ACE-Q Teen Self Report Adverse Childhood Experiences Questionnaire

What is CYW ACE-Q Teen SR

The CYW Adverse Childhood Experiences Questionnaire for Adolescents : Self Report (CYW ACE-Q Teen SR) is a clinical screening tool that calculates cumulative exposure to Adverse Childhood Experiences (ACEs). It is a 17 item instrument completed by youth age 13 to 19. Respondents are asked to report how many experience types (or categories) apply to their child, not which experiences apply (i.e. it is de-identified). The CYW ACE-Q Teen SR is intended for use in pediatric and family practice settings to identify patients at increased risk for chronic health problems, learning difficulties, mental and behavioral health problems and developmental issues due to changes in brain architecture and developing organ systems brought on by exposure to extreme and prolonged stress.

CYW ACE-Q Teen SR Printable PDF

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CYW ACE-Q Teen SR Scoring and Interpretation

The instrument is comprised of two sections: Section 1 of the CYW ACE-Q (i.e. items #1-10) consists of the traditional ten ACEs for which we have population-level data for disease risk in adults. Section 2 includes nine (CYW ACE-Q Teen and CYW ACE-Q Teen SR) items assessing for exposure to additional early life stressors identified by experts and community stakeholders. These items are hypothesized to also lead to disruption of the neuro-endocrine-immune axis, but are not yet correlated with population level data about risk of disease. They include involvement in the Foster Care system, bullying, loss of parent or guardian due to death, deportation or migration, medical trauma, exposure to community violence, and discrimination.

SECTION 1 Ten items assessing exposure to the original ten ACEs
SECTION 2 Nine items assessing for exposure to additional early life stressors relevant to children/youth served in community clinics

As an instrument calculating cumulative exposure to categories of adversity, the respondent is asked to report how many categories apply to them or their child. Respondents tally the number for each section and fill the total in the box provided. Each completed CYW ACE-Q generates a two number score, for example, a score of 3+2 (three categories endorsed in Section 1 and two endorsed in Section 2) or 4 + 4 (four categories endorsed in each section).

The traditional ACEs (Section 1) and additional items (Section 2) are kept separate in the CYW ACE-Q for purposes of research and evaluation.

The completed CYW ACE-Q will have two scores: one for Section 1 (original ten ACEs), and another for Section 2 (supplementary items). If the patient’s CYW ACE-Q score from both Section 1 and Section 2 equals zero to three (0-3) and the patient does not present with additional symptomatology, the Primary Care Provider should provide Anticipatory Guidance. If the patient’s score is one to three (1-3) with symptomatology, or four or higher, an appropriate referral to care should be made.

Section 1: Ten items assessing exposure to the original ten ACEs
Section 2: Nine items assessing for exposure to additional early life stressors relevant to children/youth served in community clinics

PsyPack can automatically score the CYW ACE-Q Teen SR assessment and prepare corresponding tables and graphs.

Further, PsyPack automatically plots a graph to help you easily track progress over time.

Sample Report of CYW ACE-Q Teen SR

Domain

Childhood Trauma, Trauma

What does CYW ACE-Q Teen SR measure

The purpose of the evaluation is to:

measure childhood trauma.

Administration

Self-administered

Type of outcome tool

Clinical

Assessment modes

Questionnaire

Age and eligibility

13-19 years

Estimated time

2 to 5 minutes

Notes

Since the questionnaire relies on client self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the client understood the questionnaire, as well as other relevant information from the client.

The CYW ACE-Q is intended for use in pediatric and family practice settings to identify patients at increased risk for chronic health problems, learning difficulties, mental and behavioral health problems and developmental issues due to changes in brain architecture and developing organ systems brought on by exposure to extreme and prolonged stress.

The instrument is comprised of two sections: Section 1 of the CYW ACE-Q (i.e. items #1-10) consists of the traditional ten ACEs for which we have population-level data for disease risk in adults. Section 2 includes nine (CYW ACE-Q Teen SR) items assessing for exposure to additional early life stressors identified by experts and community stakeholders. These items are hypothesized to also lead to disruption of the neuro-endocrine-immune axis, but are not yet correlated with population level data about risk of disease. They include involvement in the Foster Care system, bullying, loss of parent or guardian due to death, deportation or migration, medical trauma, exposure to community violence, and discrimination.

If the patient’s CYW ACE-Q score from both Section 1 and Section 2 equals zero to three (0-3) and the patient does not present with additional symptomatology (see Relevant Symptomatology listed below), the Primary Care Provider should provide Anticipatory Guidance. If the patient’s score is one to three (1-3) with symptomatology, or four or higher, an appropriate referral to care should be made.

Relevant Symptomatology

Sleep disturbance
Weight gain or loss
Failure to thrive
Enuresis, encopresis
Constipation
Hair loss
Poor control of chronic disease (such as asthma or diabetes)
Developmental regression
School failure or absenteeism
Aggression
Poor impulse control
Frequent crying
Restricted affect or numbing
High risk behavior in adolescents
Unexplained somatic complaints (such as HA or abdominal pain)
Depression
Anxiety
Interpersonal conflict

The CYW ACE-Q is not a validated diagnostic tool, and is not intended to be used in the diagnosis or cure of any disease.

Attribution and References

Bucci M, Gutiérrez Wang L, Koita K, Purewal S, Silvério Marques S, Burke Harris N. Center for Youth Wellness ACE-Questionnaire User Guide. San Francisco, CA: Center for Youth Wellness; 2015

Bucci M, Gutiérrez Wang L, Koita K, Purewal S, Silvério Marques S, Burke Harris N. Center for Youth Wellness ACE-Questionnaire User Guide. San Francisco, CA: Center for Youth Wellness; 2015

Archived link

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58. doi: 10.1016/s0749-3797(98)00017-8. PMID: 9635069.

Archived link