ACE Survey



Youn ACE (Adverse Childhood Experiences) Score is the result of a survey of some of the traumas that some children experience that can lead to significant problems later in life. The US Center for Disease Controll (CDC) has developed this 10-question survey in order to identify people who are at risk for complications caused by traumatic events in their childhood.

My reason for asking for your ACE score is to identify students who may have elevated risk of problems stemming from childhood trauma. Mr. Bigler started administering this survey in 2015, after two former LEHS students took their own lives during the summer. While we will never know whether either incident might have been prevented, it is entirely possible that if these students had someone reach out to them at the right moment, their outcomes might have been different.

There are 10 types of childhood trauma measured in the ACE Study. Five are personal: physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. The other five are related to other family members: a parent who is an alcoholic, a mother who is a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment.

This form will calculate your ACE score (the number of questions that you answer "yes").

Please fill in your information, take the survey, and click the "Submit" button when you are finished. Fields marked with a green asterisk (*) are required. If you get an error, it is probably because you left out a required field.

Note that javascript must be enabled in your browser in order to take this survey.

First name: *      Last name: * Email:

Which class are you in?:*
Physics 1 (D block)       Physics 1 (F block)       AP Physics 1 (B block)       AP Physics 1 (G block)       AP Physics 2 (C block)

  1. Did a parent or other adult in the household often or very often do either or both of the following:
    • Swear at you, insult you, put you down or humiliate you?
    • Act in a way that made you afraid that you might be physically hurt?

  2. Did a parent or other adult in the household do either or both of the following:
    • Often or very often push, grab, slap, or throw something at you?
    • Ever hit you so hard that you had marks or were injured?

  3. Did an adult or person at least 5 years older than you ever do either (or both) of the following:
    • Touch or fondle you or have you touch their body in a sexual way?
    • Attempt or actually have oral, anal, or vaginal intercourse with you?

  4. Did you often or very often feel that either (or both):
    • No one in your family loved you or thought you were important or special?
    • Your family didn't look out for each other, feel close to each other, or support each other?

  5. Did you often or very often feel that either (or both):
    • You didn't have enough to eat, had to wear dirty clothes, and had no one to protect you?
    • Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

  6. Were your parents ever separated or divorced?

  7. Did any of the following happen to your mother or stepmother?
    • She was often or very often pushed, grabbed, slapped, or had something thrown at her.
    • She was sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard.
    • She was ever repeatedly hit for at least a few minutes or threatened with a gun or knife.

  8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

  9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

  10. Did a household member go to prison?

Your ACE Score is:      Are you willing to share this number with Mr. Bigler?    

If you select "yes", Mr. Bigler will use this information to help decide whether or not to check in with you about offering some extra flexibility throughout the year. If you select "no", javascript will replace the number with "NaN" (which means "not a number").


Clicking "Submit" will share your total score (but not your answers to individual questions) with Mr. Bigler and will take you to the next (and final) page.
Clicking "Reset Form" will reset the form to its initial state.

Most people have an ACE score between zero and 2. As your ACE score increases, your risk increases for alcoholism, depression, liver disease, lung disease, smoking, attempting suicide, perpetrating domestic violence, being raped, or unintentionally becoming pregnant or getting someone else pregnant. An ACE score of 4 or higher indicates a significantly elevated risk of these problems as an adult.

If your ACE score is 4 or higher, if you know someone whose ACE score is 4 or higher, or if you have concerns relating to any of the experiences described in this questionnaire, please tell someone! Psychological trauma is not something that goes away on its own, and is not something that most people can handle without help.

If you share your ACE score with me and it is 3 or higher, I will privately and discreetly check in with you at some point in the near future, to make sure you're on somebody's radar and you're getting what you need.

You can read more about ACE scores on the ACEs Too High website.



URI of this page:
Last updated: 14 Sep 2017 by Mr. Bigler
Date of access (today's date): 22 Jan 2018

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