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
Dressing	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
Grooming	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
Shaving	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
Hygiene	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
Laundry	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
Bed/Sheets	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

Bikes	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
Pets	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
Music	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
Money	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
Television	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
Socializing	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
Romance	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: 

• Their difficulties in these areas are due primarily to neurological dysfunction.

• Their behaviors do not necessarily reflect their family’s parenting skills or attempts to impart ethical values.

• They have more problems in the area of social skills than other areas.

• Their knowledge and understanding of social skills may be higher than their ability to function is social situations.

• Their apparent level of ability is higher than their actual ability to function.

• Their ability to function is inconsistent, good one day, not the next.

• They may function at different levels of ability simultaneously.

• There is a high risk of danger because of immaturity, naiveté, lack of impulse control, and poor judgment

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