Survey Results

Survey Items: Survey instrument item number for children 0-5 years: I5, I15a-i; for children 6-11 years: I5, I16a-j; for children 12-17 years: I5, I16a-j
Variables in public use data file: ACE1; ACE3; ACE4; ACE5; ACE6; ACE7; ACE8; ACE9; ACE10; ACE12; ACE11

Denominator: Children age 0-17 years

Numerator: No adverse childhood experiences; One adverse childhood experience; Two or more adverse childhood experiences

Revisions and Changes: In 2018, the wording for ACE1 - experienced economic hardship - was changed. In addition, ACE12 - treated or judged unfairly due to sexual orientation or gender identity, ages 6-17 years - was added to the 2020 NSCH and ACE 11 - treated unfairly because of a health condition or disability - was added in 2021. These changes may have had a slight impact on the prevalences. For more information about the changes, click here.
In 2024, this measure was included as a National Outcome Measure for the first time. In 2024, the Title V NPMs and NOMs were updated. Some measures have new denominators (subsets of children) and some new measures have been added. Several NPMs and NOMs are measured with two different denominators: all children and only children with special health care needs (CSHCN). Some measures are no longer NPMs and NOMs and are now classified as Standardized Measures. For more information on the Title V MCH Block Grant measures, review this document.

Additional Notes: This is a composite measure of 11 ACE items asked in the NSCH: hard to cover basics on family's income (ACE1); parent or guardian divorced or separated (ACE3); parent or guardian died (ACE4); parent or guardian served time in jail (ACE5); saw or heard parents or adults slap, hit, kick punch one another in the home (ACE6); was a victim of violence or witnessed violence in their neighborhood (ACE7); lived with anyone who was mentally ill, suicidal, or severely depressed (ACE8); lived with anyone who had a problem with alcohol or drugs (ACE9); treated or judged unfairly due to race/ethnicity (ACE10); treated unfairly because of a health condition or disability (ACE11); and treated or judged unfairly due to sexual orientation or gender identity (ACE12, age 6-17 years). A response of 'somewhat often' or 'very often' to the question "Since this child was born, how often has it been very hard to cover the basics, like food or housing, on your family's income?" (ACE1) was coded as the child is experiencing an adverse childhood experience. The remaining survey items ACE3-ACE12 are dichotomous with 'Yes/No' response options. Finally, ACE12, discrimination due to sexual orientation or gender, was only asked of children aged 6 and up. It was not counted toward the composite score of younger children.

Treatment of Unknown Values: Missing values may be due to non-response (i.e. a skipped item) or a “don’t know” response. The way these items are handled can vary by measure. For NPMs and NOMs, having missing values for all items in an indicator will lead to the case being given a missing value on the overall measure. For some other measures, if there is a missing value on any of the items, the case will be set to missing. How missing values are handled is documented in the "Additional notes" field above when required.
Missing values are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the Interactive Data Query results table. In the majority of cases, the proportion of missing values is less than 2%. Exceptions are noted in the form of a Data Alert at the bottom of a results table. The exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Pop. Est.). To learn about the impact of the missing values on the population count estimates, click here.

History and Development:
About NSCH
The National Survey of Children’s Health (NSCH), funded and directed by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), is designed to provide annual national and state-level information on the health and well-being of children ages 0-17 years in the United States. The U.S. Census Bureau administers the survey, oversees the sampling, and produces a final data set of survey results. HRSA’s Maternal and Child Health Bureau (MCHB) develops survey content in collaboration with the U.S. Census Bureau and a Technical Expert Panel. The Technical Expert Panel consists of experts in survey methodology and children’s health, federal and state stakeholders, clinicians and researchers. In 2016, the NSCH underwent a significant redesign which combined content from both the NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). Further information on that redesign can be found in “The Design and Implementation of the 2016 National Survey of Children’s Health”.
The NSCH is conducted as a household survey, and one child per household is selected to be the subject for the detailed age-specific questionnaire. The respondent to this questionnaire is a parent or guardian who is living in the home and has knowledge of the sampled child. Survey participants complete either web-based or self-administered paper-and-pencil questionnaires. Data from the NSCH is used for scientific research, federal policy and program development, and state-level planning and performance reporting. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, systems of care for CSHCN, family interactions, parental health, school and after-school experiences, and neighborhood characteristics.
More information about the survey can be found in the “About the National Survey of Children's Health” section of this website and HRSA’s MCHB website.