TWAP093: Why You Want To Know About Activities of Daily Living

Autism and Daily Life

Activities of Daily Living: Change the World By Making Your Bed?

Activities of daily living may seem like a small thing.

But it’s the small things that make the biggest difference.

Small Decisions Made Me Get Behind

I’ve gotten behind in writing posts for this blog.

It started when I was training for another Chicago Marathon.

This year it was toward the beginning of October.

I started telling myself, “I’ve got so much training to do, I’ve got this to do, and I’ve got that to do.”

And now it’s been about three weeks since my last podcast episode or blog post!

“How will I ever get back into the groove?,” I ask myself.

It starts by sitting down at the computer and starting to type: a small action.

Making Your Bed: An Illustration

It’s the small things.

Here’s an inspirational video of a speech by Admiral William McCraven.

It’s called, “Changing the World By Making Your Bed.”

I believe all of us, both spectrum and non-spectrum, can improve our quality of living by learning about activites of daily living.

What Are Activities of Daily Living?

For a full discussion of activities of daily living, check out the Wikipedia Article.

Activities of daily living is a concept proposed in the 1950s by a research team at the Benjamin Rose Hospital in Cleveland, OH.

In her article, The Twenty Something Free Fall, Deborah Rudacille outlines the challenge many high school autistics face when they leave high school and try to transition to a more independent adult life.

Often, there are many skills that were done for the high schooler. Parents are often guilty of having difficulty “letting go,” or teaching their kids to do things on their own.

Authors Mlinac and Feng define activities of daily living as outlined below:

Michelle E. Mlinac, Michelle C. Feng; Assessment of Activities of Daily Living, Self-Care, and Independence, Archives of Clinical Neuropsychology, Volume 31, Issue 6, 1 September 2016, Pages 506–516, https://doi.org/10.1093/arclin/acw049

Activities of daily living (ADLs), often termed physical ADLs or basic ADLs, include the fundamental skills typically needed to manage basic physical needs, comprised the following areas: grooming/personal hygiene, dressing, toileting/continence, transferring/ambulating, and eating. These functional skills are mastered early in life and are relatively more preserved in light of declined cognitive functioning when compared to higher level tasks.

Basic ADLs are generally categorized separately from Instrumental Activities of Daily Living (IADLs), which include more complex activities related to independent living in the community (e.g., managing finances and medications). IADL performance is sensitive to early cognitive decline, whereas physical functioning is often a significant driver of basic ADL ability (Boyle, Cohen, Paul, Moser, & Gordon, 2002; Cahn-Weiner et al., 2007).

Why Can Activities of Daily Living Be Difficult on the Autism Spectrum?

I found this informal poll at WrongPlanet, asking whether autism/Aspergers members have difficulty with basic or instrumental activities of daily living.

Almost 100 people responded. 7% said they did not have any trouble. 14% said they have difficulty with the basic activities of daily living. 18% said they have difficulties with instrumental activities of daily living.

What was just as interesting was reading the causes of difficulties with activities of daily living:

17% said they have difficulties because of primary executive functioning/attention problems (e.g. working memory, sequencing, regulating attention, switching tasks, processing complex information, information retrieval)

10% said that they struggle with basic or instrumental activities of daily living because of sensory issues (hyper/hypo-sensitivities).

10% attributed their activities of daily living struggles to mental health issues (e.g. anxiety, depression, psychosis)

11% said they have difficulties because of social cognition problems (e.g. figuring out what others think/feel/expect)

Extra reading: Activities of Daily Living , from the Interactive Autism Network at Kennedy Krieger Institute.

Why You Want To Know About and Focus on Activities of Daily Living

1. Learning where you are helps you know where you want to be

I’ve said it before, but I’ve gotten into debt at different times in my life.

I don’t know if you’re like me, but I just ignored it for a while.

I didn’t want to see how bad things had gotten.

Finally, the pain of avoidance got too bad, and I went to see a budget counselor.

First, he made me write a list of all my debts and creditors.

Then he made me look at it!

Then I had to write all my expenses and compare them against my income.

From there, I learned what I had to cut out of my spending so that I could start climbing out of debt.

Learning about activities of daily living is like getting out of debt.

Until you and I learn about what activities of daily living are, and how we’re doing in each of the areas of daily living, we won’t know what areas we need to improve in.

Action Steps:

If you’re age 21 or younger, you can go to Casey Family Programs and register for a free account to take their activities of daily living assessment.

If you’re 22 or older, the best assessment I could find was the Waisman-ADL scale.

The scale is said to be used to measure activities of daily living functional abilities in a number of conditions. I don’t know whether it accounts for the full autism spectrum, but you can take a look for yourself and see what you think.

At the very least it will give you an idea of areas you’re fine in, and other areas you need to work on.

Finally, I’m copying and pasting this list of both basic and activities of daily living directly from Wikipedia.

Check out the list and give yourself your own rating, with 1 meaning you have no ability, 2 meaning you can do the activity with help, and 3 meaning you’re fully independent in this skill.

Instrumental activities of daily living (IADLs) are not necessary for fundamental functioning, but they let an individual live independently in a community:^[8]^[9]

Cleaning and maintaining the house

Managing money

Moving within the community

Preparing meals

Shopping for groceries and necessities

Taking prescribed medications

Using the telephone or other form of communication

Occupational therapists often evaluate IADLs when completing patient assessments. The American Occupational Therapy Association identifies 12 types of IADLs that may be performed as a co-occupation with others:^[10]

Care of others (including selecting and supervising caregivers)
Care of pets
Child rearing
Communication management
Community mobility
Financial management
Health management and maintenance
Home establishment and maintenance
Meal preparation and cleanup
Religious observances
Safety procedures and emergency responses
Shopping

2. Learning about activities of daily living gives you a framework for knowing your next steps

You can’t improve on what you don’t know.

Now that you have your ratings of both basic and instrumental activities of daily living skills in front of you, you can take courage from what you’re good at, but also set goals for learning the skills you are not so good at.

“Is it possible for someone autistic/Aspergiansto learn to be more social and live an independent life?”

I found this article helpful, since most of the commentors were on the spectrum.

I summarized ideas from their comments about how to increase your independence:

Louis Keep says that he went “from fricking basket case to (being independent)”. He recommends taking a theater or acting class, studying social skills books, and developing your special interests, especially interests that people will pay for (in his example, photography).

Another Aspergers person wrote, “do stuff, and face your fears.” This is good advice for anyone! We have to be willing to take risks, fail, and learn from our failures, if we’re going to get better at things.

No one ever learned to ride a bike without falling down a few times!

Jennifer Foster recommended learning about how you operate as an autistic. (I recommend reading Musings of an Aspie blog to learn more about your strengths and challenges as an autistic). In Jennifer’s words, “Learn how you operate, and roll with it.” Don’t apologize for who you are. Accept yourself!

Anne Lene Jakobsene, another Aspergian, she wrote that (independence) is possible, but not easy.

Executive functioning and sensory processing difficulties often get in the way.

But develop the mindset that you can get more independent and better at daily living skills with continued practice.

Check out WikiHow: How To Do Anything. Type whatever living skill you need to improve on in the search bar. Yes, some of the pictures may be corny, but I like that WikiHow is curated by hundreds of people who have helpful tips. Learn from the masses!

3. Activities of Daily Living pave the way to full(er) independence

Have you ever noticed that what you focus on expands?

What I mean is that when you start thinking about a topic, you start seeing that topic everywhere.

For example, when I set a goal to start a group for other men who are setting goals, I noticed that an acquaintance of mine had purchased the same yearly planner that I had.

We started talking over Facebook, and now, one year later, we’ve been meeting every month to go over our goals.

Two people aren’t a group, but it’s a start.

In the same way, when you determine that you want to grow in your daily living skills, you’ll find that you read articles, watch videos, and encounter people who can help you learn new skills.

I think you’d agree that we have to learn to walk before we run.

In the same way, we need to learn the basic activities of daily living, then move on to instrumental activities of daily living in order to become (more) independent.

Small Things Make A Big Difference

Maybe I’ve shared this with you before.

I can’t remember where I read it.

A man was obese and discouraged.

One day he decided to walk to the end of the block and back.

The next day he walked around the block.

He did that for a couple of weeks.

Then he started jogging around the block.

Within a year he had completed a marathon!

Take Action and Start Small:

Review the activities of daily living assessments in Step 1 and figure out which daily living skills you’re good at and where you need to improve.
Join the Thrive with Aspergers/Autism group and let us know what skills you want to improve. Let our members share in your journey.
Start reading WikiHow articles to help you improve that skill.
Celebrate your wins!

Join the Conversation

What topics would you most like covered on the show? Who would you like me to interview? Share you answer in the comments below or Ask me a question via my Contact Page.