Adverse Childhood Experiences (ACEs): What Your Score Can and Cannot Tell You
Maybe you saw it on social media: a short quiz, ten yes-or-no questions about your childhood, and a number at the end. Perhaps your score was zero, and you scrolled on. Or perhaps it was four, or six, or eight, and you sat with the screen for a while, wondering what that number means about your health, your relationships, and your future.
The Adverse Childhood Experiences (ACE) questionnaire has become one of the most widely shared self-measures in mental health. It can be a powerful starting point for understanding yourself. It is also widely misunderstood. This post explains where ACEs come from, what an ACE score can and cannot tell you, why positive childhood experiences matter just as much, and how to approach this kind of reflection gently.
A note before reading: questions about childhood can bring up painful memories. Please go at your own pace, and consider exploring this topic with a therapist.
Where the ACE framework comes from
The original ACE study was conducted in the 1990s by the U.S. Centers for Disease Control and Prevention and Kaiser Permanente. Researchers asked thousands of adults about difficult experiences before age 18 across several categories: emotional, physical, and sexual abuse; emotional and physical neglect; and household challenges such as parental separation, violence toward a parent or caregiver, substance use, mental illness, and the incarceration of a household member.
The findings were striking. More than half of participants reported at least one category of adversity. People who reported four or more categories had considerably higher rates of many later health concerns, including depression, substance use, suicide attempts, and some chronic illnesses (Felitti et al., 1998).
ACEs are common in Canada too. In a national study of more than 44,000 adults aged 45 to 85, about 62% reported at least one adverse childhood experience (Joshi et al., 2021).
What an ACE score can tell you
For many people, learning about ACEs is validating. It can help name experiences that were never acknowledged, or connect present-day struggles with what happened long ago. It can open a conversation with a therapist or doctor, and it can be a reminder that difficult childhoods are far more common than they often seem.
What an ACE score cannot tell you
The ACE score was designed to study patterns across large groups of people, not to assess individuals. Robert Anda, one of the original ACE researchers, and his colleagues have cautioned that the score is not suitable for screening individuals or assigning personal risk (Anda et al., 2020). It counts categories, but it does not capture how often something happened, how severe it was, how long it lasted, or what support was available. Two people with the same score can have had very different experiences.
Later research supports this caution. A 2022 study found that ACE scores do not accurately identify which individuals will go on to develop health problems (Meehan et al., 2022). In other words, a high score does not mean poor health is inevitable, and a low score does not mean someone has not been through something painful.
An ACE score is best understood as a starting point for reflection, not a diagnosis or a prediction.
The other side of the scale: positive childhood experiences
Adversity is only part of the story. Research increasingly shows that positive childhood experiences matter enormously. In a study of more than 6,000 adults, those who reported six or seven positive childhood experiences had 72% lower odds of depression or poor mental health in adulthood than those who reported zero to two (Bethell et al., 2019). Importantly, this pattern held across all levels of adversity.
The positive experiences studied included things like being able to talk with family about feelings, feeling supported during hard times, belonging at school, having supportive friends, having caring adults outside the family, and feeling safe and protected at home. These findings are a powerful reminder that safe, caring relationships can buffer the effects of adversity, and that they can still make a difference at any age.
ACEs are not destiny
If you have a high ACE count, it is important to hear this clearly: childhood adversity is not a life sentence. Many people who experienced significant adversity go on to build full, connected lives, often with the help of supportive relationships, therapy, and their own considerable resilience. Understanding your history can bring compassion for the ways you learned to cope, and clarity about what you may want to heal or change.
Reflecting gently
If you choose to reflect on your own childhood experiences, it can help to set aside a calm time, give yourself permission to skip questions or stop, and plan something soothing afterward. Many people find it more helpful to explore their results with a trauma-informed therapist than alone. If reflecting brings up distress that does not settle, intrusive memories, nightmares, numbness, or thoughts of harming yourself, please reach out for support.
Reflection questions worth exploring
These prompts are best explored with a professional rather than used to reach conclusions on your own.
What feelings come up when I think about my childhood?
Which experiences shaped how I cope with stress or relationships today?
Who or what helped me get through hard times as a child or teen?
What supports me now?
What would I like to understand better about my history with the help of a professional?
Support at Vive Wellness Therapy
At Vive Wellness Therapy, we understand that exploring childhood experiences can be both illuminating and painful. We offer trauma-informed support to help you make sense of your history, recognize your strengths, and heal at a pace that feels safe. If you would like support, we would be glad to hear from you whenever you feel ready.
References
Anda, R. F., Porter, L. E., & Brown, D. W. (2020). Inside the adverse childhood experience score: Strengths, limitations, and misapplications. American Journal of Preventive Medicine, 59(2), 293–295. https://doi.org/10.1016/j.amepre.2020.01.009
Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA Pediatrics, 173(11), e193007. https://doi.org/10.1001/jamapediatrics.2019.3007
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: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Joshi, D., Raina, P., Tonmyr, L., MacMillan, H. L., & Gonzalez, A. (2021). Prevalence of adverse childhood experiences among individuals aged 45 to 85 years: A cross-sectional analysis of the Canadian Longitudinal Study on Aging. CMAJ Open, 9(1), E158–E166. https://doi.org/10.9778/cmajo.20200064
Meehan, A. J., Baldwin, J. R., Lewis, S. J., MacLeod, J. G., & Danese, A. (2022). Poor individual risk classification from adverse childhood experiences screening. American Journal of Preventive Medicine, 62(3), 427–432. https://doi.org/10.1016/j.amepre.2021.08.008
This article is provided by Vive Wellness Therapy for general informational and educational purposes only. It is intended to be used alongside professional therapy and is not a substitute for assessment, diagnosis, or treatment by a qualified health professional. Self-reflection measures are not diagnostic tools. Research and clinical guidance evolve over time, and information in this article may become outdated or contain inaccuracies. If you are in crisis or thinking about suicide, call or text 9-8-8 (Suicide Crisis Helpline, available 24/7 across Canada; in Quebec, calls connect to 1-866-APPELLE). The Hope for Wellness Helpline is available to Indigenous peoples across Canada 24/7 at 1-855-242-3310. Young people can reach Kids Help Phone at 1-800-668-6868 or by texting CONNECT to 686868. If you are unsafe at home, visit sheltersafe.ca. If you or someone else is in immediate danger, or a child is at risk of harm, call 9-1-1.
