Contents

6.1 Overview of ADLs/IADLs
6.2 Adaptive Equipment
6.3 ADL/IADL Requires Substantial Impairment AND Frequent Assistance
6.4 "Needs" versus "Safety"/ Fluctuating Needs
6.5 Age Specific ADL/IADL Answer Choices
6.6 Bathing
6.7 Grooming
6.8 Dressing
6.9 Eating
6.10 Toileting
6.11 Mobility
6.12 Transfers
6.13 Communication
6.14 Learning 
6.15 Social Competency
6.16 Meal Preparation (PDF)
6.17 Money Management (PDF)
6.18 Duration of Needs

6.1 Overview of ADLs/IADLs

The computer application of the CLTS FS will calculate the child’s age and present only the ADL/IADL answer choices appropriate for the child’s age. Although the screener should not use the full paper screen, the screener may wish to take along a print-out of the ADL/IADL answer choices that match the child's age, and check the boxes. The screener can print this from the "Forms" link in the CLTS FS application.

These answer choices were developed by the screen workgroup using well-established child development guidelines. Modifications were made in order to meet our screen development goals:

• Accuracy (match current functional eligibility rules and clinical judgment)
• Brevity (unnecessary information was left out)
• Objectivity/ inter-rater reliability (i.e., reduce subjectivity as much as possible)
• Inclusiveness (able to describe various needs of children)

These four criteria can obviously conflict. The balancing between these goals is especially evident in the ADLs.

The wording of each answer choice was crafted to be as precise and objective as possible to promote inter-rater reliability. This can obviously be challenging when trying to be inclusive of all children with or without physical, cognitive, or emotional disabilities.

Similarly, brevity can conflict with inclusiveness and accuracy, since children’s abilities must be broken down by age groupings. If functional eligibility is not affected, brevity is chosen over inclusiveness. Since age-appropriate needs are not "necessary" information (they don’t help with determining program eligibilities) they are not included among the ADL/IADL answer choices. This means that screeners will not be able to describe every child’s needs, if the needs are "age-appropriate," i.e., similar to those of non-disabled children of the same age group. ("Similar" here means the same as, or too difficult to distinguish without subjectivity and excessive length of the CLTS FS)

Age-appropriate descriptions (such as complete cares for infants) were left off the CLTS FS for brevity. Babies are properly determined eligible even without checkmarks on some of the ADLs/IADLs.

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6.2 Adaptive Equipment

Some items specifically ask whether the child needs adaptive equipment. Adaptive equipment includes "medical" equipment such as wheelchairs or mechanical lifts; it can also include "low-tech" equipment the parents use, such as strollers for a three year old who cannot walk, or a baby seat to bathe a baby who cannot sit on her own. Such low-tech or generic equipment count only if they are used to compensate for a child's physical impairment. (See details under "Bathing" and "Mobility.") Note the term is "needs" equipment, whether or not the child currently has the equipment.

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6.3 ADL/IADL Requires Substantial Impairment AND Frequent Assistance

A substantial functional impairment is a restriction on the child's ability to engage in age appropriate everyday activities or perform daily functions. The ADL/IADL questions on the screen are designed to capture substantial impairments based on the child's age. The child must need hands on adult assistance to complete these functions across settings including home, school and community. The hands on help is not offered simply to complete the task quicker, or make the task easier, but is provided as a necessity to complete the task on a daily basis.

FREQUENCY is a critical aspect of the substantial impairment requirement. ADL/IADL questions are to be checked only if the child needs help from an adult in order to complete the activity of daily living, as defined by the functional screen questions, on a regular basis. If the child needs infrequent assistance to complete the task, it cannot count toward functional eligibility for long-term support programs. Therefore, if the child completes the task most of the time on his/her own and only occasionally needs help from an adult, the box for that question is not checked. In many cases, a child's need for help is quite consistent: "She can't do that," or "He always needs help with this," or "Most of the time…," In these instances, the tasks should be checked. In addition, if the child has been able to complete the specific task(s) on a rare or infrequent occasion, that means the child is considered unable to complete the task on a regular basis and the box is checked. If the child needs assistance most of the time, then the box is checked.

In general, screeners should consider whether or not the need for help is some of the time versus most of the time. If the child needs assistance from others most of the time, then it counts as a checked box on the CLTS FS - that indicates that the child's limitation is substantial. If the child needs assistance only some of the time, the ADL/IADL answer choice should not be checked - that indicates that the child's development is within the range of typical development for a child of a comparable age, and not consistent enough to be categorized as a substantial impairment.

The substantial impairment, as described in the question on the screen, must relate to the day in/day out routine of the child. If the family is providing hands on support to the child for a skill even though the child can do the task independently, then do not check the box. If a parent says, "now and then," "every few weeks," or "a few times, not mostly," the frequency is probably only some of the time and therefore the child would not meet the required level of frequency needed to check the box. One way a screener can obtain clearer information is to ask the parent "In the past few months, would you say he's needed help most of the time?" In general, consider ADL/IADL function over a six-month timeframe, unless the child has new needs or has developed new skills.

It is not expected that the screener test the child or measure her needs or abilities during a home visit. A child's needs cannot be determined from a single episode but must reflect the child's typical or average functional need over the past six months. This is particularly important when reviewing documentation about a child's abilities. A report that indicates that a child completed a specific task may not represent the typical needs of that child. Be certain to verify any statement or assessment of frequency with various care providers who know the child well.

Example A: Juan has cancer and gets very sick during chemotherapy and he needs help with his ADLs then; at other times he is independent with them. Juan gets chemotherapy one week each month. Screener does not indicate that Juan needs help with his ADLs because he needs help only some of the time - one week out of four.

Example B: Tia was potty-trained two months ago and is doing well with it. Screener does not check box for needs help with toileting (although she did, four out of the past six months), because Tia has developed this skill and now rarely needs any help.

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6.4 "Needs" versus "Safety" / Fluctuating Needs

"Needs" and "safety" should not be over-interpreted or over-used to express screeners’ subjective opinions. The CLTS FS is intended to be an objective screen of children’s need for assistance. Thus, the screener should ask, "Would another screener of another discipline rank the child the same way?" 

It is often difficult to distinguish a child’s needs from parents’ preferences. Sometimes parents may prefer to perform or help with tasks even though the child could do them. If a child can complete a task independently, but it takes them a long time, the screener needs to consider whether or not the child "needs any help to complete the task." Sometimes it takes a child so long that the parent must do the task so that the child gets to school on time. This is not just for convenience, and amounts to (on average) more than a third of the time (since it’s five days out of seven); it would be counted as help needed on the Functional Screen.

The screener will quite often encounter different versions of the child’s abilities from different parties. This is discussed in the first part of the instructions. Also, there are instructions for how to deal with fluctuating needs, and with the fact that a child may function differently, e.g., at home and at school. Please review those earlier sections as needed under 1.12 Strategies to Minimize Screening Limitations (B. Different Descriptions from Different People and C. Abilities Fluctuate).

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6.5 Age Specific ADL/IADL Answer Choices

The following tables provide information and guidance about the ADL/IADL questions on the CLTS FS. The table is organized by ADL/IADL (Bathing, Dressing, etc.). The columns to the left side of the table indicate the age at which the specific answer choice appears on the CLTS FS. If the column is white, the question applies to that age group; if the column is grey, the question does not apply to that age group. The answer choices are listed in Bold. Following the specific answer choice is an explanation of the question and/or relevant examples. Always consider the answer choice itself first; the examples are only intended to supplement that. 

In the following tables, the symbol is used to indicate that if the information listed here is true for the child, the screener would check that box on the CLTS FS. 

The symbol is used to indicate that if the information listed here is true for the child, the screener would not check that box on the CLTS FS. 

This is not an inclusive or exclusive list of information. The children for whom a CLTS FS is completed for are complicated individuals, and every situation has not been represented on the screen or in these instructions. The information provided is meant to offer guidance to the screener. For most of the questions, the answers should be relatively clear once the screener has met the child and reviewed the available documentation. For further clarification, e.g. means "for example" and i.e. means "that is, or "in other words."

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6.6 Bathing

The ability to shower, bathe or take sponge baths for the purpose of maintaining adequate hygiene (does not include hair care). For older children, this also includes the ability to get in and out of the tub, turn faucets on and off, regulate water temperature, wash and dry fully.

Bathing Table (PDF)

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6.7 Grooming

Brushing teeth, washing hands and face. Due to variations in hair care by culture, length of hair, etc, hair care is not considered for the purposes of this screen.

Grooming Table (PDF)

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6.8 Dressing

The ability to dress as necessary. This does not include the fine motor coordination for buttons and zippers. 

Dressing Table (PDF)

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6.9 Eating

The ability to eat and drink by finger feeding or using routine or adaptive utensils. The ability to swallow sufficiently to obtain adequate intake. Does not include cooking food or preparing it for consumption (cutting food into bite size pieces or pureeing if needed).

Eating Table (PDF)

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6.10 Toileting

The ability to use a toilet or urinal, transferring on/off a toilet, changing menstrual pads, and pulling down/up pants.

Toileting Table (PDF)

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6.11 Mobility

The ability to move between locations in the individual's living environment. For children, this includes home and school. Mobility includes walking, crawling, or wheeling oneself around at home or at school. For functional eligibility purposes, mobility does not include transporting oneself between buildings or moving long distances outdoors.

Mobility Table (PDF)

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6.12 Transfers

The physical ability to move between surfaces: e.g., from bed/chair to wheelchair, walker or standing position. This excludes transfers into bathtub or shower or on and off the toilet, because those are captured in bathing and toileting ADLs.

Transfers Table (PDF)

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6.13 Communication

Hearing Impairments
Many of the questions in this category are related to auditory/verbal communication. If a child has a known hearing impairment some interpretation will be required to answer the questions correctly. Consider the child's primary method of communication when answering these questions. If they communicate primarily through sign language due to a hearing impairment, then complete the questions with that understanding. For example, for a child who is deaf, when asked "Does not use more than 10 meaningful words or word approximations," the screener would inquire if they can sign 10 words. The same holds true for a child who uses a communication device as their primary mode of communication. That would not be the case for example for a child with Down syndrome who has a speech delay and is enhancing their communication with sign language. For that child, their primary method of communication is still verbal.

Some questions cannot be modified for a child with a severe hearing impairment. In these cases, check the question appropriately given this disability. For example, when asked, "Does not startle, jump or blink to sudden, loud, unexpected noises" it is expected that a child with a significant hearing impairment would have this item checked. Another example is, "Does not imitate environmental sounds through any means." If a child cannot demonstrate the communication skill with consideration of their primary mode of communication, then the item is checked on the screen.

Non-Verbal / Use of Communication Devices
Many of the questions in this category are related to auditory/verbal communication. If a child has a known significant language disorder that has resulted in the use of an alternative communication system, some interpretation will be required to answer the questions correctly. Please consider the child's primary method of communication. If they communicate using a communication devise, then complete the questions with that understanding. For example, for a child who is non-verbal and uses a Dynamite to express themselves, when asked "Does not join familiar words into phrases (e.g., "me drink," "red truck")," the screener would inquire if they are combining words on their Dynamite.

Emerging Skills
The CLTS FS is trying to capture mastered skills. If a skill listed has been mastered then check accordingly. If the skill is starting to emerge and parents/caregivers can report that they have witnessed the skill but only a few times, do not consider the skill mastered. This is especially evident in Communication and Learning.

Assessment of 35% delay or two standard deviations
The following is a list of tools that are norm referenced for receptive and expressive language. Select the correct tool from the pull down menu on the CLTS FS. Indicate the date (MM/YYYY) that the assessment was completed.

[  ] indicates child's age at which this tool can be used and considered accurate. Any numbers written with decimal points indicates the age in [years.months]. The latest editions of the test should always be used when available.

Acceptable tools for Expressive and Receptive Communication:

• Clinical Evaluation of Language Fundamentals - Preschool (CELF-P) [3 - 6.11]
• Clinical Evaluation of Language Fundamentals (CELF) [5 - 21]
• Comprehensive Assessment of Spoken Language (CASL) [3 - 21]
• Comprehensive Receptive and Expressive Vocabulary Test (CREVT) [4 - 89]
• Early Language Milestone Scale (ELMS) [Birth - 36 months]
• Fullerton Language Test for Adolescents (FLTA) [11 - 18]
• MacArthur Communicative Developmental Inventories (CDIs) [8 - 30 months]
• Miller Assessment for Preschoolers (MAP) [2.9 - 5.8]
• Oral and Written Language Scales (OWLS) [3 - 21] - Only use Listening Comprehension Scale and Oral Expression Scale results
• Preschool Language Scale (PLS) [Birth - 6]
• Reynell Developmental Language Scales [1 - 6.11]
• Sequenced Inventory for Communication Development (SICD) [4 months - 4]
• Test of Adolescent and Adult Language (TOAL) [12 - 24]
• Test of Early Language Development (TELD) [2 - 7.11]
• Test of Language Competence (TLC) [5 - 18.11]
• Test of Language Development - Primary (TOLD-P) [4 - 8.11]
• Test of Language Development - Intermediate (TOLD-I) [8 - 12]

Acceptable tools for Expressive Communication only:

• Expressive One-Word Picture Vocabulary Test (EOWPVT) [2 - 18.11]

Acceptable tools for Receptive Communication only:

• Receptive One-Word Picture Vocabulary Test (ROWPVT-2) [2 - 18]
• Test of Auditory Comprehension of Language (TACL) [2 - 9.11]
• Test of Auditory Perceptual Skills (TAPS) [4 - 13]
• The Token test for Children [4 - 12.5]

The following are commonly used assessments that DO NOT qualify as norm-referenced tools of Expressive and Receptive Communication:

1.) Not Norm-Referenced, Standardized Tools:

1. Assessment of Basic Language and Learning Skills
2. Brigance Diagnostic Inventory
3. Carolina Curriculum for Infants/Toddlers with Special Needs
4. Child Curriculum Inventory Profile
5. Denver Developmental Screen
6. Developmental Assessment for Individuals with Severe Disabilities
7. Developmental Assessment of Young Children
8. Developmental Observation Checklist System (DOCS)
9. Early Learning Accomplishment Profile (E-LAP)
10. Measurement of Language Utterance (MLU)
11. Non Speech Test for Expressive and Receptive Language
12. Portage Guide to Early Education
13. Receptive Expressive Emergent Language Scale (REEL)
14. Rosetti Infant Toddler Language Scale
15. Transdiciplinary Play Based Assessment

2.) Communication Assessments that do not measure Expressive or Receptive Communication:

1. Braken Basic Concept Scale
2. Communication Abilities Diagnostic Test (CADeT)
3. Gard Gillman and Gorman Pragmatic Language Scale
4. Goldman Fristoe Test of Articulation
5. Greenspan-Lewis Affect Basic Language Curriculum
6. Language Processing Test (LPT)
7. Northwestern Syntax Screening Test
8. Peabody Picture Vocabulary Test (PPVT)
9. Test of Early Reading Ability (TERA)
10. Test of Pragmatic Language (TOPL)
11. Test of Word Finding (TWF)

3.) Tools that measure something other than Expressive and Receptive Language but contain sub-categories regarding Communication skills. These are not accepted because the purpose of the tool is not to measure Expressive and Receptive Language. There is a communication subtest that measures the influence that communication has on behavior or intelligence or achievement or development but cannot stand alone as an assessment of communication. These often fall into the category of screening tools rather than full assessments.

1. Adaptive Behavior Assessment System
2. Adaptive Behavior Scale
3. Adolescent Test of Problem Solving
4. Autism Rating Scale
5. Battelle Developmental Inventory (BDI)
6. Bayley Scales of Infant Development
7. Behavioral Language Assessment Form
8. Differential Ability Scale (DAS)
9. Early Learning Measure (ELM)
10. Eau Claire Child Observation Recording Tool (EC-CORT)
11. Kaufman Assessment Battery for Children
12. Kaufman Brief Intelligence Test
13. Kaufman Survey of Early Academic and Language Skills
14. Mullen Scales of Early Learning
15. Psychoeducational Profile Revised
16. Scales of Independent Behavior
17. Vineland Adaptive Behavior Scales
18. Wechsler Individual Achievement Test (WIAT)
19. Wechsler Intelligence Scale for Children (WISC)
20. Wechsler Preschool and Primary Scales of Intelligence
21. Wisconsin Knowledge and Concepts Examination
22. Woodcock-Johnson Test of Achievement
23. Woodcock-McGrew-Weder Mini-Battery of Achievement
24. WRAT

When to consider the assessment results as valid?

The only assessments that should be considered when answering this question are assessments in which the evaluator is confident in the accuracy of the test results. There are many circumstances in which the test results are not accurate or are not useable. For example:

• If the results are listed with qualifiers such as "child was unable to focus on the tasks of the tests" or "child's behaviors' interfered with accurate test results" or any other indication that the results may not be a true reflection of the child's abilities.
• If the child was considered "un-testable" do not assume that they would meet a 35% delay or 2 standard deviations below the mean.
• If the child being tested was of a different age than the range that is measured by a particular tool, do not consider those results to be an accurate reflection of the child's abilities.
• If the test results you have do not list the results in percentages or by standard deviations, do not try to estimate whether or not they would fall into the required range of delay.
• The test is not a "norm referenced" tool. Whether or not a test is norm referenced can often be checked by learning more about the particular test on the internet or by asking the professional who completed the evaluation.

Screeners do not always have documentation to substantiate this item. Even when a child's delays are obviously significant, they are not usually documented in these precise terms. This item is available for those situations when the screener sees documentation in these terms. Do not worry if the screener cannot check this item. It is essentially superfluous to all the other IADL descriptions of a child's functioning. Make special note of the number of months associated with each question (it varies based on the age of the child).

Communication Table (PDF)

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6.14 Learning

Compromising Impairments
Under the category of Learning, the CLTS FS is capturing cognitive development. The questions have been stated in broad terms to try to account for different developmental issues affecting children. If a child has limitations that mask their cognitive development, try to determine the actual cognitive ability. If a child has a significant vision impairment, has a significant hearing impairment, or has a complex physical disability that compromises the child's ability to demonstrate their intelligence, consider the question in light of that impairment. For example, "Does not seek objects that were hidden" is a question asked for a 13-18 month old child. If a child is blind, this skill may not be possible to measure. If a child has a physical disability that limits their movement, we may still be able to tell that the child understands object permanence by seeing if they continue to look in the direction of a toy that was hidden or start looking away as if the toy disappeared. When the child's compromising impairments result in not being able to adequately measure their cognitive impairment, make note of the situation in the notes section on that page and contact State Clinical Staff for further assistance.

Emerging Skills
Assessment of 35% delay or two standard deviations
The following is a list of tools that are norm referenced for cognitive development. Select the correct tool from the pull down menu on the CLTS FS.

[ ] indicates child's age at which this tool can be used and considered accurate. Any numbers written with decimal points indicates the age in years.months.

* indicates an IQ test

The latest editions of the test should always be used when available.

• Battelle Developmental Inventory [Birth - 8]
• Bayley Scales of Infant Development [1 month - 42 months]
• Cognitive Abilities Scale (CAS) [3 months - 3]
• Comprehensive Test of Nonverbal Intelligence (CTONI) [6 - 18.11]
• Differential Ability Scales (DAS) [2.6 - 17.11]
• Kauffman Adolescent & Adult Intelligence Test (KAIT) [11 - 85]*
• Kaufman Assessment Battery for Children (KABC) [2.5 - 12.5]*
• Leiter International Performance Scale - Revised (Leiter-R) [2 - adult]
• McCarthy Scales of Children's Abilities [2.5 - 8.5]
• Merrill-Palmer Revised Scales of Development (M-P-R) [Birth - 6.6]
• Miller Assessment for Preschoolers (MAP) [2.9 - 5.8]
• Mullen Scales of Early Learning (MSEL) [Birth - 42]
• Primary Test of Cognitive Skills (PTCS) [Grades K-1]
• Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) [adolescence - adult]
• Reynolds Intellectual Assessment Scales (RIAS) [3 - 94]
• Slosson Full-Range Intelligence Test (S-FRIT) [5 - 65]
• Slosson Intelligence Test - Primary (SIT-P) [2.7 - 11]
• Slosson Intelligence Test - Revised (SIT-R3) [4 - 65]
• Stanford Achievement Test Series (SAT), [Grades K-12]
• Stanford-Binet Intelligence Scales (SB) [2 - Adult]*
• Test of Nonverbal Intelligence (TONI-3) [6 - 89.11]
• Universal Nonverbal Intelligence Test (UNIT) [5 - 17]
• Wechsler Adult Intelligence Scale (WAIS) [16 - 74.11]*
• Wechsler Intelligence Scale for Children (WISC) [6 - 16] *
• Wechsler Preschool Primary Scale of Intelligence (WPPSI) [2 - 6] *
• Woodcock Johnson III - Tests of Cognitive Skills (WJ III COG) [2 - 90+]

The following are commonly used assessments that DO NOT qualify as norm-referenced tools of Cognition:

1) Not Norm Referenced, Standardized tools:

1. Assessment, Evaluation, and Programming System (AEPS)
2. Brigance Diagnostic Inventory of Early Development
3. Brigance Inventory of Basic Skills
4. California Ordinal Scales of Development
5. Carolina Curricula (CCITSN or CCPSN)
6. Early Learning Accomplishment Profile
7. Hawaii Early Learning Profile Assessment Checklist (HELP)
8. Southern California Ordinal Scales of Development
9. Transdisciplinary Play-Based Assessment (TBA)

2) Achievement Tests that do not test of Cognitive Ability

1. Boehm Test of Basic Concepts
2. Cognitive Abilities Test (CogAT)
3. Developmental Assessment of Young Children (DAVC)
4. Kaufman Test of Educational Achievement (KTEA)
5. Measures of Academic Progress (MAPS)
6. Peabody Individual Achievement Test Revised (PIAT-R)
7. Test of Cognitive Skills (TCS)
8. Wechsler Individual Achievement Test
9. Wide Range Achievement Test (WRAT)
10. Wisconsin Alternative Assessment
11. Wisconsin Knowledge and Concepts Examination
12. Woodcock-McGrew-Werder Mini-Battery of Achievement (MBA)
13. Young Children's Achievement Test (YCAT)
14. Woodcock-Johnson Test of Achievement

3) Measurement of Behavior or Adaptive Skills (not tests of Cognitive Ability)

1. Achenbach's Child Behavior Checklists (CBCL)
2. Adaptive Behavior Assessment System
3. Adaptive Behavior Scales (ABS)
4. Behavioral Style Questionnaire
5. Child Development Inventory
6. Developmental Observation Checklist System (DOCS)
7. Developmental Profile II (DPII)
8. Early Coping Inventory (ECI)
9. Infant/Toddler Sensory Profile
10. Infant Toddler Developmental Assessment (IDA)
11. Psycho-Educational Profile-Revised (PEP-R)
12. Scales of Independent Behavior-Revised (SIB-R)
13. Scales of Independent Behavior-Revised (SIB-R)
14. Vineland Adaptive Behavior Scales (VABS)
15. Wisconsin Behavioral Rating Scale
16. Woodcock-Johnson Scales of Independent Behavior

4) Measurement of something other than Cognitive Ability

a. Clinical Evaluation of Language Fundamentals (CELF)
b. Columbia Mental Maturity Scale (CMMS)
c. Gates Macginitie
d. Integrated Technology Literacy Skills
e. Preschool Language Scale - 4 (PLS-4)
f. Receptive One-Word and Expressive One-Word Picture Vocabulary Test
g. Receptive-Expressive Emergent Language Test (REEL)
h. San Diego Quick Assessment
i. Scholastic Inventory Reading
j. Test of Auditory Reasoning and Processing Skills (TARPS)
k. Test of Problem Solving-Revised (TOPS-R)

5) Diagnostic Tests

1. Gilliam Autism Rating Scale
2. Global Assessment of Functioning (GAF)
3. Greenspan Developmental Checklist

6) No "Brief" Testing Accepted

1. Kaufman Brief Intelligence Test
2. Wechsler Abbreviated Scale of Intelligence

When to consider the assessment results as valid?
The only assessments that should be considered when answering this question are assessments in which the evaluator is confident in the accuracy of the test results. There are many circumstances in which the test results are not accurate or are not useable. For example:

• If the results are listed with qualifiers such as "child was unable to focus on the tasks of the tests" or "child's behaviors' interfered with accurate test results" or any other indication that the results may not be a true reflection of the child's abilities.
• If the child was considered "un-testable" do not assume that they would meet a 35% delay or 2 standard deviations below the mean.
• If the child being tested was of a different age than the range that is measured by a particular tool, do not consider those results to be an accurate reflection of the child's abilities.
• If the test results you have do not list the results in percentages or by standard deviations, do not try to estimate whether or not they would fall into the required range of delay.
• The test is not a "norm referenced" tool. Whether or not a test is norm referenced can often be checked by learning more about the particular test on the internet or by asking the professional who completed the evaluation.

Screeners do not always have documentation to substantiate this item. Even when a child's delays are obviously significant, they are not usually documented in these precise terms. This item is available for those situations when the screener sees documentation in these terms. Do not worry if the screener cannot check this item. It is essentially superfluous to all the other IADL descriptions of a child's functioning. Make special note of the number of months associated with each question (it varies based on the age of the child).

IQ Test Scores
We are forced to use full-scale IQ scores as a way to address the over-use and under-use of the diagnosis of mental retardation (MR). We are aware of the limitations of IQ testing. The federal definition of MR is a full-scale IQ below 70. Federal guidelines do acknowledge an IQ score error range of 5 points. We have chosen to use 75 as a "cut-off" point instead of 70 in recognition of that error range.

If the clinician conducting the IQ test expressed concern about the results due to the child's ability to participate in the testing process, don't use the results of that test. The screener will want to consider the results from the most recent IQ test a child has if they have had multiple tests done. It does not matter how old the IQ test is as long as it is the most current one on record for that child.

Learning Table (PDF)

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6.15 Social Competency

The ability to form relationships, interest in and skills needed to maintain positive relationships with adults and children, ability to understand the perspective and feelings of others, and skills needed to get along well in a group setting (for example, conflict resolution skills).

Social Competency Table (PDF)

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6.16 Meal Preparation

Meal Preparation Table (PDF)

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6.17 Money Management

Money Management Table (PDF)

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6.18 Duration of Needs

*Is at least one of the bathing functional impairments checked expected to last for at least one year from the date of screening?

For functional eligibility for long-term support programs, the child's need for help (i.e., her functional impairments) must be long-term. For every ADL/IADL item checked, screeners are asked to indicate whether any of the functional impairments are expected to last for at least one year from date of screening. Health care providers regularly make such predictions. If some of the functional impairments are not expected to last but one or more is, then check "yes" for this question. If the screener is not clear about the duration, the screener can seek additional information. When the expected duration is not clear, the screener should check "Yes."

Please take your time answering these questions. It is imperative that screeners accurately record the duration of any specific functional limitation. On the ADL and IADL page, consider the specific check marks in each category (Bathing, Dressing, etc) and check that the limitation is expected to last if any of the items checked are expected to last a year from the date of screening.

Example:
Brandon a 5 year old child. Under Toileting the screener has checked both Incontinent during the day and Needs physical help, step-by-step cues or a toileting schedule, consider if either one is going to last for a year. If Brandon is not likely to be incontinent for another full year, but will continue to need physical help in the bathroom, the screener would select "Yes" to the duration question because there is at least one impairment under toileting that is expected to last a year.

If a child is nearing a change in age cohort (0-6 months, 6-12 months, 12-18 months, 18-24 months, 24-36 months, 3-4 years, 4-6 years, 6-9 years, 9-14 years, 14-18 years, 18+years) and it is likely that the child will master the task you have checked but will not be able to complete the tasks listed for the next age cohort within the year, then answer "Yes" to the duration question.

The screener should check "No" if the child has cancer, an illness or surgery that resulted in higher needs than normal. This is especially true if the child had typical functional skills before this acute episode.

Example:
Carlos is a 2-month old with congenital heart defects. He is expected to have surgery next month and is expected to recover and regain full functioning within three months after that. Carlos is not eligible for long-term support programs.

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