Table 6 Adverse Childhood Experiences International Questionnaire (ACE-IQ)
| Category | Questions | Response | |
|---|---|---|---|
| P1 | Did your parents/guardians understand your problems and worries? |
Always Most of the time Sometimes Rarely Never |
1 2 3 4 5 |
| P2 | Did your parents/guardians really know what you were doing with your free time when you were not at school or work? |
Always Most of the time Sometimes Rarely Never |
1 2 3 4 5 |
| P3 | How often did your parents/guardians not give you enough food even when they could easily have done so? |
Many times A few times Once Never |
1 2 3 4 |
| P4 |
Were your parents/guardians too drunk or intoxicated ( ) by alcohol/drugs to take care of you?
|
Many times A few times Once Never |
1 2 3 4 |
| P5 | How often did your parents/guardians not send you to school even when it was available? |
Many times A few times Once Never |
1 2 3 4 |
| F1 |
Did you live with a household member who was a problem drinker ( ) or alcoholic?
|
Yes No |
1 2 |
| F2 | Did you live with a household member who was depressed, mentally ill, or suicidal? |
Yes No |
1 2 |
| F3 | Did you live with a household member who was ever sent to jail or prison? |
Yes No |
1 2 |
| F4 | Were your parents ever separated or divorced? |
Yes No |
1 2 |
| F5 | Did your mother, father, or guardian die? |
Yes No |
1 2 |
| F6 |
Did you see or hear a parent or household member in your home being yelled ( ) at, screamed at and sworn ( ) at, insulted, or humiliated ( )?
|
Many times A few times Once Never |
1 2 3 4 |
| F7 |
Did you see or hear a parent or household member in your home being slapped ( ), kicked, punched ( ), or beaten up?
|
Many times A few times Once Never |
1 2 3 4 |
| F8 |
Did you see or hear a parent or household member in your home being hit or cut with an object, such as a stick (or cane), bottle, knife, belt ( ), whip ( ) etc.?
|
Many times A few times Once Never |
1 2 3 4 |
| A1 | Did a parent, guardian, or other household member yell, scream or swear at you, insult, or humiliate you? |
Many times A few times Once Never |
1 2 3 4 |
| A2 |
Did a parent, guardian, or other household member threaten to, or actually, abandon  ) you or throw you out of the house?
|
Many times A few times Once Never |
1 2 3 4 |
| A3 |
Did a parent, guardian, or other household member, slap, kick, punch ( ), or beat you up?
|
Many times A few times Once Never |
1 2 3 4 |
| A4 | Did a parent, guardian or other household member hit or cut you with an object, such as a stick, bottle, knife, belt, whip, etc.? |
Many times A few times Once Never |
1 2 3 4 |
| A5 |
Did someone touch or fondle ( ) you in a sexual way when you did not want them to?
|
Many times A few times Once Never |
1 2 3 4 |
| A6 | Did someone make you touch their body in a sexual way when you did not want them to? |
Many times A few times Once Never |
1 2 3 4 |
| A7 | Did someone attempt sexual intercourse with you when you did not want them to? |
Many times A few times Once Never |
1 2 3 4 |
| A8 | Did someone actually have sexual intercourse with you when you did not want them to? |
Many times A few times Once Never |
1 2 3 4 |
| V1 | Did other kids, including brothers or sisters, hit you, threaten you, or insult you? |
Many times A few times Once Never |
1 2 3 4 |
| V2 | Did you see or hear someone being beaten up in real life? |
Many times A few times Once Never |
1 2 3 4 |
| V3 |
Did you see or hear someone being stabbed ( ) or shot ( ) in real life?
|
Many times A few times Once Never |
1 2 3 4 |
| V4 |
Did you see or hear someone being threatened ( ) with a knife or gun in real life?
|
Many times A few times Once Never |
1 2 3 4 |
| V5 | Were you forced to go and live in another place due to any of these events? |
Many times A few times Once Never |
1 2 3 4 |
| V6 |
Did you experience the deliberate ( ) destruction of your home due to any of these events?
|
Many times A few times Once Never |
1 2 3 4 |
| V7 | Were you beaten up by soldiers, police, militia, or gangs? |
Many times A few times Once Never |
1 2 3 4 |
| V8 | Was a family member or friend killed or beaten up by soldiers, police, militia, or gangs? |
Many times A few times Once Never |
1 2 3 4 |