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The DO-EAT: An Assessment of ADL & IADLs

May 10, 2018Life SkillsGuest Blogger

Answering the 5 Ws & How

by Allyson Locke

As a school based OT working in a high school for students with significant special needs, I spend a lot of time working on functional life skills. Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are a huge part of my job. My evaluations always include a detailed description of my student’s abilities in the areas of ADLs and IADLs and I often write goals centered on ADLs and/or IADLs. I have been on the hunt for a good measure of these areas for a while. When I came across the DO-EAT I was impressed at its potential but it took using the assessment to fully understand how useful it could be. Here’s what I have learned (so far)!

What is the DO-EAT?

The DO-EAT is performance based; students perform three tasks (making a sandwich, preparing a glass of chocolate milk, and completing a certificate of achievement). These tasks are performed in a sequence one right after the other. Within these three main activities, you have the opportunity to observe the student perform functional tasks that include putting on an apron, setting up the work area, washing their hands, using a knife, following directions, writing, and using scissors. While the student is performing each task you are observing their ability to perform the given task as well as sensory motor skills (like bilateral coordination, fine motor, and posture), performance skills (like attention, organization, and recall), behavioral and emotional components (like motivation and self-efficacy), and the number and types of cues that were given. There is a full description of the DO-EAT on Therapro’s website, DO-EAT-Assessment-Tool-for-Children.html.

What Is & Isn’t Included?

The Do-EAT includes all of the non-perishable materials needed for the assessment, see Therapro’s website for a full list DO-EAT-Assessment-Tool-for-Children.html.

The kit does not include the perishable items (milk, chocolate powder, and sandwich materials). What I have found helpful is to keep a stash of powdered milk and an empty milk jug on hand so that I can make milk when needed. The manual suggests the use of chocolate spread, cream cheese, or hummus for making the sandwich; I usually just keep a jar of Nutella on hand because it has a long shelf life. You will also need bread for the sandwich portion of this; I have access to a freezer so I usually keep a loaf in there but in a pinch I have also asked my very nice cafeteria workers for a slice (for this reason I keep an empty bread bag and clip on hand).

Who is this Assessment For?

The manual suggests that this assessment is “suitable for children with a chronological or behavioral age of five to eight years old” and that it can be used with children who have a variety of diagnosis including “Developmental Coordination Disorder (DCD), Attention Deficit Hyperactivity Disorder (ADHD), NLD (non-verbal learning disorder) and Learning Disabilities (Rosenblum P.h.D., Josman P.hD., & Goffer M.Sc., 2014)).

I work with high school aged kiddos that have a variety of diagnosis (including autism); all of my students have cognitive delays. The DO-EAT isn’t appropriate for all of my students but I can use it with my students who have the ability to follow basic directives and who have the physical ability to carry out the three tasks involved. When I write my evaluations I make note of the intended ages for this assessment and my justification for using it. There are three defined parts of this test so if I am on the fence about a student’s ability to test I start with the first task and see how it goes from there.

It is important to note that this a very language based test, there are no visuals used and the prescribed dialogue can get heavy. At times, I have found this to be a limiting factor but also a great way to support the need for accommodations including a visual rich environment. For example, I recently did an evaluation with a boy whose primary diagnosis is autism but who also has apraxia and word finding difficulties; he is generally very capable with routine self care tasks (using the bathroom, managing personal hygiene, preparing simple snacks, etc.) however, this was not reflected in the results of the testing due to the breakdown in language skills. With this, I was able to show how important visual supports were to his independence and was able to include that within the accommodations of his IEP.

Where Can the DO-EAT be Administered

The manual suggests that this assessment can be performed in a variety of environments. I have only had the opportunity to use it in the school environment (where space is not always easy to come by). I have been able to use it successfully in just about any room I find available as long as there is a table and two chairs. You will also need some sort of shelf/ bookcase/ high spot and a stepstool. Access to a sink is also crucial but it doesn’t have to be in the same room.

When: The Big Question on How Much Time?

The manual suggests that this assessment should take about 30 minutes to administer (Rosenblum P.h.D., Josman P.hD., & Goffer M.Sc., 2014); I would agree with that estimate in most cases. It definitely took me longer in the beginning as I was learning the assessment. Scoring on the other hand takes a bit and can be a little tedious; it does get quicker with practice! See below for tips on efficiency.

Why Do I Love the DO-EAT?

The main reason I find the DO-EAT so useful is that it is performance based. As a practitioner I feel I get so much more information when I watch students complete an activity. As OTs we are trained to analyze activities down to the minute detail. With the DO-EAT not only am I able to watch the student perform these activities; the assessment also gives us a structure to analyze the students approach and performance.

How Do I Use the DO-EAT?

I use two main assessments to address ADL and IADL function. Typically I use the PEDI- CAT or The REAL to give me an idea about the specific areas of ADLs or IADLs that a student may be struggling with. From there I use the DO-EAT to answer the “why”.

The observations and analysis of performance skills I gathered while administering the DO-EAT allows me to easily see where a breakdown in a student’s performance is happening (is it an issue with executive function?, is it an issue with decreased fine motor abilities?, etc.) I have a means to connect poor function in a specific ADL or IADL tasks with a cause thus answering the “why”. In addition, the DO-EAT measures the number and types of cues that a student needs in order to perform a task (does a gestural cue work?, can they figure it out with an indirect verbal prompt?, do they need a direct verbal cue?). With this information my evaluations and eventual goal writing become focused; in addition I now have a baseline.

Other Information & Helpful Tips

There is a parent questionnaire used as part of this assessment. The parent questionnaire is great in that it gives you a better understanding of the student’s function in environments that you may not necessarily be able to observe. What I appreciate however is that those responses are not needed to score the evaluation (in my experience, not every questionnaire that gets sent home, comes back!).
I would recommend practicing this assessment on a colleague/ friend/ spouse/ etc. before using it functionally. There is quite a bit involved with the observation piece of it.
The manual describes the set up very well; I have that page marked so that I can “check off” each piece as I go.
I put cards in each of my baskets so that the set up is easy and mindless.
When learning this assessment, I found it extremely helpful to record the student completing the assessment (I just took a quick video using my phone). There are a lot of details to observe; I found it overwhelming to simultaneously administer the test and also complete the observation checklist. I was able to get much more information by recording my sessions and then completing the scoring later while watching the video.

Works Cited

Rosenblum P.h.D., S., Josman P.hD., N., & Goffer M.Sc., A. (2014). DO-EAT Performance Based Assessment Tool for Children: Manual. (J. Hahn-Markowitz, M.Sc., Ed., & S. Veeder, Trans.) Wayne, NJ, USA: Maddak Inc.

Allyson Locke, MS, OTR/L
Allyson is an occupational therapist with a diverse background in both sensory integration and school based practice. She currently works in a school for children and young adults who have significant medical, mental health, and cognitive needs.

What Helps Special Needs Kids Tolerate Grooming and Hygiene?

April 4, 2018SensoryGuest Blogger

by Cathy Collyer

Occupational therapists are the “ADL specialists” on a treatment team. Building independence in self-care isn’t always the problem we are addressing. For younger kids or multiply challenged children of any age, simply tolerating experiences like nail cutting, haircuts and face washing can be the hardest part of the day. Helping children and their families to make grooming and hygiene less of an issue can improve children’s sense of safety and control. It can even build the relationship between caregivers and children.

When evaluating a child’s aversion to ADL’s, look to the comprehensive OT evaluation. While the Sensory Profile or the SPM will highlight specific challenges in oral or tactile domains, looking at a child’s level of motor, visual-perceptual and behavioral functioning provides a more complete picture of the child. Postural issues, issues with endurance, attention, or identifying unique behavioral/emotional expression of frustration will suggest potential treatment pathways or complications.

Prior to Grooming And Hygiene Activities:

Directly address sensory-based issues in a comprehensive manner. Use of the Wilbarger Protocol, creation of a sensory diet and selecting tools to desensitize aversive response can support even the most agitated child. Brief activity on a Therapy Ball can increase postural activation while modulating arousal prior to ADL’s. Other children benefit from a NUK Brush or other oral/facial input before tooth brushing or having their face washed.

During ADL’s:

The use of sensory and behavioral activities can help increase and lengthen tolerance. Some children benefit from sitting in a Beanbag Chair during grooming to provide calming input and postural stabilization. A visual timer supports a child to understand that the activity will end and provides an objective measurement. This could reduce the child’s use of whining or aggression directed at the caregiver. A Weighted Lap Pad can be helpful calming input to an agitated child. Children with sensory seeking as well as sensory sensitivity often prefer a weighted object with texture.

When the ADL Task is Completed:

Aversive responses can continue long after a child demonstrates minimal or no observable aversive response in a treatment session. Why? Because children are more than a stimulus-response cycle. They develop a sense of anticipatory anxiety and have habitual reactions that can be triggered even without sensory input.

Replacing old behaviors with more functional new habits may require slowly adapting ADL routines to decouple sequences that elicit aversion. An example of this would be allowing a child who is agitated during feeding to briefly play with washable items after a meal but before cleaning his hands. Any residual agitation from distressing feeding experiences could dissipate partially or totally before the caregiver uses deep pressure input to wipe the child’s hands.

Supporting children for ADL tolerance and eventual independence requires us to use our task analysis and evaluation skills in creative and complex ways. Building tolerance and independence is our initial goal, but successfully navigating daily ADL experiences will have wide-ranging effects. Improving grooming and hygiene experiences helps families feel calmer around ADL’s in general, improves communication, and deepens trust between caregivers and children.

Cathy Collyer, OTR, LMT, PLLC

Cathy Collyer, OTR, LMT has treated children with neurological, orthopedic and sensory processing disorders for over 20 years. She is the author of The Practical Guide To Toilet Training Your Child With Low Muscle Tone. Learn more about her work at tranquilbabies.com.

Creative Uses for the Elevated Writing Surface, Handwriting Tools and Positioning Cushions

March 12, 2018Fine Motor, Handwriting, Occupational Therapy, UncategorizedGuest Blogger

by Shoshanah Shear

Handwriting and writing position are often discussed in a school setting but what about our other clients. Let us consider a patient who is in hospital. Enabling a patient to engage in drawing, art, a pre-writing task, or writing itself following an illness or injury is invaluable. However, it can be a challenge to provide the necessary angle for a writing surface when working at the bedside. Some hospital-based OT departments have a table surface that adjusts in height as well as the angle of the writing surface. But such equipment is not always available or, if it is, there are times that a portable version is preferable.

The various slanted writing surfaces available through Therapro offer the solution. I particularly love the Collapsible Writing Surface. It opens the door to varying both the activity used in treatment as well as the location for the session.

Imagine for a moment a patient in an orthopedic ward following an MVA. The patient has multiple fractures with exoskeleton / P.O.P. and is depressed and uncooperative with all staff members. After persuading the doctor to refer to OT, a brief history reveals that the patient is an artist and the thought of not being able to draw is what depresses them enough to interfere with function on all levels.

As an OT, we can build up the grips of a pencil or paint brush. Another option to easing use of writing implement is through Triangular Crayons and Pencil Crayons. Triangular writing implements can also enable a patient of this nature to return to drawing by easing the demands of the small muscles in the hand. Although strengthening these muscles will be important, the first step might be to encourage return to meaningful activity, hence the need for an easier means of holding the writing or drawing implement.

Using the portable, collapsible slanted writing surface or easel, one can now take the patient out of the ward (whether on a trolley or in a wheelchair) and into either the OT department or, better still, the garden. A change of environment does wonders for the patient psychologically, not to mention the hope offered by enabling an artist to return to what they love best – drawing, painting or creating. Many artists gain inspiration from nature, hence being able to get into the garden can literally be a breath of fresh air that instills a desire to regain function.

Through this brief example, we can see that writing and being involved in creative pursuits is a necessary skill and activity for various age groups and types of clients, not only for children at school. The tools and equipment that are beneficial in the classroom can be equally important in a hospital or other setting.

The write slant boards or Better Board Slant Boards are also of benefit to:

a woman who is expecting and is placed on bedrest.
the elderly who has limited space due to downsizing and increasing need to take care of their backs. The fact that the slant boards are light and collapsable makes handling and storage easy for an older person.

Still related to positioning, two cushions that I have used quite often in my practice are the Disc‘O’Sit and the Movin’ Sit Air Cushion. I love the fact that they are portable and adjustable in terms of air pressure. This makes it possible to take these cushions to a treatment or evaluation in a home or workplace.

One group of clients I have found to benefit from these cushions is a pregnant woman who is experiencing lower back pain. Pregnancy related lower back pain is a common complaint which can be alleviated with appropriate exercise and positioning.

Shoshanah Shear

Occupational Therapist, healing facilitator, certified infant massage instructor, freelance writer, author of “Healing Your Life Through Activity – An Occupational Therapist’s Story” and co-author of “Tuvia Finds His Freedom”.