Childhood Trauma & Resilience Surveys

Adverse Childhood Experiences (ACE) Survey

This survey will calculate your Adverse Childhood Experiences (ACE) score. The number of questions that you answer "yes" provides an estimate of the kinds of childhood traumatic experieces you have experienced.

"ACEs" are Adverse Childhood Experiences, which are traumatic events that may have occurred during childhood. A high number of ACEs (three or more) can lead to increased risk of several mental and physical problems later in life. Having a strong support network can help build resiliency, which can protect you from some of these problems. The US Center for Disease Control (CDC) has developed this 10-question survey in order to identify people who may be at risk for complications caused by traumatic events in their childhood. (I added the eleventh question about other traumatic events that were not included in the CDC survey.)

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/caregiver who is an alcoholic, a parent/caregiver 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, deportation or abandonment.

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?
   yes     no
   
   
2. Did a parent or other adult in the household do either or both of the following:
   • Often or very often push you, grab you, slap you, or throw something at you?
   • Ever hit you so hard that you had marks or were injured?
   yes     no
   
   
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?
   yes     no
   
   
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?
   yes     no
   
   
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?
   yes     no
   
   
6. Was a parent ever lost to you through divorce, abandonment, death or another reason?
   yes     no
   
   
7. Did any of the following happen to your mother, stepmother, or another adult in your household?
   • They were often or very often pushed, grabbed, slapped, or had something thrown at them.
   • They were sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard.
   • They were ever repeatedly hit for at least a few minutes or threatened with a gun or knife.
   yes     no
   
   
8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
   yes     no
   
   
9. Was a household member depressed or mentally ill, or did a household member attempt or commit suicide?
   yes     no
   
   
10. Did a household member get deported or go to prison, or is a household member going to court to avoid deportation?
    yes     no
    
    
11. Have you experienced other significant trauma not listed above, such as watching a sibling being abused, being homeless, losing a close relative who was a significant part of your life (grandparent, aunt/uncle, etc.), surviving and recovering from a severe accident, etc.?
    yes     no
    
    

Resilience Survey

This survey will calculate your Resilience score. Your Resilience score is a measure of circumstances in your childhood that can affect your ability to deal with or "bounce back" from some of the negative effects of childhood trauma.

1. I believe that my mother loved me when I was little. (If your mother was not part of your life, choose "n/a".)
   definitely     probably     not sure     probably not     definitely not     n/a



2. I believe that my father loved me when I was little. (If your father was not part of your life, choose "n/a".)
   definitely     probably     not sure     probably not     definitely not     n/a



3. When I was little, other people helped my parents/guardians take care of me, and they seemed to love me.
   definitely     probably     not sure     probably not     definitely not



4. I've heard that when I was an infant someone in my family enjoyed playing with me, and I enjoyed it, too.
   definitely     probably     not sure     probably not     definitely not



5. When I was a child, there were relatives in my family who made me feel better if I was sad or worried.
   definitely     probably     not sure     probably not     definitely not



6. When I was a child, neighbors or my parents seemed to like me.
   definitely     probably     not sure     probably not     definitely not



7. When I was a child, there were teachers, coaches, youth leaders or ministers who were there to help me.
   definitely     probably     not sure     probably not     definitely not



8. Someone in my family cared about how I was doing in school.
   definitely     probably     not sure     probably not     definitely not



9. My family, neighbors and friends talked often about making our lives better.
   definitely     probably     not sure     probably not     definitely not



10. We had rules in our house, and we were expected to keep them.
    definitely     probably     not sure     probably not     definitely not



11. When I felt really bad, I could almost always find someone I trusted to talk to.
    definitely     probably     not sure     probably not     definitely not



12. Ever since I was little, people noticed that I was capable and could get things done.
    definitely     probably     not sure     probably not     definitely not



13. Ever since I was little, I was independent and a go-getter.
    definitely     probably     not sure     probably not     definitely not



14. Ever since I was little, I have believed that life is what you make it.
    definitely     probably     not sure     probably not     definitely not

Results & Follow-Up

Your answers to the specific questions in the surveys above are private. They will not be saved or stored, and no one—not Mr. Bigler and not anyone else—will have access to that information, no matter which of the following options you select.

However, Mr. Bigler would like to know just the numeric results (just the numbers below) in order to be appropriately sensitive to your needs throughout the year.

Your ACE Score is:     ← Is it OK for Mr. Bigler to see this number? yes     no

Your ACE score gives an estimate of how many types of traumatic events you have experienced. The higher your ACE score, the more types of trauma you have experienced.

Most people have an ACE score between 0 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.

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

Your Resilience Score is:     ← Is it OK for Mr. Bigler to see this number? yes     no

Your Resilience score gives an estimate of the extent to which your environment was able to lessen the effects of any trauma that you might have experienced. The higher your Resilience score, the less damage your trauma is likely to have done, and the better you are likely to be able to cope with it.

Most people have a resilience score between 8 and 10. A resilience score of 8 or above suggests that your support network and/or your outlook have likely helped to mitigate some of the effects of any traumatic or potentially traumatic events in your past. A resilience score below 7.5 suggests that you have grown up with less support than most of your peers, and that you are more likely to face challenges with feelings of self-confidence and self-worth as a result.

If your ACE score is 4 or higher and/or your Resilience score is less than 7.5 (or if you know someone with a high ACE score and/or a low Resilience score), 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.

Note that I don't have a "savior complex"—I do not need to be the person who helps you. I am happy to listen and offer help if you would like it, but I am also fine with not getting involved if it wouldn't be welcome.

However, please answer the following questions, which will tell me whether or not you would like me to follow up with you.

• To what extent (if any) are the above traumatic events (the questions you answered "yes" in the ACE survey) still happening?
  
  Most or all of them are still happening.
  A few of them are still happening.
  None of them are currently happening (or I didn't have any ACEs).
  I prefer not to answer.


• Regardless of how many ACEs you have, would you like me or another adult in the building to check in with you to see how you're doing?
  
  Yes, fairly regularly.
  Yes, once in a while.
  I'd like to talk with you once, but after that only if I ask or it appears to be necessary.
  Please don't, unless I ask or it appears to be necessary.


• Which of the following are part of your support network? (Check as many as apply.)
  
  I see a professional (therapist, counselor, social worker, etc.) regularly.
  I have at least one adult (such as a teacher, coach or relative) whom I can talk to.
  I have one or more close friends who are there for me when I need them.
  
  I don't feel that there is anyone I could talk to when I need to.


• Is there any other relevant information that you would like to share with me?
  
  

I am aware that not all students answer these questions honestly. It is, of course, your choice what you decide to share with me about yourself. However, I would appreciate knowing how much I should believe the numbers that are generated by this form.

Would you like to receive a copy of the email message sent to Mr. Bigler by this form? yes      no
Note: This will only work if your email address is correct at the top of this from.

Clicking "Submit" will send only the information inside this box (the number or text in the "ACE score" and "Resilience score" boxes, and the information about your support network and check-ins) to Mr. Bigler.

Your answers to the indivdiual ACE and resilience questions in this survey will be discarded when you close your browser and no one will have access to them.

Clicking "Reset Form" will reset this form to its initial state.