ADL Performance for Children and Youth

Typical development of 12 month old

Assist by holding out arms and legs; pull off socks and shoes

Typical development of 2 year old

Can undress independently, begin toilet training, varied interest in tooth brushing and bathing (need max assistance)

Typical development of 4 year old

Can dress independently, still need help with fasteners, brush teeth and wash hands independently, toilet trained

Typical development of 6 year old

Independent in choosing clothes (weather or occasion) and dressing, independent in bathing and tooth brushing, no night-time toileting accidents

Ways to asses child ADLs?

• COPM

• Pediatric activity card sort (personal care)

• Preschool activity card sort (self-care)

• Pediatric evaluation of disability inventory

• School function assessment

• Vineland Adaptive behavior scales

• REAL: roll evaluation of activities of life

• WeeFIM

• Transdisciplinary play based assessment (TPBA)

  • sensorimotor contributions to daily life and self-care

What is the first thing you should do when attempting to address an ADL with a child?

Ask are they ready? There are checklists to follow

Components of dressing readiness

• Attending to task for 5-10 minutes

• Responding to name and “look”

• Follow simple, 1 step direction

• Imitate actions of actions

• Cooperate with dressing carried out by adult

• Understands concepts of front/back, left/right

• Demonstrates body awareness in space

Components of toileting readiness

• Awareness of being wet or soiled

• Can sit comfortably on toilet/potty

• Can don/doff pants

• Shows signs of participation in elimination

• Can communicate need to eliminate

• Can stay dry for 1 hour periods

• Predictable bowel movements

• Cognitive age for at least 18 months

Components of grooming/hygiene readiness

• Power grasp

• Fine motor

• Postural control

• Sensory tolerance

Skill development perspective

• Frames of reference

  • Acquisitional/developmental (motor learning)

  • Behavioral

  • Environmental (compensatory)

  • Other? Sensory integration

General principles

1. establish- baseline of current abilities

2. set- up the environment for support

3. address- sensory processing aspects

4. prepare- the team…. consistency

5. design- design treatment around routines

Dressing: intervention techniques

• visual supports

• adapt clothing for sensory sensitivities or motor delays

• practice specific skill apart from dressing

• teach task-specific skills

• provide appropriate reinforcement and rewards

Adaptive ways to teach child how to put coat on

1. Flip method

2. Putting coat on back of chair

Backward chaining

All steps are completed by therapist until final step, final completed by child and reinforced, progressively more of the task is completed by child

Forward chaining

Considerations for potty training

• Easy to manage pants

• A safe potty

• Using a visual schedule

• Routine

• Rewards

• Diet

What is a successful toilet training method?

Brazelton, 1962 (Child oriented toilet training method)

Nocturnal incontinence

Typical for bedwetting to occur into Kindergarten- 1st grade

• Fluid restriction

• Nightlights and access

• Wetting alarms

Toileting considerations

• Consider the language we use around bowel movements or incontinence

• Punitive/shaming language linked to reduce the incidents of incontinence