ACE Study Questionnaire
Adverse Childhood Experiences (ACE Study)
In the late '90s, Dr. Vincent Felitti conducted interviews with 286 patients who had dropped out of the Kaiser Permanente Weight Loss Program. These patients left the program even while successfully losing weight. The results of these interviews showed that the majority had experienced childhood sexual abuse. The initial findings found that weight gain might be a coping mechanism for depression, fear and anxiety caused by the uncertainty of their Adverse Childhood Experiences.
Dr. Felitti and Dr. Robert Anda from the CDC went on to survey childhood trauma experiences of over 17,000 Kaiser Permanente patient volunteers under the Adverse Childhood Experiences (ACE) Study.
The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACEs increase, the risk for the health problems increases in a strong and graded fashion.
A long term study of Adverse Childhood Experiences over the lifetimes of these patients has shown a correlation between physical, emotional, and sexual abuse, along with a number of other stressful childhood experiences, and health and behavioral social problems as an adult.
Below is the questionnaire. What is your ACE Score? Contact Energy Healing Therapies to help deal with unresolved childhood trauma.
CATEGORY of CHILDHOOD EXPOSURE
Abuse by Category
Psychological
(Did a parent or other adult in the household …)
Often or very often swear at, insult, or put you down? YES NO
Often or very often act in a way that made you afraid that you would be physically hurt? YES NO
Physical
(Did a parent or other adult in the household …)
Often or very often push, grab, shove, or slap you? YES NO
Often or very often hit you so hard that you had marks or were injured? YES NO
Sexual
(Did an adult or person at least 5 years older ever …)
Touch or fondle you in a sexual way? YES NO
Have you touch their body in a sexual way? YES NO
Attempt oral, anal, or vaginal intercourse with you? YES NO
Actually have oral, anal, or vaginal intercourse with you? YES NO
Household Dysfunction by Category
Substance abuse
Live with anyone who was a problem drinker or alcoholic? YES NO
Live with anyone who used street drugs? YES NO
Mental illness
Was a household member depressed or mentally ill? YES NO
Did a household member attempt suicide? YES NO
Mother treated violently
Was your mother (or stepmother)
Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her? YES NO
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? YES NO
Ever repeatedly hit over at least a few minutes? YES NO
Ever threatened with, or hurt by, a knife or gun? YES NO
Criminal behavior in household
Did a household member go to prison? YES NO
Adapted from the ACE Study
© Energy Healing Therapies 760-961-4027 [email protected] www.Pat-Farrell.com
In the late '90s, Dr. Vincent Felitti conducted interviews with 286 patients who had dropped out of the Kaiser Permanente Weight Loss Program. These patients left the program even while successfully losing weight. The results of these interviews showed that the majority had experienced childhood sexual abuse. The initial findings found that weight gain might be a coping mechanism for depression, fear and anxiety caused by the uncertainty of their Adverse Childhood Experiences.
Dr. Felitti and Dr. Robert Anda from the CDC went on to survey childhood trauma experiences of over 17,000 Kaiser Permanente patient volunteers under the Adverse Childhood Experiences (ACE) Study.
The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACEs increase, the risk for the health problems increases in a strong and graded fashion.
A long term study of Adverse Childhood Experiences over the lifetimes of these patients has shown a correlation between physical, emotional, and sexual abuse, along with a number of other stressful childhood experiences, and health and behavioral social problems as an adult.
Below is the questionnaire. What is your ACE Score? Contact Energy Healing Therapies to help deal with unresolved childhood trauma.
CATEGORY of CHILDHOOD EXPOSURE
Abuse by Category
Psychological
(Did a parent or other adult in the household …)
Often or very often swear at, insult, or put you down? YES NO
Often or very often act in a way that made you afraid that you would be physically hurt? YES NO
Physical
(Did a parent or other adult in the household …)
Often or very often push, grab, shove, or slap you? YES NO
Often or very often hit you so hard that you had marks or were injured? YES NO
Sexual
(Did an adult or person at least 5 years older ever …)
Touch or fondle you in a sexual way? YES NO
Have you touch their body in a sexual way? YES NO
Attempt oral, anal, or vaginal intercourse with you? YES NO
Actually have oral, anal, or vaginal intercourse with you? YES NO
Household Dysfunction by Category
Substance abuse
Live with anyone who was a problem drinker or alcoholic? YES NO
Live with anyone who used street drugs? YES NO
Mental illness
Was a household member depressed or mentally ill? YES NO
Did a household member attempt suicide? YES NO
Mother treated violently
Was your mother (or stepmother)
Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her? YES NO
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? YES NO
Ever repeatedly hit over at least a few minutes? YES NO
Ever threatened with, or hurt by, a knife or gun? YES NO
Criminal behavior in household
Did a household member go to prison? YES NO
Adapted from the ACE Study
© Energy Healing Therapies 760-961-4027 [email protected] www.Pat-Farrell.com
