The original questionnaire used in the ACE Study asked about ten categories of experience before the age of eighteen. They fall into three groups: three forms of abuse, two forms of neglect, and five household conditions. This page describes each in ordinary language.
This page names abuse, neglect and household violence in general terms. It contains no graphic description, but it is not neutral reading. If any of it is close to home, take it slowly.
Abuse
Physical abuse. Being hit, struck, or physically hurt by an adult in a way that left a mark or caused injury — beyond ordinary discipline, and repeated or severe enough to be frightening.
Emotional abuse. Being sworn at, insulted, humiliated or put down by an adult in the household often enough that it became a feature of daily life, or being made to feel genuinely afraid of physical harm.
Sexual abuse. Sexual contact or coercion involving an adult or a substantially older person. This was the category whose prevalence most surprised the study's authors — it appeared far more often in an ordinary insured population than anyone had expected.
Neglect
Neglect is the absence of something a child needed rather than the presence of something harmful, which makes it easy to underestimate. The research does not treat it as a lesser category.
Physical neglect. Not having enough to eat, being dirty with no one attending to it, having no one to care for or protect you, or not being taken to a doctor when it was needed.
Emotional neglect. Growing up without the sense that anyone in the family made you feel important, special, loved, or looked out for. Households can be materially comfortable and emotionally empty; children in them can find it particularly hard to name what was wrong, because on paper nothing was.
Household dysfunction
The remaining five categories are not about what was done to the child directly. They are about the conditions the child lived inside — and they matter because a child's stress response is regulated largely by the stability of the adults around them. That is the link explained on why the household categories count.
A household member with a substance use problem. Living with someone who was drinking problematically or using drugs. The child may never have been harmed directly and still lived with unpredictability, secrecy and a reversal of who was looking after whom.
A household member with serious mental illness. Living with a parent or adult who was seriously depressed, had another significant mental illness, or attempted suicide. This category describes an environment, not a moral failing on anyone's part; illness is not blame.
Violence against a parent. Seeing or hearing a parent or caregiver being physically hurt by a partner. Research since the 1990s has broadened this in two important ways: it is well documented in both directions between partners, and a child does not have to witness the violence to be affected. Hearing it through a wall is enough.
Parental separation or divorce. The permanent loss of a parent from the household. The wider evidence is clear that the disruption, conflict and instability around a separation drive most of the effect rather than the separation itself — a well-handled parting is a very different experience from a contested one.
An incarcerated household member. Having a parent or other household member go to prison. This carries a distinctive load: the absence, the loss of income, the disruption of care, and a stigma that often makes it the hardest of the ten for a child to talk about.
What the list leaves out
These ten came from one study of one population in the 1990s, and they were never intended as a complete inventory of what harms children. Absent from the list, and well documented elsewhere: poverty and food insecurity, racism and discrimination, bullying, community violence, the death of a parent or sibling, serious childhood illness and medical trauma, foster placement, homelessness, and disaster or displacement.
Several later versions of the questionnaire add some of these, which is one reason two people can take two different ACE questionnaires and get two different numbers. The CDC now frames the field in terms of preventing adversity and building protective conditions rather than around the ten items alone, and the National Child Traumatic Stress Network publishes material on the broader range of childhood trauma.
How to hold the list
Two habits keep this framework useful rather than corrosive.
The first is to remember that these categories describe circumstances, not people. A category is not a label for a family, and it is certainly not a label for a child.
The second is to remember that the list only counts one side. It has no entry for the grandmother who kept things steady, the teacher who noticed, or the friend's house that was always open. Those things are real, they are measurable, and they change outcomes. See what a score means and our page on protective factors.