Adult WHO Disability Assessment (WHODAS 2.0) - Parent/Guardian

Assessment 1 of 39

Form Instructions & Things to Know

How to fill this form:
  • Read each question carefully before selecting an answer.
  • Select the most accurate option based on your observations.
  • Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins

Estimated completion time.

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Note: This is a screening and assessment tool, not clinical (medical).

First, please provide your contact information.

Information about the individual being assessed.

1. In the last 30 days, how much difficulty did your relative have in concentrating on doing something for ten minutes?
2. In the last 30 days, how much difficulty did your relative have in remembering to do important things?
3. In the last 30 days, how much difficulty did your relative have in analyzing and finding solutions to problems in day-to-day life?
4. In the last 30 days, how much difficulty did your relative have in learning a new task, for example, learning how to get to a new place?
5. In the last 30 days, how much difficulty did your relative have in generally understanding what he or she say?
6. In the last 30 days, how much difficulty did your relative have in starting and maintaining a conversation with him or her?
7. In the last 30 days, how much difficulty did your relative have in standing for long periods, such as 30 minutes?
8. In the last 30 days, how much difficulty did your relative have in standing up from sitting down?
9. In the last 30 days, how much difficulty did your relative have in moving around inside their home?
10. In the last 30 days, how much difficulty did your relative have in getting out of their home?
11. In the last 30 days, how much difficulty did your relative have in walking a long distance, such as a kilometer (or equivalent)?
12. In the last 30 days, how much difficulty did your relative have in washing their whole body?
13. In the last 30 days, how much difficulty did your relative have in getting dressed?
14. In the last 30 days, how much difficulty did your relative have in eating?
15. In the last 30 days, how much difficulty did your relative have in staying by himself or herself for a few days?
16. Because of their health condition, in the past 30 days, how much difficulty did your relative have in dealing with people he or she do not know?
17. Because of their health condition, in the past 30 days, how much difficulty did your relative have in maintaining a friendship?
18. Because of their health condition, in the past 30 days, how much difficulty did your relative have in getting along with people who are close to him or her?
19. Because of their health condition, in the past 30 days, how much difficulty did your relative have in making new friends?
20. Because of their health condition, in the past 30 days, how much difficulty did your relative have in sexual activities?
21. Because of their health condition, in the past 30 days, how much difficulty did your relative have in taking care of his or her household responsibilities?
22. Because of their health condition, in the past 30 days, how much difficulty did your relative have in doing his or her most important household tasks well?
23. Because of their health condition, in the past 30 days, how much difficulty did your relative have in getting all of the household work done that is needed?
24. Because of their health condition, in the past 30 days, how much difficulty did your relative have in getting the household work done as quickly as needed?
25. In the past 30 days, how much difficulty did your relative have in his or her day-to-day work/school?
26. In the past 30 days, how much difficulty did your relative have in doing his or her most important work/school tasks well?
27. In the past 30 days, how much difficulty did your relative have in getting all of the work done that is needed?
28. In the past 30 days, how much difficulty did your relative have in getting all the work done as quickly as needed?
29. Participation in society in the past 30 days, how much of a problem did your relative have in joining in community activities (for example, festivities, religious, or other activities) in the same way as anyone else can?
30. Participation in society in the past 30 days, how much of a problem did your relative have because of barriers or hindrances around him or her?
31. Participation in society in the past 30 days, how much of a problem did your relative have living with dignity because of the attitudes and actions of others?
32. Participation in society in the past 30 days, how much of a problem did your relative have because of barriers or hindrances around him or her?
33. Participation in society in the past 30 days, how much of a problem did your relative have living with dignity because of the attitudes and actions of others?
34. Participation in society in the past 30 days, how much time did your relative spend on his or her health condition or its consequences?
35. Participation in society in the past 30 days, how much has your relative been emotionally affected by his or her health condition?
36. Participation in society in the past 30 days, how much has his or her health been a drain on his or her financial resources or the financial resources of other relatives?