Childhood Occupations: ADLs And IADLs

Question 1

ADLs

Answer 1

• activities oriented towards taking care of one’s body
• fundamental to living in a social world
• linked to development of autonomy, self-awareness, and life satisfaction

Question 2

Dressing (ADLs for children)

Answer 2

• putting on and off clothes
• adjusting clothing
• managing fasteners
• on and off shoes
• selecting suitable clothes and accessories (higher level)

Question 3

Developmental progression of dressing (MEMORIZE!)

Answer 3

• age 1 = cooperates in dressing, pulls off shoes and socks
• age 2 = removes unfastened front opening garments and helps pull down pants
• age 3 = puts on and pull over shirt, puts on shoes without fasteners, puts on socks, pulls pants independently, zips/unzips engaged zipper, buttons large buttons
• age 3.5 = snaps or hooks in front, unzips separating zipper, can dress with supervision for correct orientation of front and back garments
• age 4 = removes pullover garment, zips, buckles, puts on shoes, lace but cannot tie, consistent with front/back of garments
• age 5 = ties/unties and dresses unsupervised

Question 4

Bathing

Answer 4

• transfer safely to/from tub or shower
• obtain and use supplies
• wash body pats
• maintain position in tub

Question 5

Toileting (ADLs for children)

Answer 5

• control of bowel and bladder movements
• clothing management
• hygiene

Question 6

Developmental sequence of toileting (MEMORIZE!)

Answer 6

• age 1 = shows distress when soiled
• age 2 = child begins to initiate interest in potty training
• 30 months = child indicates a need to urinate or have bowel movement
• age 3 = child will often toilet on own
• age 4 = child has few accidents
• age 4.5 = child toilets independently and pulls up and adjusted clothing
• age 5 = child washes hands after toileting

Question 7

Self-care (ADLs for children)

Answer 7

• brushing teeth
• combing and managing hair
• hand washing
• applying deodorant
• applying deodorant
• maintaining personal care items such as glasses, braces, orthotics, adapted equipment
• shaving
• menstrual care

Question 8

Feeding (ADLs for children)

Answer 8

• eating and drinking = ability to keep and manipulate food and fluids in mouth as well as swallow mouth contents
• self-feeding = set up, arrange & bring food to mouth from plate or cup

Question 9

Developmental progression for self-feeding (MEMORIZE!)

Answer 9

• 6-9 months = wants to help with feeding, starts holding and mouthing large crackers/cookies, plays with spoon, grabs/bangs spoon, puts both ends in mouth
• 9-13 months = finger feeds soft foods and foods that melt quickly
• 12-14 months = dips spoon in food, moves spoon to mouth but is messy and spills
• 15-18 months = scoops food with a spoon and feeds self
• ages 2-3 =-1 stabs food with a fork
• ages 3-5 = eats independently

Question 10

IADLs

Answer 10

• actives to support daily life in home and community
• integral relationship exists between IADLs and community participation

Question 11

IADLs for children and youth

Answer 11

• care of pets
• care of siblings
• communication device use
• community mobility
• financial management
• health management
• household chores
• meal preparation and clean up
• safety and emergency responses

Question 12

Importance of chores in childhood

Answer 12

• the percentage of children engaged in household chores has decreased over time
• household chores promote social, cognitive, and physical benefits
• correlation with household chores and executive function
• the benefits of chores has also been well researched such as fostering interpersonal skills, responsibility, educational attainment and career success, and mental health, such as empathy

Question 13

Factors affecting performance and participation

Answer 13

• age
• developmental level
• health status
• motor abilities
• sensory processing skills
• cognitive skills
• executive function skills
• interests, motivations, preferences
• family expectations
• culture
• physical environment
• self-determination = the right to control situations and make choices

Question 14

ADLs and IADLs for children with high support needs

Answer 14

• some children and young adults may never be fully independent in self-care or IADLs
• decisions require consideration of safety issues, physical exertion, and time requirements
• need to assist young people to develop skills to mange this aspect with dignity and autonomy
• children need to be able to educate others to help them with ADLs and IADLs that they might not be able to do it themselves

Question 15

Assessing ADLs and IADLs

Answer 15

• occupational profile
• observation of child completing task
• standardized assessment
• when assessing, typically it’s more so talking with the parents and observing the children

Question 16

Occupational profile

Answer 16

• What are the child/family concerns?
• What can the child currently do? Strengths? Weaknesses?
• Values and interests?
• Barriers to engagement?
• Desired outcomes?

Question 17

Observation of child completing task

Answer 17

• observe in natural environment if possible
• activity analysis

Question 18

Standardized assessment

Answer 18

• Pediatric Evaluation of Disability Inventory (PEDI) = ADLs
• HELP (Hawaii Early Learning Profile) = IADLs
• these are the two examples of standardized assessments

Question 19

Pediatric Evaluation of Disability Inventory (PEDI)

Answer 19

• ADLs
• identifies functional capabilities and delays
• looks at functional skills, caregiver assistance, and modifications
• 6 months to 7.5 years
• 20-60 minutes
• observations, interview, and rating scale
• self-care, mobility, and social function

Question 20

HELP (Hawaii Early Learning Profile)

Answer 20

• IADLs
• screening and programming for 6 areas of functioning (self-help, cognition, language, GM, FM, and social-emotional)
• birth to 3 and 3-6 years
• time: several sessions
• curriculum-based assessment/developmental screening

Question 21

Following evaluation

Answer 21

• complete intervention plan
• write goals
• develop intervention approach (based upon the OTPF)
• create/promote: activities to enhance performance (child DOES NOT have a delay)
• establish/restore: establish a skill not yet developed (child has a delay)
• maintain: preserve performance capabilities
• modify: change the context of the activity
• determine method for service delivery
• consider outcome measure

Question 22

Interventions: ideas to promote dressing

Answer 22

• dress up clothes/costumes
• dressing relays (for older kids)
• dressing dolls (ages 2-3), books, and activity boards
• practice opening different fasteners on various containers
• encourage classroom use of different fasteners

Question 23

Interventions: Grooming

Answer 23

• various toothbrushes, toothpaste, hairbrush
• songs to encourage movements and flow when completing grooming tasks
• body paints/soap on different body parts to cue where to wash
• various wash cloths, towels, shampoo, bubble, bath, soap
• use toys that encourage filling, pouring, squeezing

Question 24

Interventions: ideas to promote self-feeding

Answer 24

• scooping games in sandbox with shovel/spoon
• use utensil to play with putty/clay
• straw relays
• art projects using utensils
• cooking activities with different shaped utensils
• foods with different consistences and tastes
• let child choose placement, plate, glass, utensil

Question 25

Strategy to promote ADLs: activity analysis

Answer 25

- look at the occupation and break it down (what are the barriers?) - break down ADLs into smaller steps - as learning, decrease physical and verbal cues - use visual cues for each step - can have child check off steps - analyze and record performance - benefit = can be used across contexts

Question 26

Strategy to promote ADLs: prompts

Answer 26

- instructional cues to help child perform task - physical assistance (most support) - modeling - gesture prompts - picture prompts - verbal instruction (least support) - face prompts as abilities increase - benefits = increase success rate - helps with initiation continuation, sequencing, termination of task

Question 27

Strategy used to promote ADLs: visual supports

Answer 27

- help child sequence task - real objects (highest support needs) - photos - abstract pictures - printed words (least) - benefits = helps child understand what is expected with visual cues (not dependent on verbal) - remains available if child forgets a step - may eliminate commands to child and help be more self-directed

Question 28

Strategy to promote ADLs: video modeling

Answer 28

- videotape child performing task in 2-3 minute segments - demonstrate all or part of a task - give specific examples of how to prompt child and give feedback - benefits = gives consistent caregiver instructions - self as model to learn new tasks - peer models can be motivating

Question 29

Strategy used to promote ADLs: positive feedback

Answer 29

- reinforcement given once task is completed correctly - child checks off steps completed - adult provides positive reinforcement following completion - benefits = encourages motivation

Question 30

Strategy to promote ADLs: backward chaining

Answer 30

- adult completes most of task, child completes final step, immediate reinforcement given - add more steps of the tasks for child to complete (last 2 steps, last 3 steps) - adult does fewer steps until child complete entire task - benefit = gives immediate success and feedback for children easily frustrated or with low self esteem

Question 31

Strategy used to promote ADLs: forward chaining

Answer 31

- child does first step of task, then therapist completes other steps - add more steps for child to do - benefits = child learn in correct sequence - helps child initiate, sequence, continue and generalize - builds self-confidence gradually