Daily Living Skills Scale (DLSS)

Abstract

The Daily Living Skills Scale (DLSS; Uljarević et al., 2023) is a 53-item, comprehensive, open-source, and informant-reported instrument specifically developed to measure key facets of Daily Living Skills (DLS). The scale was designed for applicability across the full spectrum of developmental ages and cognitive functioning levels, making it highly relevant for individuals with various Neurodevelopmental Disabilities (NDD).

The development process was iterative and guided by the principles of the Patient-Reported Outcomes Measurement Information System (PROMIS) framework. This involved conceptual mapping, literature review, and expert evaluation by clinician-scientists and caregivers. The DLSS covers diverse skill areas, broadly categorized into three subdomains: Self-Care, Home-Care, and Community Participation. Initial validation confirmed a strong unidimensional factor structure and demonstrated excellent reliability and validity, including strong correlations with the Vineland Adaptive Behavior Scales, Third Edition (VABS-3).

Keywords

Adaptive Functioning, Autism, Classical Test Theory, Community Participation, Conditional Reliability, Daily Living Skills, Home-Care, Model Reliability, Neurodevelopmental Disabilities, Self-Care.

Authors

Uljarević, Mirko; Spackman, Emily K.; Cai, Ru Ying; Paszek, Katherine J.; Hardan, Antonio Y.; Frazier, Thomas W.

Purpose

The DLSS is designed to provide a detailed and practical assessment of a diverse range of daily living skills and behaviors. Its primary objective is to offer a standardized, open-source instrument capable of assessing adaptive functioning across a broad demographic and developmental range.

Crucially, the scale is calibrated for use across the spectrum of neurodevelopmental disabilities, facilitating reliable measurement of functional independence in populations often excluded or poorly represented by traditional adaptive behavior measures. It aims to capture specific skills necessary for self-sufficiency, including personal hygiene, meal management, safety, and community mobility.

Construct

The DLSS measures Daily Living Skills (DLS), which is a crucial domain within the broader concept of Adaptive Functioning. This construct encompasses the set of conceptual, social, and practical skills learned and performed by people in their everyday lives to function independently.

The skills captured by the 53 items are organized conceptually into three subdomains that serve as analogs to components of the VABS-3: Self-Care (e.g., grooming, dressing, feeding), Home-Care (e.g., housekeeping, health management), and Community Participation (e.g., leisure activities, transportation, safety). Although these subdomains are conceptually valuable, the underlying psychometric analysis supported a robust, unified factor representing global daily living competence.

Validity

The DLSS demonstrated strong evidence of convergent validity. The scale’s total scores showed strong correlations with the Total Daily Living Skills domain raw scores derived from the Vineland Adaptive Behavior Scales, Third Edition (VABS-3). Furthermore, the specific DLSS subscale scores exhibited the expected strong correlations with their analogous VABS-3 Daily Living Skills domain subscales.

In terms of discriminant validity, the DLSS total score showed an anticipated moderate negative correlation with an Autism Spectrum Disorder (ASD) diagnosis, confirming that while adaptive deficits are related to ASD, the measure is not redundant with the diagnosis itself. Higher correlations were appropriately observed between DLSS total scores and measures of constructs known to be functionally related to daily competence, such as executive functioning and motor functioning, reinforcing the ecological relevance of the scale.

Reliability

The DLSS exhibits high levels of reliability across various statistical frameworks.

Model Reliability: The overall Daily Living Skills (DLS) factor demonstrated excellent model reliability, indicated by an omega coefficient ($omega$) of 0.98.

Internal Consistency: The measure showed high internal consistency, assessed using Cronbach’s alpha ($alpha$). The total scale achieved $alpha$ = 0.97. All three subscales also exhibited strong internal consistency: Self-care ($alpha$ = 0.96), Home-care ($alpha$ = 0.94), and Community participation ($alpha$ = 0.94).

Conditional Reliability/Item Response Theory Analyses: Analyses based on Item Response Theory (IRT) confirmed that conditional reliability estimates were very good ($geq$0.80) across a very wide range of latent trait scores (from $theta = -4.2$ to $theta = +2.4$). This confirms the scale’s ability to precisely measure DLS across individuals with both very low and high levels of adaptive functioning.

Factor Analysis

Confirmatory Factor Analysis (CFA): CFA provided strong support for a unidimensional model, suggesting that a single overarching factor underlies Daily Living Skills. The model fit indices were excellent: CFI = 0.953, TLI = 0.951, and RMSEA = 0.073 (95% CI: 0.071–0.074). In addition to the total score, three conceptual subscales were computed: Self-care (28 items), Home-care (10 items), and Community participation (15 items).

Measurement Invariance: The single-factor model demonstrated evidence of strict Measurement Invariance (invariance of factor loadings, thresholds, and residual variance) across crucial demographic groups, including sex, age, race, and ethnicity. This confirms that the DLSS measures the DLS construct in the same way, regardless of the respondent’s demographic background.

Instrument

Test Type: Original

Format: Items are rated on a 4-point Likert scale with the following choices: “Not able to complete (total assistance needed),” “Requires significant prompting or assistance,” “Requires minimal prompting or assistance,” “Completely independent (does not require any assistance or prompting)”.

Language Available: English

Population Group: Human; Male; Female

Age Group: Childhood (birth-12 yrs); Preschool Age (2-5 yrs); School Age (6-12 yrs); Adolescence (13-17 yrs)

Population Details: Location: United States. Respondents: Parents of Children Aged 2–17 with Autism, Children with Other Neurodevelopmental Disabilities, and Neurotypical Controls.

Test Methodology: Test Validity; Convergent Validity; Discriminant Validity; Test Reliability; Internal Consistency; Factor Analysis; Confirmatory Factor Analysis; Item Response Theory; Measurement Invariance; Structural Equation Modeling.

Number of items: This measure consists of 53 items.

Factors and Subscales:

• Subscales: Self-Care (28 items); Home-Care (10 items); Community Participation (15 items).

Keywords

Adaptive Functioning, Autism, Classical Test Theory, Community Participation, Conditional Reliability, Daily Living Skills, Home-Care, Model Reliability, Neurodevelopmental Disabilities, Self-Care.

Authors

Author ORCID Identifier:

• Spackman, Emily K.: http://orcid.org/0000-0003-2300-439X

• Frazier, Thomas W.: http://orcid.org/0000-0002-6951-2667

Affiliation:

• Uljarević, Mirko: Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University

• Spackman, Emily K.: School of Psychological Sciences, University of Melbourne

• Cai, Ru Ying: Aspect Research Centre for Autism Practice

• Paszek, Katherine J.: Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University

• Hardan, Antonio Y.: Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University

• Frazier, Thomas W.: Department of Psychology, John Carroll University

Affiliation Email addresses:

• Uljarević, Mirko: [email protected]

Correspondence Address:

• Uljarević, Mirko: [email protected]

Permissions & Fee and Test Year

Test Year: 2023

Commercial: No

Fee: No

Permissions: Contact Corresponding Author

References

• Uljarević, M., Spackman, E. K., Cai, R. Y., Paszek, K. J., Hardan, A. Y., & Frazier, T. W. (2023). Daily living skills scale: Development and preliminary validation of a new, open-source assessment of daily living skills. Frontiers in Psychiatry, 13, Article 1108471. https://doi.org/10.3389/fpsyt.2022.1108471

Items of the Daily Living Skills Scale (DLSS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

No data is Available