synopsis（简介）

The Adverse Childhood Experiences Questionnaire (ACE-Q) is a 10-item measure to quantify instances of adverse or traumatic experiences that the client has had before the age of 18. The ACE-Q checks for the client’s exposure to childhood psychological, physical, and sexual abuse as well as household dysfunction including domestic violence, substance use, and incarceration.

The ACE-Q can be administered in a self-report manner (for adults or teenagers) or can be reported by parents to indicate the experiences of their child. Given some of the questions may be triggering for trauma clients, some clinicians opt to read the questions to the client and answer the ACE-Q in a collaborative way rather than request self-report.

Clinically, the ACE-Q can be used to help inform treatment because of the connection between adverse childhood experiences, social issues, and adult mental and physical health. The ACE-Q can also help those who have a high score become more informed about their increased risk factor for health issues as well as validate their experiences. People with high scores are likely to benefit from interventions that support their mental health and promote the development of adaptive behaviours.

The ACE-Q was used in the Adverse Childhood Experiences (ACE) Study (Felitti et al., 1998), which found that the ACE-Q score is correlated with later life mental health challenges as well as health risk behaviours (including substance abuse) and serious health problems. These include increased risk for depression, suicide attempts, alcoholism, drug abuse, smoking, 50 or more sexual partners, physical inactivity, severe obesity, sexually transmitted disease, increased risk for broken bones, heart disease, lung disease, liver disease, and multiple types of cancer (Felitti et al., 1998).

童年不良经历问卷（ACE-Q）由 10 个项目组成，用于量化服务对象在 18 岁之前的不良或创伤经历。ACE-Q 可检查受试者是否在童年时期遭受过心理、身体和性虐待，以及家庭功能障碍，包括家庭暴力、药物使用和监禁。
ACE-Q 可以以自我报告的方式进行（针对成人或青少年），也可以由家长报告，以说明其子女的经历。鉴于某些问题可能会触发创伤客户，一些临床医生选择向客户宣读问题，并以合作的方式回答 ACE-Q，而不是要求客户自我报告。
在临床上，由于不良童年经历、社会问题和成人身心健康之间存在联系，ACE-Q 可以用来帮助提供治疗信息。ACE-Q 还可以帮助那些高分者更多地了解他们健康问题的风险因素，并验证他们的经历。得分高的人很可能会从支持其心理健康和促进其适应行为发展的干预措施中受益。
童年不良经历（ACE）研究（Felitti et al., 1998）中使用了 ACE-Q，研究发现 ACE-Q 分数与日后的心理健康挑战以及健康风险行为（包括药物滥用）和严重的健康问题相关。这些问题包括抑郁、自杀未遂、酗酒、滥用药物、吸烟、50 个或更多性伴侣、缺乏运动、严重肥胖、性传播疾病、骨折风险增加、心脏病、肺病、肝病和多种癌症（Felitti et al., 1998）。

Psychometric Properties（心理测量学特性）

The ACE Study was completed on over 9,500 individual adults ranging in age from 19 to 92 years of age (Felitti et al., 1998). The ACE Study found that the higher someone’s ACE-Q score – the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and several other consequences.

A graded dose-response association has been found between ACE-Q score and risk for depression, risk for PTSD, relationship problems, emotional distress, worker performance, financial problems, current family problems, high stress, and inability to control anger (Anda et al., 2004; Hillis et al., 2004; Nurius, Logan-Greene, & Green, 2012; Ramiro et al., 2010). High ACE-Q scores also predict risk for homelessness which is especially prevalent in individuals with comorbid substance use disorders and mental illness (Patterson, Moniruzzaman, & Somers, 2014). Findings also suggest that people cannot merely “age out” of the mental health effects of ACEs; adults over the age of 65 with higher ACEs have increased odds of mood and personality disorders (Raposo, Mackenzie, Henriksen, & Afifi, 2014). Compared to people with an ACE-Q score of 0, people with an ACE-Q score of 6 are more likely to have a shorter lifespan by 20 years.

ACE 研究的对象是 9,500 多名成年人，年龄从 19 岁到 92 岁不等（Felitti et al., 1998）。ACE 研究发现，一个人的 ACE-Q 分数越高（一个人童年经历的逆境类型越多），他患慢性病、精神疾病、暴力、成为暴力受害者以及其他一些后果的风险就越高。

研究发现，ACE-Q 分数与抑郁风险、创伤后应激障碍风险、人际关系问题、情绪困扰、工作表现、财务问题、当前家庭问题、高压力和无法控制愤怒之间存在分级剂量反应关系（Anda et al., 2004; Hillis et al., 2004; Nurius, Logan-Greene, & Green, 2012; Ramiro et al., 2010）。高 ACE-Q 分数也预示着无家可归的风险，这在合并有药物使用障碍和精神疾病的人中尤为普遍（Patterson, Moniruzzaman, & Somers, 2014）。研究结果还表明，人们不能仅仅 "老去 "ACE 对心理健康的影响；65 岁以上的成年人中，ACE 较高者患情绪和人格障碍的几率也会增加（Raposo, Mackenzie, Henriksen, & Afifi, 2014）。与 ACE-Q 分数为 0 的人相比，ACE-Q 分数为 6 的人更有可能缩短 20 年的寿命。

Scoring and Interpretation（评分解释）

A response of Yes for each question is summed to provide an overall ACE-Q score (out of 10). The higher the score, the more adverse childhood experiences the client has had and the higher the risk for social, mental, or other wellbeing problems. The majority of all adults (52%–75%) score one or higher on the ACE-Q (CDC, 2010; Edwards et al., 2007; Ford et al., 2011; Ramiro et al., 2010; Rothman, Bernstein, & Strunin, 2010).

Scores of 4 or more are considered clinically significant. A minority (5%–10%) of the general population score 4 or more, where the general long-term health consequences become most pronounced (Hughes et al., 2017).

Compared with people who have an ACE-Q score of 0, people with an ACE-Q score of 4 are twice as likely to be smokers, 5 times more likely to have depression, 7 times more likely to be alcoholic, 10 times more likely to take illicit drugs, and 12 times more likely to attempt suicide.

如果每个问题的回答都是 "是"，则汇总得出 ACE-Q 总分（满分 10 分）。得分越高，说明客户童年的不良经历越多，出现社会、心理或其他健康问题的风险越高。大多数成年人（52%-75%）的 ACE-Q 得分为 1 分或更高（CDC, 2010; Edwards et al., 2007; Ford et al., 2011; Ramiro et al., 2010; Rothman, Bernstein, & Strunin, 2010）。

4 分或以上被认为具有临床意义。一般人群中有少数人（5%-10%）得分在 4 分或 4 分以上，对健康的长期影响最为明显（Hughes et al., 2017）。

与 ACE-Q 得分为 0 分的人相比，ACE-Q 得分为 4 分的人吸烟的几率是 0 分的两倍，患抑郁症的几率是 0 分的 5 倍，酗酒的几率是 0 分的 7 倍，服用违禁药物的几率是 0 分的 10 倍，企图自杀的几率是 0 分的 12 倍。