This questionnaire is designed to assess your exposure to adverse experiences during childhood. Please answer each question honestly with a yes or no response. Keep track of how many yes and no's you respond with.

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1. Before your 18th birthday, did a parent or other adult in the household often or very often swear at you, insult you, put you down, humiliate you, or act in a way that made you afraid that you might be physically hurt?

2. Before your 18th birthday, did a parent or other adult in the household often or very often push, grab, slap, throw something at you, or ever hit you so hard that you had marks or were injured?

3. Before your 18th birthday, did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way?

4. Before your 18th birthday, did you often feel that no one in your family loved you or thought you were important?

5. Before your 18th birthday, did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? 

6. Before your 18th birthday, was a biological parent ever lost to you through divorce, abandonment, or other reason?

7. Before your 18th birthday, was your mother or stepmother often pushed, grabbed, hit, had something thrown at her, or threatened with a weapon?

8. Before your 18th birthday, did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

9. Before your 18th birthday, was a household member depressed or mentally ill, or did a household member attempt suicide?

10. Before your 18th birthday, did a household member go to prison?

 

Scoring:

• For each "yes" answer, add one point to your score.

• Your ACE Score is the total number of "yes" answers.

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