Adverse Childhood Experiences Scale – R4

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The ACES-R4 (Adverse Childhood Experiences Scale – R4) is a refinement of the original scale. The original multipart questions are divided into individual and more specific questions. Additionally the yes-no response options are replaced with a Likert scale to document reoccurrence. The questionnaire simply asks whether or not events occurred and is not a formal psychometric assessment. Some patterns of responses have been found to be associated with risk for mental health conditions among adults. The ACES-R4 may assist in starting conversations about childhood events or suggest background for identified conditions.


  • Provides information from traditional ACES scale
  • Separates double barrel questions in the traditional ACES for better specificity of experiences
  • Uses simple Likert scale instead of yes/no


  • May serve as a screen for certain conditions
  • Assists in starts conversations about childhood events
  • Intake tool to flag background issue
  • Improved research tool related to healthcare utilization


  • Time requirement from 5-10 minutes
  • Two online administration options:
    • Computer prompted - clinician/technician reads questions and enters response
    • Computer administered - clinician/technician sets up interview and patient interacts directly with the program