ACE Assessment Methodology

Based on the landmark CDC-Kaiser ACE Study—one of the most important public health discoveries in history

The ACE Study (1995-1997)

The Adverse Childhood Experiences Study, conducted by Dr. Vincent Felitti and Dr. Robert Anda at Kaiser Permanente and the CDC, surveyed over 17,000 adults about childhood adversity. The findings shocked the medical community: childhood trauma strongly predicts adult disease, mental illness, addiction, and early death.

People with an ACE score of 4+ had 2x the risk of heart disease, 12x the risk of suicide attempts, and 7 years shorter life expectancy. The higher your ACE score, the higher your risk for health problems—but understanding your score is the first step toward healing.

Key Researchers & Frameworks

Dr. Vincent Felitti

ACE Study Co-Founder

Kaiser Permanente physician who discovered the trauma-disease connection and created the original 10 ACE questions

Dr. Robert Anda

ACE Study Co-Investigator

CDC epidemiologist who co-led the study and continues researching ACE health outcomes and interventions

Dr. Nadine Burke Harris

Pediatric ACEs Expert

Former California Surgeon General who brought ACE screening into pediatric practice, showing toxic stress impacts brain development

Dr. Bruce Perry

Neurosequential Model

Child trauma expert showing how early adversity affects brain development and the importance of protective factors

Dr. Dan Siegel

Interpersonal Neurobiology

Research on how neglect and emotional deprivation shape neural pathways and can be healed through relationships

Dr. Bessel van der Kolk

Developmental Trauma

Expanded ACE research to include developmental trauma and body-based impacts beyond the original 10 categories

The 10 Original ACE Categories

Abuse

  • •Emotional abuse
  • •Physical abuse
  • •Sexual abuse

Neglect

  • •Emotional neglect
  • •Physical neglect

Household Dysfunction

  • •Mother treated violently
  • •Substance abuse in household
  • •Mental illness in household
  • •Parental separation/divorce
  • •Incarcerated household member

We also assess expanded ACEs: Bullying, community violence, discrimination, loss of parent, foster care, homelessness, and protective factors (supportive relationships, safe spaces, resilience resources).

Health Impacts by ACE Score

ACE Score 0Baseline health risk
ACE Score 1Slightly elevated risk for some conditions
ACE Score 2-3Moderate risk increase for chronic disease, mental illness
ACE Score 4+2x risk heart disease, 12x risk suicide attempts, 4x risk depression, 7x risk alcoholism
ACE Score 6+Life expectancy reduced by 20 years on average

Note: ACE scores predict risk at population level, not individual destiny. Many people with high ACE scores thrive through resilience, therapy, and supportive relationships.

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