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