Instrumental activities of daily living

IADLs extend beyond basic self-care

Basic activities of daily living commonly include dressing, eating, bathing, toileting, grooming, and mobility. IADLs generally involve planning and managing broader home or community tasks.

A National Institute on Aging workshop page gives cooking, shopping, chores, and cleaning as IADL examples. Its context is aging research, so it supplies general terminology rather than an autism assessment or care standard.

Independent is one support state

A person can complete an activity independently, use a checklist, rely on an app, share it with family, direct a paid helper, or delegate it. Each can support self-determination.

Avoid scoring all human assistance as failure. Someone who chooses meals, approves the shopping list, and directs another person to drive may have meaningful control even when they never enter the store. Record decision-making, participation, and support separately.

Choose the task and outcome together

Ask which activity matters now, what problem it solves, and what role the person wants. A goal might involve ordering groceries, preparing one safe meal, checking a bus route, making an appointment, or telling a supporter how to clean a valued collection.

The CDC autism treatment page says occupational therapy can teach skills that help a person live as independently as possible and notes that services may occur across home, health, educational, and community settings. CDC’s overview does not prescribe a single sequence or dose.

Analyze access before teaching

Performance can depend on literacy, executive functioning, motor access, sensory conditions, communication, technology, transportation, time, money, health, and partner reliability. Change the interface or environment when that solves the barrier.

Use plain-language bills, automatic reminders, labeled storage, adapted tools, delivery, route apps, shared calendars, visual instructions, or preportioned materials when they fit. Test the support in the real setting and keep a fallback.

Automation still needs ownership

Automatic payments, medication reminders, grocery subscriptions, smart appliances, and shared calendars can reduce task burden. They can also fail, charge unexpectedly, expose private information, or continue after circumstances change.

Name who reviews each automated process, how often, which alerts matter, and what happens during an outage. The person should understand and approve the arrangement in an accessible form to the extent applicable, with legal authority handled separately when needed.

ASHA states that AAC users should always have their communication tools or devices. Include vocabulary for choice, questions, consent, cost, help, errors, safety, and stopping.

Some tasks carry higher stakes

Medication, banking, contracts, food safety, appliances, online privacy, driving, and emergencies can create medical, financial, legal, or physical risk. A task analysis never replaces the qualified authority for those domains.

Verify who may make the decision, which safeguards apply, and what requires supervision or review. Avoid practicing with real money, medication, credentials, or dangerous equipment until the plan and authority are ready. Use simulations or low-risk steps when appropriate.

A fictional weekly-plan example

Luis chooses eight weekly IADL activities: select meals, create a grocery list, order groceries, store food, prepare one lunch, schedule transport, review one bill, and message a supporter about a repair.

At month end, he completes three independently, completes three with technology or a checklist, directs a supporter for one, and delegates one by choice. The record shows 8 of 8 activities reached a chosen completion state.

Independence is 3 of 8, while chosen participation is 7 of 8 because Luis delegates one task without taking an active step. Neither figure alone represents quality. The team also records one pricing error caught before purchase and no safety incidents.

Measure the state that matters

Define each activity, due opportunity, completion state, support level, error requiring correction, and safety event. Preserve cancelled and unavailable opportunities by reason. Pair performance with burden, satisfaction, time, cost, access, and the person’s control.

Prompt reduction may be useful when the person wants less help. Stable assistance may be the goal when it improves reliability or frees time for valued activities.

Revisit IADLs during transitions

Moving, starting work, changing benefits, losing a caregiver, recovering from illness, or adopting new technology can change support. Plan before the old arrangement ends. Document who owns each next action and how the person will communicate changes.

The National Institute on Aging’s home-support page lists help with chores, meals, money management, transportation, and healthcare among possible home supports. The BACB Ethics Code addresses competence, medical needs, involvement, consent, assent when applicable, intervention, and collaboration for covered professionals.