged approach that targets the body, not just the mind.
- Movement is mandatory. Since trauma lives in the nervous system, talking about it in therapy often isn't enough. Things like yoga, tai chi, or even just rhythmic walking can help reset the "vagus nerve," which is the main highway of your parasympathetic nervous system (the "rest and digest" side).
- Sleep is a non-negotiable. High cortisol wreaks havoc on sleep cycles. Prioritizing a dark, cool room and a strict routine helps tell your body that the "war" is over and it's safe to power down.
- Mindfulness, but be careful. Meditation is great for many, but for some with high trauma scores, sitting in silence can actually trigger flashbacks. If that's you, try "grounding" exercises instead—focusing on five things you can see, four you can touch, three you can hear.
- Community matters. Isolation is a stressor. Connection is a biological necessity. Finding a "tribe" or even one person who truly "gets it" can lower your baseline stress levels significantly.
- Dietary shifts. Inflammation is the link between childhood trauma and adult disease. Eating an anti-inflammatory diet (lots of leafy greens, healthy fats, less processed sugar) isn't just about weight; it's about calming the systemic inflammation caused by years of toxic stress.
The ACE test for childhood trauma shouldn't be a source of despair. Think of it as a tool for radical self-compassion. If you've been hard on yourself for "not having it together" or struggling with health issues, maybe it's time to look at the score. It’s a reminder that you survived something difficult, and your body did exactly what it was designed to do: it kept you alive. Now, the work is teaching your body that it’s finally okay to relax.
If you are looking for your own score, you can find the original ten questions through the CDC or various mental health non-profits. Just remember: the number is the start of the conversation, not the end of it. It’s an invitation to start looking at your health through a lens of history rather than just symptoms.
Next Steps for Action
- Calculate your score using the official CDC-Kaiser questions, but do so in a safe, quiet space where you won't be interrupted.
- Consult a trauma-informed professional. If you plan to discuss this with a doctor or therapist, specifically ask if they are "trauma-informed." This ensures they understand the biological link between ACEs and physical health.
- Focus on the "Buffer." Identify the "Positive Childhood Experiences" (PCEs) you did have. Research shows that even in the face of high ACEs, having supportive relationships can significantly mitigate the long-term health risks.
- Prioritize nervous system regulation. Instead of focusing on "fixing" symptoms, look into somatic experiencing or EMDR (Eye Movement Desensitization and Reprocessing), which are specifically designed to address how the body stores traumatic memories.