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Screening Measures

Although there is no specific measure for toxic stress, there are several instruments available to help screen for adverse childhood experiences and for related behavior problems. Several of those measures are summarized below:

Adverse Childhood Experiences (ACE) Questionnaire

The Adverse Childhood Experiences (ACE) Questionnaire was originally developed by Dr. Felitti and colleagues. 1 It is a 10-item measure intended to assess 10 types of childhood adversity in three different areas of abuse, including emotional and physical abuse, physical neglect, and abuse associated with living in a dysfunctional household. Adverse childhood experiences include: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, mother treated violently, household substance abuse, household mental illness, parental separation or divorce and incarcerated household member. This questionnaire was designed to measure the occurrence of adverse experiences an individual experienced before the age of 18 years.


• The ACE is a brief screener.
• Is available in English, Spanish, French, German, Norwegian, and Swedish.

Psychometric Properties:

• “The ACE is a reliable, valid and economic screen for retrospective assessment of adverse childhood experiences.”2
• Has adequate internal consistency (Cronbach’s alpha = .88).3

Administering, Scoring, and Interpreting the ACE

The questionnaire begins with the following statement: While you were growing up, during your first 18 years of: Did you …. The answer choices are Yes or No. Each affirmative answer (Yes) is assigned 1 point. ACE score is determined by adding up all the points.
An ACE Score of 0 suggest that the person reported no exposure to childhood trauma. An ACE Score of 10 suggests that the person reported exposure to childhood trauma. The higher the ACE Score, the greater the likelihood that a person will develop one or more of the following health problems: ischemic heart disease, cancer, chronic bronchitis or emphysema, hepatitis or jaundice skeletal fractures, diabetes, smoking, sexually transmitted diseases , depression, etc.


1Felitti, 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 cause of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258.

2Wingenfeld, K., Schäfer, I., Terfehr, K., Grabski, H., Driessen, M., Grabe, H., . . . Spitzer, C. (2010). Reliable, valide und ökonomische Erfassung früher Traumatisierung: Erste psychometrische Charakterisierung der deutschen Version des Adverse Childhood Experiences Questionnaire (ACE). Psychotherapie Psychosomatik Medizinische Psychologie Psychother Psych Med, 61(01). doi:10.1055/s-0030-1263161.

3Murphy, A., Steele, M., Dube, S. R., Bate, J., Bonuck, K., Meissner, P., . . . Steele, H. (2014). Adverse Childhood Experiences (ACEs) Questionnaire and Adult Attachment Interview (AAI): Implications for parent child relationships. Child Abuse & Neglect, 38(2), 224-233.