paediatrics

Adverse Childhood Experiences (ACE) Score

Retrospective questionnaire assessing 10 categories of adverse childhood experiences. Higher ACE scores correlate with increased risk of physical and mental health conditions in adulthood. Used in paediatric, family medicine, and public health settings.

Physical abuse -- adult in household pushed, grabbed, slapped, or threw something at parent OR hit so hard it left marks*

Emotional abuse -- adult swore at, insulted, or put down parent or made parent afraid of being hurt*

Sexual abuse -- adult touched or fondled in a sexual way, or touched adult in a sexual way without consent*

Emotional neglect -- did not feel loved, important, or special; family did not look out for each other*

Physical neglect -- not enough to eat, wore dirty clothes, not taken to doctor; family did not take care of each other*

Parental separation or divorce*

Domestic violence -- mother or stepmother pushed, grabbed, slapped, or had something thrown at her, OR kicked, bitten, hit with a fist, or threatened with weapon*

Household substance misuse -- lived with someone who drank too much or used street drugs*

Household mental illness -- lived with someone who was depressed, mentally ill, or attempted suicide*

Incarcerated household member -- lived with someone who went to prison*

Score interpretation

No ACEs Identified 0

ACE Score 0 -- no adverse childhood experiences reported; baseline risk

→ Protective factors discussion; praise strengths: strong family support, stable schooling, positive peer relationships; primary prevention: parenting support, healthy relationships education; no specific ACE-related intervention indicated; trauma-informed care principles apply to all consultations.

Low-Moderate ACE Burden 1–3

ACE Score 1-3 -- some adverse experiences; trauma-informed approach warranted

→ Trauma-informed care: acknowledge adversity sensitively; assess for developmental, emotional, and behavioural sequelae; GP/HV follow-up; school nurse liaison; parenting support (Triple P, Family Nurse Partnership if eligible); CAMHS referral if symptoms of anxiety, depression, or ADHD; safeguarding check if abuse suspected; resilience building: identify protective factors; note ACE score in records with appropriate confidentiality.

High ACE Burden -- Increased Lifelong Health Risk 4–10

ACE Score >= 4 -- significantly elevated risk of physical/mental health problems; multi-agency response

→ Multi-agency safeguarding assessment (MASH referral if child at risk); CAMHS urgent referral; social care involvement if current child protection concerns; GP shared care plan; trauma-specific therapies: trauma-focused CBT, EMDR; health surveillance: cardiovascular risk factors, substance use screening, mental health; school support plan (EHCP assessment if learning needs); family support worker; parenting programmes; note: ACE score DOES NOT predict individual outcomes -- many individuals with high ACE scores are resilient with appropriate support; avoid stigmatisation; document sensitively.

Interpretation bands for the ACE Score. Apply clinical judgement and local guidance.

References

Felitti VJ et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med. 1998;14(4):245-258.
Public Health Wales. Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population. 2015.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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