Fostering Independence: Introducing Instrumental Activities of Daily Living

Published on

Trisomy 21 Update

Every day, from the moment you wake up until you go to sleep for the night, you’re performing “activities of daily living,” otherwise known as ADLs. ADLs are basic self-care tasks that we expect all individuals to master: like getting dressed and undressed, feeding yourself, brushing your teeth, taking a shower and going to the bathroom.

When your child’s occupational therapist talks about “instrumental activities of daily living,” or IADLs, they’re referring to the higher level skills that are required to not only take care of yourself, but to live independently. Examples of IADLs include activities such as meal prep, chores, cleaning, managing money and taking public transportation.

All children are raised with the goal of helping them become independent young adults. Children with trisomy 21 (Down syndrome) are no exception! For parents, families, caregivers and healthcare providers who work with children with Down syndrome, it is important to maintain the expectation that all children are capable of independence.

Instrumental skills should be introduced early and incorporated into your family’s daily routine. By doing this, you can naturally provide the time, supervision and practice required for children with Down syndrome to learn and master IADLs and become as independent as possible in adulthood.

Introducing new skills

Children with Down syndrome often require specific teaching strategies, including additional time and practice, to learn new skills. This is especially important when learning more complex skills like IADLs. One great tool occupational therapists use to teach these new skills is called chaining.

Chaining breaks down a task into smaller steps to allow a child to master each individual aspect of the task. As steps are mastered, we continue adding steps until your child can independently complete the task. Both forward chaining and backward chaining can help build self-confidence and skill retention.

Below are suggested age ranges to introduce a variety of IADL skills for children with Down syndrome. All children develop differently, so choose one or two activities at a time to work on with your child.

Ages 4-7

Self-care tasks
  • Learn to do fasteners and buttons: Put on coats, boots, scarves, gloves and hats
  • Learn to style own hair
  • Pick out own clothes
  • Dress for the weather: For example, if it’s raining, you’ll need rain boots and an umbrella
  • Make the bed
  • Clean up toys
  • Put dirty clothes in hamper
  • Help to set and clear the table
  • Help carry and put away groceries
  • Help feed pets or walk the dog
Meal prep
  • Learn to cut own food with a knife
  • Open own containers: Unscrew lids, pull open bags
  • Retrieve simple snacks from known location
  • Help with meal prep: Begin reinforcing safety skills with stovetop and oven; practice pouring, stirring and mixing

Ages 8-12

Continue or initiate working on all skills for ages 4 to 7 if not yet mastered.

Meal prep
  • Help to prepare meals: Gather ingredients and supplies, follow recipe with parent, learn to cut vegetables
  •  Learn to make snacks and easy meals such as a PB&J sandwich
  • Learn to use the microwave
  • Help to load and unload the dishwasher
  • Fold clothes
  • Learn to sweep the floors and vacuum with supervision
  • Begin to pack own backpack and organize school work
  • Help to pack lunch
  • Learn to use a calendar/planner to keep track of assignments and important dates
Life skills
  • Identify money
  • Save money for special treat
  • Learn to make a phone call: How to dial phone numbers; appropriate etiquette when answering and hanging up

Ages 13-15

Continue or initiate working on all skills for ages 4 to 7 and 8 to 12 if not yet mastered.

Meal prep
  • Learn to use the stovetop and oven with supervision
  • Prepare simple meals
  • Help to make grocery lists
  • Help with grocery shopping
  • Be responsible for one or two weekly chores
  • Manage own homework
  • Start waking up to an alarm versus Mom and Dad
Life skills
  • Money management: Determine how much something will cost, if you have enough money to purchase, and if there should be change
  • Discuss body changes and look into sexual education options that your family is comfortable with

Ages 16-18

Continue or initiate working on all skills for ages 4 to 7, 8 to 12, and 13 to 15 if not yet mastered.

Meal prep
  • Learn to make healthy meal choices including portion sizes and food selection.
  • Follow a simple recipe independently.
Life skills
  • Learn the importance of safety regarding sexuality as well as the dangers of drugs and alcohol
  • Begin job training or other volunteer opportunities
  • Learn to be safe in the community: How to get to familiar locations and use a navigation app on smart phone for directions
  • Begin to manage own schedule: Learn punctuality, how to manage time

Remember to ask about incorporating these types of skills into your child’s IEP at school for additional opportunities for your child to practice and master these life skills.