Table 5. Modified ACE questionnaire.

ACE, adverse childhood experience.

ACE QUESTIONNAIRE
Verbal Abuse	Category A	Did a parent often swear at you or insult you?	Yes	No
Physical Abuse	Category B	Did a parent or adult often push, grab or slap you?	Yes	No
		Did a parent or adult hit you so hard that you were bruised?	Yes	No
Sexual Abuse	Category C	Did a person older than you have sexual contact with you?	Yes	No
Household Substance Abuse	Category D	Did you live with anyone who got drunk daily?	Yes	No
		Did you live with anyone who used street drugs?	Yes	No
Household Mental Illness	Category E	Was a household member mentally ill or depressed?	Yes	No
		Did a household member attempt suicide?	Yes	No
Family Member Treated Violently	Category F	Did you witness a family member being pushed, grabbed, or slapped?	Yes	No
		Did you witness a family member being kicked or hit with a fist?	Yes	No
		Were you ever repeatedly hit for at least a few minutes?	Yes	No
		Ever been threatened with or hurt by a gun or knife?	Yes	No
Separation From Parents	Category G	Did you ever live with someone apart from your parents?	Yes	No
Incarcerated Household Member	Category H	Did a household member ever go to prison?	Yes	No
Parental Separation or Divorce	Category I	Were your parents ever separated or divorced?	Yes	No
Bullying	Category J	Did you ever experience bullying in school?	Yes	No
Foster Parents	Category K	Did you live with foster parents?	Yes	No