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Using the ADL method ​
Last edited on: 22-9-2026
NOTE: The English version of this is still in the works. Please check back at a later time. You can use the date by "last edited on" above to see if anything changed since you least visited.
DISCLAIMER
Even though this information has been written with as much accuracy in mind, it is NOT based on actual scientific research. It's purely something I thought of myself. Don't take it too seriously.
Even though this information has been written with as much accuracy in mind, it is NOT based on actual scientific research. It's purely something I thought of myself. Don't take it too seriously.
Contents
Introduction ​
On this page I explain how you can use the ADL method within my framework to see which support needs label you might fall under.
To understand the contents of this page, it's important you understand what the different ADLs (not yet available in English) are, and what the difference is between the basic and instrumental ADLs. Besides that it's important you've read and understood the other subjects on the Support needs labels: Esther's interpretation page.
Defining the support needs labels ​
I'll first define how I interpret the different support needs labels.
LSN: Needs significant support with a few iADLs, adhering to the definition of "needing". Can do all bADLs without significant help.
MSN: Needs significant support with most iADLs and a few bADLs. The "can't do" category without the significant support is at the minimum about half "executive-functionally."
HSN: Needs significant support with all the iADLs and the vast majority of the bADLs. The "can't do" category without the significant support is at the minimum mainly "practically."
Table ​
I've also put the information in a table, to hopefully make it more clear. The cells tell how much significant support someone has to need. NB: the numbers and percentages are a product of my own mind. Don't take them too seriously.
| bADLs | iADLs | Minimum category | |
|---|---|---|---|
| LSN | None (0) | A couple (2-3) | N/A |
| MSN | A few (3-4) | Most (5-6) | Executive-functionally (≥50%) |
| HSN | The vast majority (6+) | All (8) | Practically (≥75%) |
In-between labels ​
If you see the spectrum of the lowest LSN to the highest HSN as a straight line (which is an oversimplification, but for visualization), then the definitions written down above would be the "middle" of each label. I'll also define the in-between labels.
L/MSN: Needs significant support with a (couple) bADL(s) and a few iADLs. The "can't do" category without the significant support is at the minimum about 75% "rationally" and at the minimum about 25% "executive-functionally."
M/HSN: Needs significant support with most bADLs and the vast majority of the iADLs. The "can't do" category without the significant support is at the minimum about half "executive-functionally" and at the minimum about half "practically."
The table will then be:
| bADLs | iADLs | Minimum category | |
|---|---|---|---|
| LSN | None (0) | A couple (2-3) | N/A |
| L/MSN | A couple (1-2) | A few (3-4) | Rationally/ Executive-functionally (75/25) |
| MSN | A few (3-4) | Most (5-6) | Executive-functionally (50%) |
| M/HSN | Most (5) | The vast majority (6-7) | Executive-functionally/ Practically (50/50) |
| HSN | The vast majority (6+) | All (8) | Practically (75%) |
What to look at? ​
There are different moments in your life you could look at to discover which support needs labels fits you best. You can look at your average support needs, or to a very difficult period in your life. I decided that, when using my framework, you should look at your baseline of the last 9 months to 2 years. While doing this, you should look at what you need to have a good quality of life and to be content with your life. You also need to look at your support needs as a whole. So do not only look at one diagnosis or cluster of symptoms, look at everything at the same time.
lower than LSN: Minimal support needs ​
There might be someone who doesn't reach the threshold for LSN as defined by my framework, but would still like to have a support needs label. This might be because they do have a diagnosis or disability and need a little support for that. In that case, that person would fall under minimal support needs (MiSN).
Defining "significant" ​
So to see which label you could fall under, you need to know for which ADLs you need significant help. But when is something significant enough? When does it count? Unfortunately, there isn't really a concrete answer to that. What I can say is what kinds of things are important to look at:
- The amount of support. This can be between a little to a lot.
- The kind of help, while taking the hierarchy in Defining "help", ADL method into account.
- The consequences of when the help isn't there. This can be between mild and catastrophic.
- The "can't do" category someone experiences.
Guidelines for "significant enough" ​
At this point in time, there isn't a way to think of a reliable and 100% accurate algorithm that decides if the help you receive for a specific ADL is significant enough. This was to be expected, because otherwise there would've been published scientific papers on it by now. But what I can do, is give loose guidelines. So that's hat I'll do here. Because of this, however, do not take them too seriously.
Important: There's a difference between needing help with something per de definition of "needing", and that help being significant enough according to my framework. You can need help with something, but it's possible that the help doesn't pass the border of what my framework determines as significant enough. This doesn't mean that the help you receive isn't "bad" enough, just that it's not seen as significant enough by my framework.
When is the help i receive significant enough for a certain ADL? ​
The numbers in the cell of the table show how how many different help methods from a certain category you need for the help to be significant enough for that specific ADL.
| bADL | iADL | |
|---|---|---|
| Category A | 1+ | 1+ |
| Category B | 2+ | 2+ |
| Category C | 3+ | 2+ |
| Category D | 4+ | 3+ |
| Category E | Never | Never |
As a reference, the different categories:
A: High human help
B: Human environmental and high adaptive help
C: Low human and prompted environmental help
D: High self, low adaptive, and adaptive environmental help
E: Low self and independent self help
Additional method ​
Each help method you need to do a task, counts as 1 point for the help category it fits in. The total amount of point of a category can then be halved to transfer them to one category above that one. So if you need 1 category B and 2 category C help methods for an ADL, they can also count as 2 category B help methods together. If the ADL was a iADL this wouldn't have made a difference. But if it was about a bADL it would, because the threshold of significance could be passed this way. Important: you're not allowed to use this method to make 2 category E help methods count as 1 category D method.
Examples ​
Example 1: iADL "preparing a mail" ​
Different people want to see if they need a significant amount of help for the iADL "preparing a meal", according to my framework.
Person X ​
When person X wants to make a meal, they usually need help consisting of:
- Using a simple cookbook (low adaptive help -> category D)
- Earplugs against the noise (independent environmental help -> category E)
They need 1 category D and 1 category E help method. The threshold of significance for category D is 3+, while person X has a score of 1 for that category. Because of that, they do not need significant help for the iADL "preparing a meal", according to my framework.
Person Y ​
When person Y wants to make a meal, they usually need help consisting of:
- A step-by-step visual guide (high adaptive help -> category B)
- Someone who stays with them and reminds them to take breaks when they get overwhelmed (prompted environmental help -> category C)
- Someone who reminds them to start the task (low human help -> category C)
They need 1 category B and 3 category C help methods. The threshold of significance for category C is 2+, in which person Y has a score of 2. Because of this they do need significant help for the iADL "preparing a meal", according to my framework.
When using the additional method explained earlier, person Y would also need enough help in category B, because the 2 category C help methods can be changed into 1 category B help method, which would make the total of needed category B help methods 2, which would pass the needed threshold.
Person Z ​
When person Z wants to make a meal, they usually need help consisting of:
(Still needs translation)
Wanneer persoon Z een maaltijd wilt maken, heeft die meestal hulp nodig bestaand uit:
- Een kant-en-klare maaltijd (hoge adaptieve hulp -> categorie B)
- Iemand die voor hun kookt (hoge menselijke hulp -> categorie A)
Hen heeft 1 categorie A en 1 categorie B hulpmethoden nodig. De grens van significantie voor categorie A ligt op 1+. Persoon Z heeft 1 categorie A hulpmethode nodig, waardoor die voor de iADL "maaltijden bereiden" wel significante hulp nodig heeft.
Voorbeeld 2: bADL "uiterlijke verzorging" ​
Verschillende mensen willen onderzoeken of ze voor de bADL "uiterlijke verzorging" een significante hoeveelheid hulp nodig hebben.
Persoon M ​
Persoon M heeft voor uiterlijke verzorging meestal hulp nodig bestaand uit:
- Een alarm op hun mobiel als herinnering (lage adaptieve hulp -> categorie D)
- Hun spullen op vast plekken houden (zelfstandige omgeving hulp -> categorie E)
- Een visueel stappenplan van een taak (hoge adaptieve hulp -> categorie B)
Hen heeft 1 categorie B, 1 categorie D en 1 categorie E hulpmethode nodig. Voor bADLs ligt de grens van significantie voor categorie B op 2+ en D op 4+. Persoon M heeft voor de bADL "uiterlijke verzorging" geen significante hulp nodig volgens deze richtlijnen.
Persoon N ​
Persoon N heeft voor uiterlijke verzorging meestal hulp nodig bestaand uit:
- Een douchestoel tijdens het douchen (hoge adaptieve hulp -> categorie B)
- Iemand die suggereert de taak nodig lijkt (lage menselijke hulp -> categorie C)
- Iemand die hun helpt het douchen te initiëren (lage menselijke hulp -> categorie C)
- Zelf muziek aanzetten voor tijdens de taak (zelfstandige omgeving hulp -> categorie E)
Hen heeft 1 categorie B, 2 categorie C en 1 categorie E hulpmethode nodig. Voor bADLs ligt de grens van significantie voor categorie B op 2+ en C op 3+. Het lijkt alsof persoon N geen significante hulp nodig heeft, alleen als we de aanvullende methode gebruiken staan 2 punten voor categorie C gelijk aan 1 punt voor categorie B. Hierdoor heeft persoon N wel significante hulp nodig voor de bADL "uiterlijke verzorging".
Persoon O ​
Persoon O heeft voor uiterlijke verzorging meestal hulp nodig bestaand uit:
- Iemand die de taak volledig overneemt (hoge menselijke hulp -> categorie A)
Hen heeft 1 categorie A hulpmethode nodig. Voor bADLs ligt de grens van significantie voor categorie A op 1+. Hierdoor heeft persoon O wel significante hulp nodig voor de bADL "uiterlijke verzorging".
Voorbeeld 3: label bepalen ​
Verschillende mensen willen onderzoeken onder welk ondersteuningsbehoefte label ze kunnen vallen.
Persoon P ​
Persoon P heeft voor 4 bADLs en 6 iADLs significante hulp nodig. Wanneer deze hulp wegvalt wordt de "niet kunnen" categorie van de ADLs ongeveer 80% executief-functioneel en 20% rationeel.
Deze persoon voldoet zowel voor het aantal ADLs waar hen significante hulp bij nodig heeft (4/3-4 en 6/5-6), als de minimaal benodigde "niet kunnen" categorie (80%/50%) onder MSN. Hen valt volgens mijn richtlijnen dus onder MSN. Het label wat het beste bij hun past kan echter anders zijn.
Persoon Q ​
Persoon Q heeft voor 6 bADLs en 8 iADLs significante hulp nodig. Wanneer deze hulp wegvalt wordt de "niet kunnen" categorie van de ADLs voor ongeveer 40% executief-functioneel en ongeveer 60% praktisch. Hoewel persoon Q voldoet aan de hoeveelheid significante ADLs om onder HSN te vallen, zorgt het feit dat hun "niet kunnen" categorie niet 75% minimaal praktisch is er voor dat die volgens mijn richtlijnen niet onder HSN kan vallen. Maar hun "niet kunnen" categorie valt wel voor 50% minimaal praktisch en 50% minimaal executief-functioneel (40% + de overgebleven 10% van praktisch, die hoger in de hiërarchie staat).
Deze persoon valt volgens mijn richtlijnen onder M/HSN. Het label wat het beste bij hun past kan echter anders zijn.
Persoon R ​
Persoon R heeft voor 2 bADLs en 5 iADLs significante hulp nodig. Wanneer deze hulp wegvalt wordt de "niet kunnen" categorie van de ADLs voor ongeveer 30% praktisch, 50% executief-functioneel en 20% rationeel. Dit betekent dat persoon R aan de grens zou voldoen van 50% minimaal executief-functioneel (50% executief-functioneel + 30% praktisch, die hoger in de hiërarchie staat, = 80%) voor MSN. Alleen omdat die niet voldoet aan het minimale aantal ADLs voor MSN, valt die hier volgens mijn richtlijnen niet onder.
Deze persoon valt volgens mijn richtlijnen onder L/MSN. Het label wat het beste bij hun past kan echter anders zijn.
That was all for this subject. Click here to go back to the "Support needs labels: Esther's interpretation" page.