What is adaptive functioning?
directly inspired by this post by @five-thousand-loaves-of-bread
In short, adaptive functioning is a holistic view of someone's ability to adjust and change their behaviour in different environments and situations. This is a term primarily used to discuss people with developmental and intellectual disabilities and how they fare in comparison to their peers.
Someone's adaptive functioning is measured in three domains, which is why I called it holistic. All of these domains, separately and together, can affect someone's adaptive functioning.
There's the conceptual domain, the social domain, and the practical domain.
Conceptual domain: This refers to a person's cognitive skills, including their aptitude for knowledge acquisition, logical and critical thinking skills.
Social domain: This refers to a person's interpersonal skills. That includes things like the ability to understand other people's thoughts and emotions, the ability to create and maintain healthy interpersonal relationships, the ability to understand social situations and make judgements on them, and the ability to communicate in interpersonal relations.
Practical domain: This is where things like activities of daily living would come in. The practical domain measures how much a person can carry out daily tasks independently. Yes it includes things like shopping for food, maintaining hygiene, making meals. But overall you can think of it as the ability of self-management. Being able to keep track of what you need to do and when, initiate those tasks, plan for future tasks, manage your finances and time to make tasks possible, etc. There's a lot of organisation that goes into the practical domain.
Well how does it differ from basic and instrumental activities of daily living (b&iADLs)?
While ADLs are part of how we measure adaptive functioning, they can also be entirely distinct. ADLs are about being able to independently carry out regular activities.
Basic ADLs woule include self maintenance or self care tasks that are daily necessities. Things like brushing, showering, toileting, feeding oneself, dressing oneself, walking independently, transferring oneself. These are things that are directly related to one's immediate wellbeing and basic needs.
Instrumental ADLs include more long-term maintenance and self care, like going shopping and meal prepping, managing money, managing transport to places, managing medications, managing housecare and chores. Being able to do iADLs dramatically improves one's quality of life and allows them to live independently, work jobs, and such.
When measuring ADLs, we only consider whether or not someone can do them or not. This doesn't necessarily measure their overall ability or what sort of care they will need, because that depends on the reasons why they can't perform these activities. This can be a measurement of someone's support needs, but it's not comprehensive.
For example if someone can't meal prep because they don't have the ability to grip kitchen utensils, certain adaptive equipment or pre-cut foods can facilitate them being able to do this. They still can't perform that iADL without intervention or support.
If someone can't meal prep because they don't understand that knives are dangerous and will hurt themselves, or they can't connect that chopping some carrots will eventually lead to having vegetable soup because of cognitive difficulties, or simply don't understand that meal prepping is a necessity and can't direct their attention to anything that doesn't immediately intrest them, they still can't perform that iADL. Sometimes their cognitive issues may mean that they don't have the ability to independently manage tasks that need to be doing in order to facilitate necessities such as meals. This would be because of low adaptive functioning. The support they would need for cooking might be constant supervision, or to be disallowed from cooking altogether and have other people prepare meals.
Likewise if someone has no ability to hold utensils, depending on why, they might need a different method to get food into their mouth. Someone without the ability to understand the steps of feeding, such as getting food on the spoon, opening the mouth, chewing, swallowing they struggle with the same bADL. But the intervention needed to make feeding possible would be different. A carer might have to feed them, remind them to open their mouth, close their mouth, chew and swallow for each bite.
In these situations considering only the fact that someone cannot perform an ADL doesn't really represent what support needs that they have. It's not a comprehensive measurement of support needs specifically, even if it is an indication of impairment. If we understand adaptive functioning and what it means, then we can better understand the support needs of disabled people. We will understand that someone might have low adaptive functioning but is able to do certain ADLs and someone with high adaptive functioning might not be able to perform certain ADLs. We can also understand the difficulties, barriers, and support needs of intellectual and/or developmentally disabled people.
