The REAL is a standardized rating scale developed to assess children’s ability to care for themselves at home, school, and in the community. This assessment rates a child’s ability to conduct activities of daily living (ADLs) and instrumental activities of daily living (IADLs) that are most common among children between the ages of 2 years and 18 years 11 months.
136
15-20 minutes
Children
2 - 18
yearsInitially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Kays Fihakhir, Amanda Hopcroft, and Sara Nadeem.
Potential uses for the tool include determining the need for skilled and supportive services, developing IEPs and choosing intervention services, making decisions on placements and living arrangements, evaluating programs and conducting research.
Several areas of occupation are not assessed in the REAL consisting of: social participation, rest and sleep, leisure, play, and work.
The REAL is a simple, quick tool that may benefit from combination with additional assessments.
The REAL may function best as a screening tool.
Limited information on psychometric properties is available.
Children without Disabilities: (Roll & Roll, 2013; n = 786; age range: 2-18 years)
|
Age Groups |
ADL SEM |
IADL SEM |
|
Preschool (2:0-5:11) |
1.41 |
1.73 |
|
Elementary (6:0-9:11) |
3.00 |
2.00 |
|
Preadolescent (10:00-12:11) |
2.45 |
1.41 |
|
Teenage (13:00-18:11) |
4.00 |
2.65 |
|
Overall average |
5.74 |
4.00 |
Children without Disabilities: (Roll & Roll, 2013)
ADL MDC: 15.91
IADL MDC: 11.08
Children without Disabilities: (Roll & Roll, 2013)
|
Sample |
n |
Age Range (Years) |
Mean Standard Scores |
|
U.S. Normative |
786 |
2-18 |
100.00 |
|
Foreign |
59 |
2-16 |
97.12 |
|
Canadian |
17 |
- |
97.11 |
|
European |
33 |
- |
97.67 |
|
United Kingdom |
28 |
- |
98.48 |
Children with Disabilities: (Roll & Roll, 2013)
|
Sample |
n |
Age Range (Years) |
Mean Standard Scores |
|
Children with Disabilities |
164 |
2-18 |
67.14 |
|
Autism Spectrum Disorder |
50 |
- |
54.53 |
|
Attention Deficit Disorders |
25 |
- |
85.08 |
|
Cerebral Palsy |
7 |
- |
-6.17 |
|
Down Syndrome |
7 |
- |
55.17 |
|
Developmental Delay |
7 |
- |
60.34 |
|
Speech Delay |
12 |
- |
99.53 |
|
Learning Disabled |
5 |
- |
76.32 |
|
Sensory Integration Disorders |
5 |
- |
88.86 |
Children without Disabilities: (Roll & Roll, 2013)
Excellent test-retest reliability for ADL subscales: (r = .98)
Excellent test-retest reliability for IADL subscales: (r = .98)
Children without Disabilities:
Interrater reliability: (Roll, & Roll., 2013)
Excellent interrater reliability for ADL subscales: (Cronbach’s α = .94)
Excellent interrater reliability for IADL subscales: (Cronbach’s α = .96)
Children without Disabilities: (Roll & Roll, 2013)
Children without Disabilities*: (Roll & Roll, 2013; age range: 2:00-18:11)
Adequate to Excellent ADL item intercorrelation (r = .33 to .63)
Adequate IADL item intercorrelation (r = .31 to .54)
Poor to Adequate ADL to IADL intercorrelation (r = .10 to .49)
Children without Disabilities**: (Roll & Roll, 2013; age range: 2:00-18:11)
Excellent correlations between ADL construct and ADL items (r = .73 to .91)
Excellent correlations between IADL construct and IADL items (r = .67 to .83)
Children without Disabilities**: (Roll & Roll, 2013; age range: 6:00-18:11)
Poor to Excellent correlations between ADL construct and ADL items (r = .18 to .85)
Adequate to Excellent correlations between IADL construct and IADL items (r = .58 to .88)
*Intercorrelations calculated using Fischer’s z transformation.
**Correlations calculated using a confirmatory factor analysis goodness-of-fit.
“Content areas for the REAL were chosen for standardization based on clinical experiences in multiple settings as well as content from the American Occupational Therapy Association’s Occupational Therapy Practice Framework: Domain and Process, second edition” (Roll & Roll, 2013, p. 13).
Content validity of the REAL was determined by a panel of professionals including occupational therapists, a COTA, physical therapists, and speech language pathologists from a variety of settings, who reviewed statements within the REAL for appropriate wording and gave feedback (Roll & Roll, 2013, p. 13).
Roll, K., & Roll, W. (2013). The Roll Evaluation of Activities of Life: The evaluation of activities of daily living skills (ADLs) and the instrumental activities of daily living skills (IADLs). Minnesota, MN: Pearson.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.