Assessment &

treatment of
IADLs & Leisure
 Table of Contents

01 03
How Children Learn to
Defining IADL Perform & Participate in
IADLS
02
IADL Performance in
Relationship to
Participation
Table of Contents

Person,
Self- Environment, &
IADLs &
04 Environment 05 Determination
& IADLs
06 Occupation Factors
that Influence
IADLs
Interventio
Evaluation n Outcome
07 Approaches to
Target IADLs
08 Approaches
to Target
09 Measurement to
Target IADLs
IADLs
 01
Defining
IADL
• According to the Occupational Therapy Practice Framework (OTPF),
instrumental activities of daily living (IADLs) are generally considered
more complex than activities of daily living (ADLs).

• Children's competence in performing IADLs contributes to their

participation in broader sets and sequences of occupations in home, school
and/or work, and community life.

• Children and adolescents who are referred to occupational therapy services

often experience IADL performance and participation challenges.

• As part of interprofessional teams, occupational therapists have the expertise

to partner with children, adolescents, and families in enabling IADL
performance and participation as it contributes to positive skill development.
02 IADL
Performance in
Relationship to
Participation
• Satisfying experiences when participating in an IADL will increase the
likelihood that the children return to the activity and further build their
competencies.

• The distinction between IADL performance and participation has

implications for what outcome gets emphasised when implementing the
occupational therapy process to address a client’s IADL challenges.

• It is possible that a child’s participation may be the outcome of greatest

interest initially, so as to help the occupational therapist understand the types
of valued IADLs that are the most problematic from the client’s perspective.

• In contrast, the quality of the child’s performance of these valued but

problematic IADLs may be emphasised more when trying to identify the
most salient person, environment, and occupation factors to address during
the course of an IADL-focused intervention,
 03
How children learn to
perform & participate
in IADLS
• Children first engage in IADL skills as toddlers and typically acquire more
opportunities for IADI performance when they reach adolescence and seek to
participate in the community with increased autonomy.

• IADL performance and participation continues to develop through

adolescence into young adulthood.
 04
Iadls &
Environment
• An integral relationship exists between IADLs and access to various
environments.

• Methods for learning to participate in the community may be tacit or more

explicit.

• Disruption to these experiences during childhood due to injury or disabling

condition can have a negative influence on adult occupational performance.

• Successful completion of IADLs is one element to support the transition to

independent community living.

• The occupational therapist provides important guidance in fostering IADLs

for children who have various disabling conditions compromising the
acquisition and performance of IADLs.
 Self-
05 Determination &
IADLs
• Self-determination has been identified as a factor that promotes independent
community living.

• Self-determination is conceptualised from both a person-environment

interaction and a social-ecological perspective.

• Field et al. (1998) define self-determination as “a combination of skills,

knowledge, attitudes, and behaviours that enable a person to engage in goal-
directed, self-regulated, autonomous behaviour."

• Self-determination encompasses many of the behaviours often referred to as

life skills that are both innate and learned.

• Several factors, including the educational setting, the severity of the disabling
condition, and the presence of challenging behaviours impact self-
determination.
• Opportunities to develop problem-solving skills, understand one's own strengths
and limitations, and make choices are critical to developing these skills.

• The development of self-determination is supported by providing young children

the opportunity to identify interests, make choices, and learn how to share and take
turns.

• When these options and opportunities are severely limited or absent, there is an
increased risk of learned helplessness.

• Learned helplessness occurs when actions repeatedly fail to produce results or

when individuals are not afforded the opportunity to make repeated attempts with
specific activities or tasks.

• The performance of IADLs is not singularly a matter of skills or knowledge but is

a combination of these factors with social and cultural expectations for children
and adolescents.
06
Person, Environment, &
Occupation Factors that
Influence IADLs
• There are a complex host of factors that can support or hinder a child's
IADL performance and participation,

• Occupational therapists commonly use occupation-focused models to frame

their practice with children and clearly communicate their contributions to
the child's interprofessional team.

• Some of these organising models of practice, such as the Person-

Environment-Occupation Performance (PEOP) model, emphasise equal
consideration of factors specific to the person, the child's environment, and
the demands of the IADL occupation itself that might be relevant targets for
intervention.
Person Factors That Influence IADLs
• Children and caregivers each have abilities and preferences that can
influence a child's IADL performance and satisfaction with participation,

• For caregivers, person factors such as their mental health (e.g., stress level),
physical or cognitive abilities, and employment status may influence their
preferences about the importance of targeting IADLs.

• For children, person factors include things like the child's capacities.

• In addition to their abilities, children’s preferences (values, interests) shape

decisions about valued IADLs.
Environmental Factors That Influence IADLs

• In young children, caregiver perceptions of home environmental support

have been found to mediate the association between child and family factors
and the child's participation.

• Environmental features are extrinsic to the child and include a number of

dimensions, such as physical features (e.g., housing layout, physical items in
the home), sensory features (e.g., noise and other stimuli), social
relationships (e.g., supportive sibling), and attitudes of individuals who are
present with and encourage the child (e.g., peer advocate) during IADL
completion.

• Cultural norms about IADLs can also shape children’s preferences for
IADLs based on where the child grows up.
Occupation Factors That Influence IADLs

• The physical, cognitive, and social task demands of the occupation are also
uniquely considered by occupational therapists when targeting IADLs.

• Alternatively, the sequencing of IADL tasks can place demands on the

child's concentration,
 07
Evaluation Approaches to
Target IADLs
• IADLs are an important consideration for the occupational therapy
evaluation, the occupational profile and the analysis of occupational
performance.

• When developing the client's occupational profile, it is important to consider

the IADLs that are meaningful and relevant to the child or adolescent and
their parents or caregivers.

• This can be done through informal interviews (with or without formal

observation), as well as through the use of formal assessments such as the
Canadian Occupational Performance Measure (COPM) or Adolescent and
Young Adult Activity Card Sort (AYA-ACS).
08
Intervention Approaches to
Target IADLs
• ADLs can be a component of occupational therapy intervention as both a strategy
for addressing underlying skills as well as an outcome of the intervention, meaning
the performance of the IADL is the primary focus of the occupational therapy
treatment.
 09
Addressing
IADLs across
Practice Settings
• IADLs are a relevant intervention for children and adolescents across several
practice settings and, with creativity, can be addressed in hospitals, clinics, and
schools.

• Evidence suggests that the best outcomes occur when IADLs can be addressed
within the natural environment, such as the home, grocery store, public
transportation, or other community environment.

• However, when intervention cannot occur within the natural environment,

occupational therapists can use strategies to increase the likelihood that skills will
generalise, such as simulating the natural environment as much as possible and
collaborating closely with the child’s family members to identify strategies that
will easily carry over at home or in the community.
¿?
10
Outcome Measurement
to Target IADLs
• Occupational therapy practitioners consider outcome measurement an
important part of the overall occupational therapy process.

• Being thoughtful about documenting progress can also lead to more

targeted goals.

• Collecting data to measure progress can happen in a variety of ways, and

it is important for each occupational therapy practitioner to find a method
that works for them and for each situation.
Thank you!