Tri-Level Man

John Kellerman’s Levels of Ability For Self-Care and Daily Living Skills

© 2004 Teresa Kellerman


Like most young adults with Fetal Alcohol Syndrome, John functions at many different levels of ability.


Prenatal exposure to alcohol causes damage to the brain, with significant impairments due to damage in the frontal lobes, which control inhibitions, impulse control, and judgment.  Because of damage to the frontal lobes and other areas of the brain, John has difficulties with remembering rules and directions, with learning from consequences, with social interactions, with controlling his impulses, and with judgment and making decisions.  Sometimes his level of ability is at the 4-year-old level, sometimes he is functioning at the level of a 10-year-old, and sometimes he is like a teenager. 


Most of the time he is functioning at different levels of ability during the same day, or even at the same time. 


The following chart will give you an idea of how John might function at different levels for various skills or activities:


Skill Area

Teen-adult level

Needs frequent cues

and follow-up checks

8-10 year old level

Needs close supervision

or frequent monitoring

4-6 year old level

Needs assistance or needs

someone to do it for him


Wants to be “cool”

Likes to be comfortable

Needs help choosing clothing

that is appropriate for occasion

Needs cues to tie shoes and

to pull up his pants zipper


Desire to look nice, but

requires lots of reminders

Can comb and brush his own

hair, but needs reminders

Needs someone to clip his

fingernails and toenails


Wants to look nice, but is not

aware of his appearance

Can use an electric shaver with supervision and assistance

Needs someone to assist with maintenance of shaver


Strong desire to impress females,

but needs cues

Can wash his hands before meals, with reminders

Can bathe, shampoo, brush teeth with cues and frequent checks


Can sort laundry items, can operate a washer/dryer with supervision

May wear dirty clothes again

if no clean clothes are available

Cannot use bleach, needs help folding and putting clothes away


Can make his bed with reminders, can remove sheets for laundry

Needs help putting clean sheets on bed and with washing sheets

Sleeps all night by himself, may suck his thumb, likes stuffed animals


Interested in ATVs and motorcycles, understands importance of safety

Can ride a bike but forgets safety rules, easily distracted

Does not watch for traffic or pedestrians or other bike riders

Cars, Driving

Likes trucks and RVs, wishes he could drive, wants to be independent

Likes to play driving games, has poor impulse control, bad judgment

Poor reflexes, problems with fine motor, coordination, cannot drive

Food Preparation

Good knowledge about healthy food selections, likes to have choices

Uses fork and spoon okay, can clean up after meal with cues

Needs help cutting meat, can make a PB&J, needs cues for manners


Enjoys his dog’s affection, understands concept of responsibility for pet

Can walk the dog with supervision, can pick up dog poop with checks

Needs reminders to feed and water the dog, hugs the dog too hard


Plays drums like a pro, has good knowledge about instruments

Likes to pay the guitar, likes to listen to radio and CDs

Needs help tuning instruments, needs cues for quiet times


Desires to buy his own “stuff” and to own things like tools and magazines

Can carry a wallet with a few dollars, but might lose it

Cannot make change or figure out a budget, doesn’t understand value


Likes to use the remote control and video game control

Enjoys children’s movies and easy games, doesn’t understand plots

Needs help making choices of TV shows, movies, games


Wants to have friends and to be respected and trusted

Likes people, talks too much, can be annoying, naïve and vulnerable

Overly friendly to strangers, tells secrets, needs close supervision


Strong sexual attraction due to abnormal levels of hormones

Reasonable knowledge about sex, romance, courting, dating manners

Enjoys close interactions with females, hugs too close and long


These are all specific to John and do not necessarily apply to all adults with FAS.  Some individuals may have higher or lower levels of function.  Some individuals may require more or less supervision than John.  There are some general guidelines that do apply to nearly all of them: 



Download this article (PDF file)

FAS Community Resource Center

Fasstar Enterprises