The ACE Test—A Tool We Trust—But Should We?

If you’ve worked in social services, education, or healthcare, you’ve likely come across the ACE test—short for Adverse Childhood Experiences. It’s a simple ten-question screening

tool designed to identify early trauma and flag potential long-term health risks.

Since its introduction in the 1990s, the ACE test has become widely used in trauma-informed care. And in many ways, it’s been revolutionary.

Here’s what it asks, in essence:

·    Were you often insulted, humiliated, or emotionally abused at home?

·    Were you ever pushed, slapped, or physically harmed by a parent or adult?

·    Were you ever sexually touched or assaulted by someone older?

·    Did you often feel unloved or emotionally neglected?

·    Did you often lack food, clean clothes, or a sense of safety?

·    Were your parents ever separated or divorced?

·    Did you witness domestic violence in your home?

·    Did someone you lived with misuse alcohol or drugs?

·    Did someone in your household experience depression or attempt suicide?

·    Was someone you lived with ever incarcerated?

Each “yes” adds one point to your ACE score. The higher the number, the more likely a person is to experience mental and physical health struggles later in life.

But here’s the problem:

It’s also incomplete.

And in some cases, dangerously so.

What the ACE Test Gets Right

The science is solid: Childhood trauma affects brain development, immune function, and stress regulation. The higher your ACE score, the higher your statistical risk for chronic illness, addiction, depression, and early death.

For many people, the ACE test opens a door they never realized was there. A chance to connect the dots between a difficult childhood and the challenges they face now. It offers validation—and sometimes, that’s life-changing.

It also equips professionals with a quick, accessible way to start conversations about trauma. And that matters.

But What About the Trauma It Doesn’t Measure?

The ACE test only asks about ten types of adversity—primarily things like physical abuse, divorce, household addiction, or a parent being incarcerated. That’s a start, but it barely scratches the surface of what trauma can look like.

There’s no checkbox for:

·    Living in extreme poverty

·    Surviving sexual exploitation or trafficking

·    Growing up in an unsafe neighborhood

·    Enduring long-term emotional neglect

·    Witnessing a sibling’s abuse

·    Experiencing racism or systemic discrimination

·    Losing someone to suicide

·    Being placed in dangerous or unstable foster care

·    Etcetera

·    Etcetera

·    Etcetera

And nowhere does it assess the duration or severity of any of these experiences.

You could live in absolute chaos for years and still walk away with a score that doesn't reflect the full picture.

The Illusion of a Score

I’ve seen this firsthand—through my professional lens, and through the characters I write.

Some trauma survivors would appear “high-functioning” by traditional standards. They had a roof over their heads. They went to school. They even smiled in photos. But they were enduring things that never made it onto the ACE questionnaire.

The test assumes that trauma fits into neat, countable categories. But real trauma doesn’t behave that way. It doesn’t sit quietly inside ten questions. It spills. It layers. It rewires a person’s nervous system and then dares them to explain why they can’t sleep or trust or breathe freely in a room that reminds them of then.

Beyond the ACE Score

We now know that trauma leaves a physical imprint. It shows up in the immune system. It mimics chronic illness. It shapes behavior and response patterns so deeply, it can be mistaken for personality. And emerging research on epigenetics suggests that trauma can be passed down through gene expression, impacting future generations on a cellular level.

That’s not something a score of 3 or 7 or even 10 can capture.

What Now?

The ACE test isn’t inherently flawed—but it is limited. It’s a starting point, not a diagnosis. A flag, not a full map. And in our efforts to become more trauma-informed, we need to make sure we’re not leaving survivors behind simply because their trauma wasn’t on the original list.

Let’s keep using the ACE test—but let’s also keep asking better questions. Listening closer. Looking beyond what’s easy to count.

Because trauma is complex. So is healing.

And neither one fits in a checkbox.

If you’re thinking, “Now what?” — I wrote about that too. (Part 2: What Healing Can Look Like)