ACE + SPACE (Expanded) – Brief Screening Tool

Before age 18, did you experience any of the following?
Tick Yes / No. Skip anything you prefer not to answer.

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1. ACE (Core 10)

Abuse & Neglect

1. Emotional abuse (swearing, insults, humiliation) ☐ Yes ☐ No
2. Physical abuse (hit, slapped, or hurt) ☐ Yes ☐ No
3. Sexual abuse ☐ Yes ☐ No
4. Felt unloved / not important ☐ Yes ☐ No
5. Family not supportive / not close ☐ Yes ☐ No
6. Basic needs not met (food, clothing, protection) ☐ Yes ☐ No
7. Caregivers unable to care (e.g. substance use, mental health) ☐ Yes ☐ No

Household Challenges
8. Parents separated / divorced ☐ Yes ☐ No
9. Domestic violence toward caregiver ☐ Yes ☐ No
10. Household mental illness / substance misuse / suicide attempt ☐ Yes ☐ No
11. Household member incarcerated ☐ Yes ☐ No

ACE Score (0–10): ______

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2. SPACE (Expanded Adversity)

Social / Environment
12. Poverty / ongoing financial stress ☐ Yes ☐ No
13. Food insecurity ☐ Yes ☐ No
14. Housing instability / homelessness ☐ Yes ☐ No
15. Unsafe neighbourhood / exposure to violence ☐ Yes ☐ No

Peer / Identity
16. Bullying or peer victimisation ☐ Yes ☐ No
17. Discrimination (race, disability, gender, sexuality, etc.) ☐ Yes ☐ No

Loss / Disruption
18. Death of close caregiver / loved one ☐ Yes ☐ No
19. Foster care / separation from family ☐ Yes ☐ No
20. Forced move / migration ☐ Yes ☐ No

Family Context
21. Ongoing high conflict at home ☐ Yes ☐ No
22. Took on adult/carer role as a child ☐ Yes ☐ No
23. Emotional support from adults was lacking ☐ Yes ☐ No

Health
24. Serious illness / repeated hospitalisation ☐ Yes ☐ No
25. Distressing medical or dental experiences ☐ Yes ☐ No

Expanded Count (optional): ______

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3. PCE (Positive Childhood Experiences)

26. At least one safe, supportive adult ☐ Yes ☐ No
27. Trusted friend ☐ Yes ☐ No
28. Sense of belonging (school/community) ☐ Yes ☐ No
29. Opportunities for play / enjoyment ☐ Yes ☐ No
30. Some routine / stability at home ☐ Yes ☐ No

PCE Score (0–5): ______

Original CDC–Kaiser study Adverse Childhood Experiences Questionnaire

While you were growing up, during your first 18 years of life:

1. Did a parent or other adult in the household often or very often …swear at you, insult
you, put you down, or humiliate you? Or act in a way that made you afraid that you
might be physically hurt?
If yes enter 1 …………………..
2. Did a parent or other adult in the household often or very often … push, grab, slap, or
throw something at you? Or ever hit you so hard that you had marks or were injured?
If yes enter 1 …………………..
3. Did an adult person at least five years older than you ever… touch or fondle you or
have you touch their body in a sexual way? Or attempt or actually have oral, anal, or
vaginal intercourse with you?
If yes enter 1 …………………..
4. Did you often or very often feel that … no one in your family loved you or thought you
were important or special? Or your family didn’t look out for each other, feel close to
each other, or support each other?
If yes enter 1 …………………..
5. Did you often or very often feel that … you didn’t have enough to eat, had to wear
dirty clothes, and had no one to protect you? Or your parents were too drunk or high
to take care of you or take you to the doctor if you needed it?
If yes enter 1 …………………..
6. Were your parents ever separated or divorced?
If yes enter 1 …………………..
7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or
had something thrown at her? Or sometimes, often, or very often kicked, bitten,
hit with a fist, or hit with something hard? Or ever repeatedly hit for at least a few
minutes or threatened with a gun or knife?
If yes enter 1 …………………..
8. Did you live with anyone who was a problem drinker or alcoholic or who used street
drugs?
If yes enter 1 …………………..
9. Was a household member depressed or mentally ill, or did a household member
attempt suicide?
If yes enter 1 …………………..
10. Did a household member go to prison?
If yes enter 1 …………………..
Now add up your “Yes” answers: ………………….. This is your ACE Score