Screening worksheet

Adverse Childhood Experiences

This short questionnaire asks about difficult experiences that can happen early in life — things like abuse, neglect, loss, or stress in the household. It's used to understand how childhood adversity can shape health and wellbeing over time.

There are 10 yes-or-no questions about the years before you turned 18. You can skip any question, pause whenever you need to, and stop at any time. Your answers stay on your device — nothing is sent or saved unless you choose to email or download your results.

A score here is a starting point for a conversation, not a diagnosis and not a prediction. Many people with high scores live full, healthy lives — supportive relationships and other protective factors make a real difference.

Adapted from the Adverse Childhood Experience Questionnaire for Adults (ACEs Aware / California Surgeon General's Clinical Advisory Committee), based on the CDC–Kaiser ACE Study.
Thinking back to before your 18th birthday…

Choose Yes or No for each. Tap a selected answer again to clear it.

0
out of 10

Your score updates as you answer

Each "Yes" adds one point. The total is simply how many types of adversity you experienced.

Do you feel these experiences have affected your health?

Optional, and separate from your score — just your own sense of it.

Anything you'd like to note?

Opens your mail app with your total score (not your individual answers) and a private link to review or continue later. Nothing is stored on any server.

Experiences in childhood are only one part of your story, and there are many paths to healing. If any of this brings up strong feelings, consider reaching out to a counselor or someone you trust. If you're in crisis or thinking about harming yourself, in the US you can call or text 988 (the Suicide & Crisis Lifeline) any time, day or night.