Asking about ACEs

Adverse Childhood Experience (ACE) studies have been carried out in a number of countries including England and Wales since the original was published in 1998, in the United States. The studies have found links between adverse experiences up to age 18 and later health and wellbeing.

As part of the ACE study, a questionnaire was developed which can be used to establish an ACE score. The score is the number of ACEs that someone has experienced, with the maximum being 10.

There are 10 questions, which cover

  • types of personal experiences - such as physical, emotional and sexual abuse
  • experiences related to family members - such as growing up in a household where there is drug, alcohol or domestic abuse.

Questionnaire limitations

It’s important to remember that the questions have a number of limitations when used to understand the experience of one person.

The ACE questionnaire doesn't assess everything, such as

  • experiences of bullying at school
  • bereavement
  • discrimination. 

It doesn't take into account the context of a person’s life, such as

  • their age
  • the duration and intensity of trauma and adversity
  • whether there were any safe and supportive relationships.

A person’s own score may not accurately reflect the range and relevance of their experiences.

Using the questionnaire

Anyone seeking to use information about ACEs as part of a routine enquiry or to formulate a care plan should have received appropriate training, and know how to respond appropriately to the information that is received.

Any enquiry about ACEs within a service setting should be used to start a therapeutic conversation that considers what (if any) response or support will be required rather than a form of problem categorisation.

It should be used within the context of clear organisational plans about how this information will be used and be part of a wider assessment.

The original ACE study questionnaire can be found in appendix A of the Scottish Public Health Network (ScotPHN) paper named "Polishing the Diamonds".

NHS Education for Scotland has produced a Trauma Training Framework, which is designed to support the planning of training for a trauma and adversity informed workforce. More information about this can be found on the NHS Education website (external site).

NHS Health Scotland has held seminars to share learning on routine enquiry about ACEs. You can access the slides and reports from the seminars below.

In schools

It is not recommended that schools routinely screen or undertake ACE scores in children. This could lead to unhelpful labelling and stigmatisation of children, and their families, who have higher scores.

Assessment practices should always be contextual, child-centred, proportionate and in line with the Getting it Right for Every Child National Practice model. More information can be found on the Education Scotland site (external site).

Contact us

You can contact the Childhood Adversity team for more information about our work.