Description

The Adverse Childhood Experiences (ACE) measure is a self-report tool used to assess exposure to potentially traumatic events occurring before age 18. The original ACE questionnaire includes items covering three types of abuse (emotional, physical, sexual) and four categories of household dysfunction (substance abuse, mental illness, incarceration, and violence toward mother). The version included in this Measurement Repository is a modified form of the ACE that differs slightly from the original measure in content and length, while maintaining the core goal of assessing cumulative childhood adversity. As with the original ACE framework, scores from this adapted version are used as indicators of risk associated with later health outcomes and can inform prevention, early intervention, and public health efforts.

AI/AN Communities where the measure has been used

Southwest tribal communities

Demographics of AI/AN participants where the scale has been used

Adult caregivers

Notes on adaptations or modifications

  • The original Adverse Childhood Experiences (ACEs) questionnaire developed by Felitti et al. (1998) includes 17 items assessing childhood exposure to abuse, neglect, and household dysfunction. Koss et al. adapted this measure for Native communities by adding items related to Indigenous-specific experiences, including out-of-home placements such as boarding school attendance, foster care, and adoption.
  • The version of the ACEs included in this measurement repository is a modified measure informed by both prior instruments. It includes 21 items assessing a broad range of childhood adversities, including household mental illness, substance use, incarceration, parental separation, economic hardship and unmet basic needs, interpersonal and direct abuse, neglect, peer bullying, and neighborhood violence. This version does not include items related to out-of-home placements and differs from both cited measures in length and content

Modality and administration

Self-report; this measure is administered using paper and pencil, REDCAP mobile app, or an online REDCap link sent to the participant.

Scoring

9 items have 3-point responses – Yes, No, Don’t know/not sure
1 item has a 4-point response – Yes, No, Parents not Married, Don’t know/not sure
11 items have a 4-point response scale – Never, Once, More than once, Don’t know/not sure

Psychometric evidence

Not available with articles

Citation(s)

  • Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
  • Koss, M. P., Yuan, N. P., Dightman, D., Prince, R. J., Polacca, M., Sanderson, B., & Goldman, D. (2003). Adverse Childhood Exposures and Alcohol Dependence among Seven Native American Tribes. American Journal of Preventive Medicine, 25(3), 238–244. https://doi.org/10.1016/s0749-3797(03)00195-8
  • Gillson S, Hautala D, Steinberg R, Walls M. The ongoing legacy of Indigenous family separation: Long-term outcomes of child welfare involvement among American Indian and First Nations youth. Child Abuse Negl. 2026 Mar;173:107884. doi: 10.1016/j.chiabu.2026.107884. Epub 2026 Jan 12. PMID: 41529334.