CLTS FS Instructions Module 6 - Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)

Contents

6.1 Overview of ADLs/IADLs
6.2 ADL/IADL Requires Substantial Impairment AND Frequent Assistance
6.3 Child Functions within Normal Limits
6.4 "Needs" versus "Safety"/ Fluctuating Needs
6.5 Step by Step Cueing versus Reminders and Encouragement
6.6 Corroborating Activities of Daily Living Between Home and Other Environments
6.7 Communication and Learning Assessments
6.8 Age Specific ADL/IADL Answer Choices
6.9 Bathing
6.10 Grooming
6.11 Dressing
6.12 Eating
6.13 Toileting
6.14 Mobility
6.15 Transfers
6.16 Communication
6.17 Learning
6.18 Social Competency
6.19 Meal Preparation (PDF)
6.20 Money Management (PDF)
6.21 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 in a home visit, the screener may wish to take along a printout of the ADL/IADL answer choices that match the child's age, and refer to it as needed. 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 (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 eligibility) 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," that is, 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 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 ADL on a regular basis, as defined by the functional screen questions. 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 their 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, which means the child is considered unable to complete the task on a regular basis, 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, which 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, which 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 their 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 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 needs help with his ADLs then; at other times, he is independent with them. Juan gets chemotherapy one week each month. The 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. The screener does not check the 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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6.3 Child Functions within Normal Limits

On all ADLs and IADLs, screeners must determine if the child functions within normal limits prior to selecting any specific item(s) under a category (for example, Bathing, Dressing, Communication, or Social Competency). If indeed a child functions within normal limits for that particular ADL or IADL, then "None of the Above Apply" must be selected for that child. A screener can support this selection by writing a note that explains that the child does not have substantial functional impairments in that particular skill area. The specific items available on the CLTS FS are only to be selected once it has been determined that a child does not function within normal limits.

Example A: Jeffrey does not receive speech therapy at school, his parents do not express any concerns about his ability to communicate and during the home visit the screener is able to have a conversation with Jeffrey. In this circumstance, "None of the Above Apply" would be selected under Communication on the IADL page without any further review of the particular options under Communication.

Example B: It is reported that Savanna bathes herself and that no other person is in the bathroom during this task. There is no need to ask any further questions for Bathing on the ADL page. "None of the Above Apply" is selected.

Example C: Emily is a very social child. She has friends and is able to advocate for her own needs. She is not involved in any social skills classes at school. Her social skills are within normal limits. "None of the Above Apply" is selected under Social Competency on the IADL page and no additional specific questions about social competency are asked.

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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 a child's need for assistance. Thus, the screener should ask, "Would another screener of another discipline rank the child the same way?"

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." Just because a child is physically capable of completing a task independently does not mean the child does not need assistance. Sometimes it takes a child so long that the parent must do the task so the child gets to school on time. This is not just for convenience and amounts to most of the time (since it's five days out of seven); it would be counted as help needed on the functional screen. This only applies to situations where the family members are providing physical assistance to get the task completed.

It is not uncommon for a child or parent to underrate the need for assistance. Screeners should use the following process when determining a child’s level of help needed:

  • Ask more questions and rely on professional expertise in interview and observation. Ask the family or child for additional details or perhaps a demonstration of a skill. Consider the whole picture, to see if the “pieces” make sense.
  • Seek additional information from other people, such as the other parent, other family members, teachers, therapists, physicians. and others who interact with the child in a variety of settings.
  • Ask, “Given all this information, what would other screeners choose for an answer?

To review an example of how to use this process, please see Section 1.8 A. of the instructions.

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, for example, at home and at school. Please review those earlier sections as needed under 1.8 Screening Limitations.

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6.5 Step-by-Step Cueing versus Reminders and Encouragement

Many ADL questions will ask whether the child requires "Step-by-Step Cueing." This represents a need for another person to be present while the child completes the task to verbally cue the child for each step throughout the task. For example, "Put the toothpaste on the brush, put the brush in your mouth, brush these teeth, now these teeth, put the toothbrush down, rinse, and spit." It does not apply to children who need to be told repeatedly to brush their teeth or take a shower. It does not apply to children who have to be sent back in to shower again because they missed a spot or didn't rinse enough. It does not apply to children who use a visual reminder of the steps of the process, like a chart or list. It literally means step-by-step verbal instruction.

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6.6 Corroborating ADLs Between Home and Other Environments

It is imperative that screeners examine the child's abilities and limitations in multiple environments. Some of the questions on the ADL page, especially those regarding grooming, dressing, toileting, mobility and eating, must be evaluated in multiple environments. Questions about bathing are more limited to the child's home environment, and perhaps the parents are the only resource for this information. For the other ADLs and IADLs, it is essential that screeners find out how the child functions throughout their day, in different environments. For very young children, their home may be the only environment in a day, but many children also attend early childhood, day care environments, or various school programs. Older children may be able to directly describe their ability to care for themselves in these different environments.

Examples:

  • Are they able to use the bathroom independently at school?
  • Can they eat independently in other places?
  • Do they need help washing their hands and face when outside their family's home?
  • Do they communicate effectively in the community?

The screen is to capture the child's ability most of the time. To neglect to gather information about a child's ability to complete ADLs and IADLs outside of the home results in an incomplete picture and therefore, an incomplete screen. To truly reflect the level of limitation a child has and the type of support they require throughout their day, information about ADLs and IADLs must be gathered and corroborated by multiple sources.

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6.7 Communication and Learning Assessments

All assessments listed for Communication and Learning are standardized norm-referenced tests that specifically measure expressive communication, receptive communication, or cognition. A norm-referenced assessment is designed such that a child's performance is compared to a larger group. Usually the larger group or "norm sample" is a national sample representing a wide and diverse cross-section of children. The result is a bell curve based on that normative sample. The normative sample also determines for which age group these assessments and results can be used. In contrast, criterion-referenced assessments measure how well a student performs against an objective or criterion rather than another student.

Valid Results
The results of any assessment must be considered VALID. The only scores that should be considered when answering this question are assessment results 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 and therefore 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, do not consider those results to be an accurate reflection of the child’s abilities.
  • If the child was considered "un-testable" do not assume that they would meet a 30% delay or two 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 was not administered in full or within the allotted time limit, do not consider those results to be an accurate reflection of the child’s abilities.

Make special note of the number of months and years associated with each question (it varies based on the age of the child).

In order to document a valid assessment on the CLTS FS, the following information must be available:

  • Assessment date (MM/YYYY)
  • Name of the assessment tool
  • Valid results of the assessment
    • Within normal limits
    • A percent delay (greater than, less than, or equal to the required delay for purposes of functional eligibility)
    • A standard deviation below the norm (greater than, less than, or equal to the required delay for purposes of functional eligibility)

Knowing the child's percentile is not the same as their percent delay and is not relevant for the purpose of the CLTS FS.

Interpreting Test Results - Standard Deviations
Interpreting test results is often difficult. Most tests are based on a normative score of 100 with a standard deviation of 15. That means normal results are within 15 points of 100; or between 85 and 115. To get this average, one standard deviation is subtracted from the norm and one standard deviation is added to the norm (100-15 = 85 and 100+15 = 115). Low normal or borderline scores fall between 70 and 85, which is one to two standard deviations below the norm. If one standard deviation is 15 points, then two standard deviations is 30 points. Assuming that 100 is the norm, two standard deviations below the norm would be a score of 70 or below. All scores between 70 and 130 are considered within normal limits. Many test results do not report a final score that fits into the category of standard deviations. One option is to contact the professional who administered the test. In the case of communication assessments, any speech pathologist may be able to help accurately interpret the results. In the case of cognitive assessments, any psychologist may be able to help accurately interpret the results.

Some norm-referenced tests results indicate scores in the single digits, like 1 or 3. Without knowing the norm score and the standard deviation score, these are very challenging to interpret. Again, consulting with the administrator of the assessment or another qualified professional may be the best method to interpret this data.

Interpreting Test Results - Percent Delay
The most important meaning to be aware of when talking about percentages is to understand the clear distinction between percent delay and the term "percentile". Percentile is often listed in the results of a norm-referenced assessment. It represents where the child's score ranks against all scores from other children who have taken that same assessment. By definition, a percentile rank is the proportion of scores in a distribution that a specific score is greater than or equal to. For instance, if a student received a score of 95% on a math test (by getting 95 out of 100 questions correct) and this score was greater than or equal to the scores of 88% of the students taking the test, then the percentile rank would be 88. The student would be in the 88th percentile. Clearly percentile does not address what percentage of a delay the student has in math. In this example, the student would have a 5% delay with a percentile of 88.

In general, assessments of children with communication or learning delays result in percentile scores that are often much lower, like the first or second percentile. Although this sounds like a substantial delay, it does not directly translate to how delayed their skills are.

A percent delay measures how far behind the child's results are to other children their age. This is evident in age-equivalency (AE) scores. If a 12-year-old child took a norm-reference test and had a valid result with an AE score of 6;6 (years; months), they would be more than 30% delayed. In fact, they are demonstrating nearly a 50% delay. This is the most common use of percent of delay: looking at the age of the child at the time of testing and the age equivalence they scored on communication and cognitive assessments. This calculation of percent delay can only occur when you know the age at the time of testing and the valid AE score the child had.

There are 12 months in a year. This has to be incorporated in order to turn a child's age, or AE score into an integer. Remember that age-equivalency scores are written in years and months (years; months). If a child's age is 4 years 6 months, or a child's AE score is 4;6, that is the same as 4.5 years (as an integer). Take the number of months and divide by 12 months in a year. One can also decide to perform the equations in total months rather than with integers. For example, if a child's age is 4 years, 6 months, that's 54 months. Take the number of years, multiply by 12, and add the additional number of months.

Examples:

  • If a child's age is 5 years, 7 months or AE is 5;7:
    • 5.6 years (7/12=.58=0.6, 5+0.6=5.6)
    • 67 months (5x12+7=67)
  • If a child's age is 2 years, 11 months or AE is 2;11:
    • 2.9 years (11/12=0.9, 2+0.9=2.9)
    • 35 months (2x12+11=35)

To determine percent delay:

  1. Take the valid age-equivalency score and divide it by the child's age at the time of testing. This tells you the percent they scored on the assessment.
  2. Subtract the percent they scored from 1.0 or 100%.

Example A
An child who was 8 years old at the time of testing scores a valid AE score of 6. Start by taking 6 divided by 8 and your result is .75 or 75% (6/8 = .75), which is the percent the child scored. Subtract .75 from 1.0 or 75% from 100% and you will see their percent delay is .25 or 25% (1.0-.75=.25 or 100-75=25%).

Example B
A child who was 9-and-a-half-years old at the time of testing scores a valid AE score of 6;2.

In Years: Take 6.16 (their AE score in years) divided by 9.5 (their age at testing in years) with a result of .648, rounded to the nearest hundredths is .65 or 65%. That means they scored 65%. Second, and the most important step, subtract the results from 1.0, so in this case, 1.0-.65 = .35 or 35% delay.

In Months: Take 74 (their AE score in months) divided by 114 (their age at testing in months) with a result of .649? - rounded to the nearest hundredths is .65 or 65%. That means they scored 65%. Second, and the most important step, subtract the results from 1.0, so in this case, 1.0-.65 = .35 or 35% delay.

Example C
A child's who was the time of testing is 13 years and 4 months scores a valid AE score of 8;9.

In Years: Starting with 8.75, the AE score in years, divided by the age at the time of testing, in this case 13.33 years. 8.75/13.33 = .656. This rounds up to .66. Now subtract that from 1.0 (1.0-.66) and you get .34 or 34% delay.

In Months: Starting with 105, the AE score in months, divided by the age at the time of testing, in this case 160 months. 105/160 = .656. This rounds up to .66. Now subtract that from 1.0 (1.0-.66) and you get .34 or 34% delay.

On the functional screen, screeners are required to indicate the results of the valid assessment. There are three options available:

  • Within normal limits
  • Percent delay
  • Standard deviation below the norm

For children under a year of age:

  • Normal limits score is considered between 75-125.
  • Percent delay must be greater than or equal to 25% to be considered a substantial functional impairment.
  • Standard deviation below the norm must be greater than or equal to 1.5 SD below the norm to be considered a substantial functional impairment.

For children a year old or older:

  • Normal limits score is considered between 70-130.
  • Percent delay must be greater than or equal to 30% to be considered a substantial functional impairment.
  • Standard deviation below the norm must be greater than or equal to 2 standard deviations below the norm to be considered a substantial functional impairment.

Full-Scale Intelligence Quotient (IQ)
The full-scale IQ scores are used as a way to address the overuse and under-use of the diagnosis of intellectual disability (ID). There are limitations of IQ testing. The federal definition of intellectual disability is a full-scale IQ below 70. Federal guidelines do acknowledge an IQ score error range of five points. The Wisconsin Department of Health Services has 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 taken. It does not matter how old the IQ test is as long as it is the most current one on record for that child. The screener is required to select the accurate drop-down option based on the child's valid Full-Scale IQ Score on the CLTS FS.

Assessment Results within Normal Limits
If the valid norm-referenced standardized test results or IQ score do not represent a substantial functional impairment in communication or learning, the screener must include the results on the functional screen. These test results are more objective and comprehensive than any of the individual options listed on the functional screen and provide valid and reliable evidence that this child does not meet the required degree of delay for this IADL.

Regardless of the assessment results, once a valid, norm-referenced, standardized assessment or IQ has been entered under Communication or Learning on the IADL page, the rest of the items under Communication or Learning will become null and void. If the testing indicates that a child has a substantial functional impairment, then the duration question will automatically be answered "Yes." If the results do not support a substantial functional impairment, then the duration question will automatically be answered "No."

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6.8 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 category (Bathing, Dressing, and so on). 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 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 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.

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6.9 Bathing

The ability to shower, bathe, or take sponge baths for the purpose of maintaining adequate hygiene (does not include hair care). For children ages 9 and older, 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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6.10 Grooming

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

Grooming Table (PDF)

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6.11 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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6.12 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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6.13 Toileting

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

Toileting Table (PDF)

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6.14 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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6.15 Transfers

The physical ability to move between surfaces: for example, from bed or 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. This does not include transfers in and out of a car or other vehicle.

Transfers Table (PDF)

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6.16 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 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, it is expected that a child with a significant hearing impairment would have this item checked: “Does not startle, jump or blink to sudden, loud, unexpected noises.” 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.

Nonverbal/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 device, then complete the questions with that understanding. For example, for a child who is nonverbal and uses a Dynamite to express themselves, to complete, “Does not join familiar words into phrases (for example, ‘me drink,’ ‘red truck’),” the screener would inquire if they are combining words on their Dynamite.

Assessment of 30% delay or two standard deviations
Refer to the Norm-Referenced Assessment Tools for Receptive and Expressive Language (PDF). The latest editions of the test should always be used when available. Select the correct tool from the drop-down menu on the CLTS FS. Indicate the date (MM/YYYY) that the assessment was completed.

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. Transdisciplinary Play Based Assessment
  2. Communication assessments that do not measure expressive or receptive communication:
    1. Bracken 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 subcategories 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-Werder Mini-Battery of Achievement
    24. WRAT

Communication Table (PDF)

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6.17 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-to-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.

Assessment of 30% delay or two standard deviations
Refer to the Norm-Referenced Assessment Tools for Cognitive Development (PDF). The latest editions of the test should always be used when available. Select the correct tool from the drop-down menu on the CLTS FS. Indicate the date (MM/YYYY) that the assessment was completed.

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 Curriculum (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 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
    1. Clinical Evaluation of Language Fundamentals (CELF)
    2. Columbia Mental Maturity Scale (CMMS)
    3. Gates-MacGinitie
    4. Integrated Technology Literacy Skills
    5. Preschool Language Scale - 4 (PLS-4)
    6. Receptive One-Word and Expressive One-Word Picture Vocabulary Test
    7. Receptive-Expressive Emergent Language Test (REEL)
    8. San Diego Quick Assessment
    9. Scholastic Inventory Reading
    10. Test of Auditory Reasoning and Processing Skills (TARPS)
    11. 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

Learning Table (PDF)

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6.18 Social Competency

Social competency is composed of self-awareness, social awareness, self-management, relationship management, and responsible decision making. Unlike many ADL/IADLs, social competency is a skill that continues to develop throughout childhood for all children. As children age, the skills required for social competency become much more sophisticated and subtle. As a result, the questions contained in the CLTS FS that aim to measure delays in social competency require that the screener consider the child’s development to that of their same-age peers. It would be uncommon for a child with significant behavior or functional limitations to be at the same social competency level as that of peers of the same age.

If a child is unable to develop the social skill due to a physical, communication, or learning impairment, then they will demonstrate delays in social competency. If the item under social competency asks for the child’s ability to perform the subtle social act, but the child in question cannot perform the primary social act, then select that item for the child. For example, one of the social competency statements is, “Does not control his/her temper in disagreements with other children.” If the child does not have the ability to have disagreements with other children, then this is selected for them, even though the question is designed to address the more advanced skill of controlling their temper. As this example demonstrates, the inability to perform a primary social act (have disagreements with other children) as a result of a physical, communication, or learning impairment can be why a child may seem to meet the identified areas for an age cohort under an item in the screen (Does not control his/her temper in disagreements with other children), while failing to meet questions under younger age cohorts or all of the components of social competency. When a child’s inability to perform a primary social act prevents them from performing a subtle social act, the screener should make selections in these areas, even though the child may not have the specific deficit referenced. In these cases, screeners must include detailed notes to explain selections made on the screen.

 

Social Competency Table (PDF)

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6.19 Meal Preparation

Meal Preparation Table (PDF)

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6.20 Money Management

Money Management Table (PDF)

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6.21 Duration of Needs

*Is at least one of the 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 (their functional impairments) must be long term. For every ADL/IADL item checked, screeners are asked to indicate whether the functional impairment(s) 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, and so on) 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 A:
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 B:
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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Last Revised: July 8, 2019