Daily Living Skills Scale (DLSS)

Abstract

The Daily Living Skills Scale (DLSS; Uljarević et al., 2023) is a 53-item comprehensive, open-source, informant-reported instrument specifically designed to capture key aspects of daily living skills (DLS). It is developed for use across a full developmental range (age and cognitive functioning) and demographic spectrum, and is applicable across various neurodevelopmental disabilities (NDD). The DLSS aims to encompass a diverse range of skills and behaviors broadly categorized into self-care, homecare, and community participation subdomains. These include personal hygiene and grooming, dressing and undressing, meal preparation and feeding, toileting, housekeeping, health and medication management, leisure time activities, ensuring a safe environment, and transportation and mobility. The development and refinement of the DLSS followed an iterative series of steps informed by the Patient-Reported Outcomes Measurement Information System (PROMIS) framework. This process involved generating a conceptual map of key content areas, conducting a literature review to identify existing relevant scales, and evaluating a preliminary item bank by neurodevelopmental disability clinician-scientist experts and caregiver/patient informants. Minor modifications were made based on this feedback, resulting in the final 53-item DLSS. The scale was administered to parents of children aged 2–17 with autism, other neurodevelopmental disabilities, and neurotypical controls. Confirmatory factor analysis supported a unidimensional factor structure. Additionally, three subdomains were conceptually derived as analogs to the Vineland Adaptive Behavior Scales, third edition (VABS-3; Sparrow, Cicchetti, & Saulnier, 2016) subscales. The study reported on the reliability and validity of the DLSS.

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.

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Purpose

This scale is designed to assess a range of different daily living skills and encompass a diverse range of skills and behaviors. It is specifically intended for use across a full developmental range (age and cognitive functioning), demographic spectrum, and across the spectrum of neurodevelopmental disabilities.

Validity

Convergent and Discriminant Validity: The DLSS total scores demonstrated strong correlations with the Vineland Adaptive Behavior Scales, third edition (VABS-3; Sparrow, Cicchetti, & Saulnier, 2016) Total Daily Living Skills domain raw scores. Furthermore, the DLS and VABS-3 Daily Living Skills domain subscale scores exhibited the expected strong correlations. The DLSS total score showed a moderate and expected negative correlation with an Autism Spectrum Disorder (ASD) diagnosis. As anticipated, correlations with other measures that do not assess daily functioning but evaluate clinical domains that could reduce adaptive function were also in the moderate range. Given the importance of executive functioning and the close relationship between motor functioning and daily living skills, the correlations between DLSS total scores and measures of these constructs were higher, which was not surprising.

Reliability

Model Reliability: The Daily Living Skills (DLS) factor demonstrated a model reliability of ω = 0.98. Internal Consistency: The total scale showed high internal consistency (α = 0.97). The subscales also exhibited strong internal consistency: Self-care (α = 0.96), Home-care (α = 0.94), and Community participation (α = 0.94). Conditional Reliability/Item Response Theory Analyses: Conditional reliability estimates indicated very good reliability (≥0.80) for the total DLS scale across a wide range of scores, from very low (θ = −4.2) to high (θ = +2.4).

Factor Analysis

Confirmatory Factor Analysis: Confirmatory Factor Analysis (CFA) demonstrated an excellent fit of a unidimensional model to the data, with fit indices of CFI = 0.953, TLI = 0.951, and RMSEA = 0.073 (95% CI: 0.071–0.074). Three conceptual subscales were also computed: self-care (28 items), home-care (10 items), and community participation (15 items). Measurement Invariance: A single-factor model showed evidence of measurement invariance of factor loadings, thresholds, and residual variance (strict invariance) across sex, age, race, and ethnicity.

Instrument: Daily Living Skills Scale (DLSS)

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; Home-Care; Community Participation.

Keywords

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

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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

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

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Items of the Daily Living Skills Scale (DLSS)

No data is Available