Scoring Clinical Vignettes (Self-Examination)—ADL–Occupational Skills 6–51

CLINICAL VIGNETTES

ADL–Occupational Skills
(Problem Area 4)
6–52 Mastering the Kennedy Axis V

Kennedy Axis V—ADL–Occupational Skills (Problem Area 4)

100 Superior ADL–occupational skills in a wide range of activities (e.g., in school, on the job, as a
homemaker, pursuing a complicated hobby); superior workmanship; work challenges never seen to get out of
hand; is sought out by others because of his/her work skills. No symptoms. Skills are consistent with those
expected of a successful college graduate.

90 Good skills in all ADL–occupational activities; no more than average difficulties with any work
assignment. Absent or minimal symptoms. Skills are consistent with those expected of a successful high school
graduate.

80 No more than slight impairment in occupational skills or skills in school; has slight difficulty
performing at an average level; slight difficulties with routine chores, work assignments, or schoolwork
assignments; slight impairment in workmanship.

70 Mild difficulty with occupational skills or skills in school (e.g., minor difficulty following
instructions, workmanship is somewhat sloppy), but generally functioning fairly well.

60 Moderate difficulty with occupational skills or skills in school (e.g., probably employed; however,
has trouble carrying through assignments; some difficulty problem solving or following instructions; some
difficulty driving a car; some difficulty knowing how to budget money; some difficulty maintaining a home or
apartment).

50 Serious impairment in occupational skills or skills in school (e.g., unable to keep a job for more
than a few weeks due to poor occupational skills; almost failing in school; moderate difficulty following
instructions; moderately sloppy workmanship); needs supervision when shopping for food; some difficulty using
public transportation; some difficulty preparing self a reasonable, family-style meal; some difficulty ordering, eating
properly, tipping, etc., in a regular restaurant; some difficulty making a long-distance phone call.

40 Major impairment in occupational skills or skills in school (e.g., unable to work at a job for any
significant period or do routine housework due to poor work skills; failing in school due to poor academic skills);
needs supervision to use public transportation; mild to moderate difficulty ordering and eating in a fast-food
restaurant; poor understanding of how to budget money.

30 No job and unable to independently maintain a home due to serious impairment in skills needed
to perform ADLs and tasks at home; serious difficulty following instructions; needs some supervision to prepare
simple meals for self, such as a sandwich and beverage; needs supervision to dress self, make a local phone call,
follow a very simple self-medication procedure; needs constant supervision to complete more complicated ADLs
(e.g., operating a washer and dryer); very sloppy workmanship; some difficulty responding appropriately to a fire
alarm; difficulty finding way back from short errands.

20 Gross impairment in skills needed to perform ADLs and tasks at home (e.g., needs some
supervision to maintain minimal personal hygiene; is almost totally unable to follow simple instructions; needs
supervision to feed self; unable to function independently (e.g., needs constant supervision to complete most
simple tasks; does not know the value of money; unable to dial 911 in an emergency; unable to find way back from
short errands).

10 Demonstrates almost no ADL skills (e.g., is totally unable to follow instructions; unable to complete
most tasks even with constant supervision; may even have to be physically assisted to complete a task, including
eating or dressing); persistent inability to maintain minimal personal hygiene; considerable external support
(e.g., nursing care and supervision) is needed to prevent him/her from accidentally harming self (e.g., wandering
into traffic, danger of seriously burning self when attempting to cook or when smoking); unable to appropriately
respond to a fire alarm.

NR Not rated
 Scoring Clinical Vignettes (Self-Examination)—ADL–Occupational Skills 6–53

ADL–Occupational Skills
NAME: Abbott, George
AGE: 35
Pt. has an above-average IQ. He graduated from high school and had been working full time for many years
in a factory repairing equipment, including computers. Recently, pt. was laid off because his job was
contracted to an outside company. He feels that he needs some help getting another job and has come in for
our job-counseling program. He may also be interested in further job training. He reports getting reasonably
good reviews on his job performance.

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Ratings

ADL–Occupational Skills = 90
1) PSY = 100 2) SOC = 90 3) VIO = 90 4) ADL = 90 5) SAb = 80 6) MED = 90 7) ANC = 90
GAF Eq = 95
Dangerousness Level = 80

Explanation of ADL–Occupational Skills Rating

High school graduate with above-average IQ = 90 or better

Able to do reasonably good full-time work at a high school graduate–level job = 90
6–54 Mastering the Kennedy Axis V

ADL–Occupational Skills
NAME: Cross, Anthony
AGE: 24
Pt. graduated from high school. He has been driving a delivery van full time for the last 5 years. Pt. was
considered a fairly good worker; however, recently his depression lead to his frequently missing work. At
times, he even had difficulty driving his van because of his impaired focal attention. Staff states that ADL skills
are fairly good; however, because of a lack of motivation, he often does not use his ADL skills (e.g., he often
neglects his personal hygiene). His depression appears to interfere with his problem-solving skills.

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Ratings

ADL–Occupational Skills = 80
1) PSY = 45 2) SOC = 60 3) VIO = 50 4) ADL = 80 5) SAb = 95 6) MED = 70 7) ANC = 80
GAF Eq = 60
Dangerousness Level = 50

Explanation of ADL–Occupational Skills Rating

Fairly good worker in competitive, full-time employment = 80

Factor out depressive symptoms (these are captured under Psychological Impairment):
• Impaired focal attention and problem solving
• Lack of motivation
• Neglect of personal hygiene
 Scoring Clinical Vignettes (Self-Examination)—ADL–Occupational Skills 6–55

ADL–Occupational Skills
NAME: Davis, Richard
AGE: 45
Pt. needs minimal supervision to dress himself; however, he needs almost constant supervision to complete
more complicated ADLs. Pt. is unable to make his bed without supervision. Pt. has great difficulty following
even simple instructions. Pt. is felt to be unable to find his way back from errands. Workmanship is very
sloppy. Focal attention is very poor. Pt. does well with very repetitive tasks.

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Ratings

ADL–Occupational Skills = 25
1) PSY = 20 2) SOC = 35 3) VIO = 50 4) ADL = 25 5) SAb = 80 6) MED = 80 7) ANC = 70
GAF Eq = 35
Dangerousness Level = 35

Explanation of ADL–Occupational Skills Rating

Needs minimal supervision to dress himself; however, he needs almost constant supervision to complete
more complicated ADLs = 30
Great difficulty following even simple instructions = 25
Unable to find his way back from errands = 20
6–56 Mastering the Kennedy Axis V

ADL–Occupational Skills
NAME: Griffin, Paul
AGE: 30
Staff states that pt.’s personal hygiene is moderately impaired. Staff states that pt. is generally disheveled in
his dress. When directed to do so, he can make his bed, prepare simple meals, and do basic housework. Pt. is
able to drive a car; however, his license has been suspended for drinking and reckless driving. Pt.’s
workmanship is moderately to very sloppy. His lack of motivation makes it very difficult to fully assess his ADL
skills.

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Ratings

ADL–Occupational Skills = 55
1) PSY = 40 2) SOC = 50 3) VIO = 40 4) ADL = 55 5) SAb = 30 6) MED = 70 7) ANC = 50
GAF Eq = 45
Dangerousness Level = 30

Explanation of ADL–Occupational Skills Rating

Can make his bed, prepare simple meals, and do basic housework = 50 or better
Able to drive a car (drinking is measured under Substance Abuse) = 60 or better
Workmanship is moderately to very sloppy (this is likely to be due in part to poor motivation) = 40 but
probably better
 Scoring Clinical Vignettes (Self-Examination)—ADL–Occupational Skills 6–57

ADL–Occupational Skills
NAME: Palmer, John
AGE: 44
Pt.’s dress is generally unkempt. Staff states that he uses the washing machine. When motivated, he is able to
follow fairly complicated instructions, such as copying a single page on the copier. Able to make his bed and
dress himself with prompting. Pt. has some difficulty using public transportation. He was able to drive a
stolen car when on escape; however, his driving was reported as poor. Pt. needs supervision when shopping
for food.

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Ratings

ADL–Occupational Skills = 50
1) PSY = 40 2) SOC = 50 3) VIO = 70 4) ADL = 50 5) SAb = 50 6) MED = 80 7) ANC = 70
GAF Eq = 55
Dangerousness Level = 50

Explanation of ADL–Occupational Skills Rating

Uses washing machine and copier and makes bed = 50 or better

Some difficulty using public transportation = 50
Can drive, but has poor driving skills = 50
Needs supervision when shopping for food = 50
6–58 Mastering the Kennedy Axis V

ADL–Occupational Skills
NAME: Powers, Jennifer
AGE: 35
Pt. has an above-average IQ. She was a very good student in nursing school and went on to get her master’s
degree in nursing. She is working full time as a nursing supervisor at a local hospital. She appears to be doing
very well in her job. She is very skilled with budgeting and keeping her home in excellent shape. Pt. does
exceptionally well in her volunteer work with the PTA.

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Ratings

ADL–Occupational Skills = 100

1) PSY = 90 2) SOC = 100 3) VIO = 100 4) ADL = 100 5) SAb = 100 6) MED = 100 7) ANC = 100
GAF Eq = 100
Dangerousness Level = 90

Explanation of ADL–Occupational Skills Rating

Above-average IQ = 90 or better
Very good college-level student = 100
Successfully employed at a college-level job = 100
Very skilled at budgeting and keeping her home in excellent shape = 100
Does exceptionally well in volunteer PTA work = 90 or better
 Scoring Clinical Vignettes (Self-Examination)—ADL–Occupational Skills 6–59

ADL–Occupational Skills
NAME: Renaldo, Alice
AGE: 24
Staff states that pt. is doing fairly well in her full-time, competitive employment; however, she is having some
difficulty keeping up with her college work. Staff states that she is always well dressed and well groomed. Pt.
states that she is doing well at her job; however, she feels that her boss puts too many demands on her. Pt.
states that taking a college course has been more difficult than she had expected.

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Ratings

ADL–Occupational Skills = 90
1) PSY = 50 2) SOC = 80 3) VIO = 70 4) ADL = 90 5) SAb = 90 6) MED = 70 7) ANC = 90
GAF Eq = 70
Dangerousness Level = 65

Explanation of ADL–Occupational Skills Rating

Mild difficulty with full-time competitive employment and part-time college work = 80 to 90
6–60 Mastering the Kennedy Axis V

ADL–Occupational Skills
NAME: Rosenthal, William
AGE: 51
Pt. demonstrates very few ADL skills. He needs almost constant supervision to maintain minimal personal
hygiene. Pt. is able to follow simple instructions with constant supervision. Unable to find his way back to
ward. Dependent patient.

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Ratings

ADL–Occupational Skills = 20
1) PSY = 20 2) SOC = 10 3) VIO = 45 4) ADL = 20 5) SAb = 70 6) MED = 40 7) ANC = 70
GAF Eq = 25
Dangerousness Level = 15

Explanation of ADL–Occupational Skills Rating

Needs almost constant supervision to maintain minimal personal hygiene = 20

Able to follow simple instructions with constant supervision = 20
Unable to find way back to ward = 20
Dependent patient = 20 or worse
 Scoring Clinical Vignettes (Self-Examination)—ADL–Occupational Skills 6–61

ADL–Occupational Skills
NAME: Sawyer, Barbara
AGE: 42
Pt. appears to have an IQ around 115 based on IQ testing. Pt.’s basic ADL skills are fairly good; however, she
needs assistance with independent ADLs, such as home management and budgeting. Pt. has some difficulty
driving a car; however, she has no significant difficulty using public transportation. When motivated, pt. has
no significant difficulty preparing a family-style meal, including shopping for the food. During periods of
decompensation, pt.’s ADLs are markedly impaired.

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Ratings

ADL–Occupational Skills = 60
1) PSY = 50 2) SOC = 80 3) VIO = 50 4) ADL = 60 5) SAb = 80 6) MED = 50 7) ANC = 80
GAF Eq = 60
Dangerousness Level = 50

Explanation of ADL–Occupational Skills Rating

Needs assistant with home management and budgeting = 60

Difficulty driving a car = 60
No significant difficulty using public transportation = 60 or better
Able to prepare a family-style meal = 60 or better
The fact that the client has periods of decompensation should have no significant effect on the ADL–
Occupational Skills rating. Once the client has recompensated, these skills should manifest themselves
because they were only covered up by the patient’s symptoms. Other subscales, including the
Psychological Impairment subscale and Violence subscales, should capture the symptoms of the
decompensation.
6–62 Mastering the Kennedy Axis V

ADL–Occupational Skills
NAME: Scott, David
AGE: 50
Pt. appears to have a normal IQ. Pt. appears to have adequate ADL skills to fairly successfully maintain his
apartment in the community. He went to school until the 11th grade; later the pt. obtained his GED. Pt.
joined the Navy 20 years ago and earned a honorable discharge after 4 years. Pt.’s work record was sporadic,
and he was described as having low ambition. Pt.’s work experience included mill worker, movie
projectionist, and waiter. Alcohol was reported to have contributed to his problems at work.

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Ratings

ADL–Occupational Skills = 75
1) PSY = 40 2) SOC = 75 3) VIO = 50 4) ADL = 75 5) SAb = 60 6) MED = 70 7) ANC = 70
GAF Eq = 60
Dangerousness Level = 50

Explanation of ADL–Occupational Skills Rating

Adequate ADLs to fairly successfully maintain an apartment in the community = 70 or better

Honorable discharge from the Navy = 70 or better
Some difficulty with high school graduate–level jobs = 70
Factor out low ambition and alcohol
 Scoring Clinical Vignettes (Self-Examination)—ADL–Occupational Skills 6–63

ADL–Occupational Skills
NAME: Sellers, Mark
AGE: 63
Pt. has a low-normal IQ. He needs supervision with grooming, bathing, and dressing. Pt. generally refuses to
even attempt more complicated tasks. Poor motivation and poor attention span probably cover up pt.’s skills.

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Ratings

ADL–Occupational Skills = 30
1) PSY = 30 2) SOC = 45 3) VIO = 40 4) ADL = 30 5) SAb = 85 6) MED = 40 7) ANC = 80
GAF Eq = 35
Dangerousness Level = 40

Explanation of ADL–Occupational Skills Rating

Low-normal IQ = 60
Needs supervision with grooming, bathing, and dressing = 30
Refuses to attempt more complicated tasks (covers up possible higher functioning, may justify a higher score)
Poor motivation and poor attention span cover up pt.’s ADL skills (difficult to fully factor this out; if fully
factored out, this may justify a higher score)
6–64 Mastering the Kennedy Axis V

ADL–Occupational Skills
NAME: Woods, Gilbert
AGE: 28
With prompts and encouragement, pt. is able to do simple tasks on the ward. Pt. has a high school
education; however, he has deteriorated over many years in association with his mental illness. Staff feels that
pt.’s ADL skills are concealed by delusional, disorganized thinking and markedly impaired attention span. He
has some difficulty finding his way back from short errands.

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Ratings

ADL–Occupational Skills = 30
1) PSY = 20 2) SOC = 35 3) VIO = 35 4) ADL = 30 5) SAb = 90 6) MED = 90 7) ANC = 70
GAF Eq = 30
Dangerousness Level = 35

Explanation of ADL–Occupational Skills

With prompts, able to do simple tasks on the ward = 30

Has a high school education = 80 or better; however, this is wiped out by his deterioration
ADL skills are concealed by his mental illness (this positive factor is negated by the fact that his skills have
been concealed for many years)
Some difficulty finding his way back from short errands = 30