Understanding Child Functioning
Every child is unique. Some children require a little extra help in specific areas of life, while others may need ongoing support. These guidelines aim to provide families and professionals with a common language to describe a child's progress in various aspects of daily life, including health, emotions, learning, and relationships.
They are not labels or limits, but simply a way to understand the kinds of care and support a child might need. Many children grow and change with the right help and support, and families play a significant role in helping them reach their full potential.
About the Guidelines
AdoptUSKids.org originally developed these guidelines, but they have since been adapted by MARE staff. They serve as a general resource to help workers and families understand how a child functions in daily life and to consider whether a family may be a good fit. Adoption workers determine the child’s level based on their professional experience and knowledge of the youth.
Physical Functioning
Physical functioning refers to a child’s health, mobility, and ability to perform age-appropriate daily living activities such as feeding, dressing, toileting, and hygiene.
Mild Needs
Does not require equipment for daily living.
Needs only average or slightly above-average medical care.
Manages basic self-care independently.
Uses mainstream transportation and communication.
May have a condition fully managed by medication or expected to improve with time.
May be developmentally delayed, but has a good prognosis for catching up.
Moderate Needs
Requires non-life-support equipment (e.g., braces, hearing aids, adaptive devices).
Has a stable condition (not correctable but not degenerative).
May need moderate home modifications.
May require corrective surgery or up to weekly medical appointments.
Performs daily self-care with some assistance.
May need occasional help with transportation or communication.
Severe Needs
Requires life-support equipment.
Has a progressive, degenerative, or terminal illness.
Needs significant home modifications and frequent hospitalizations.
Requires two or more medical appointments per week.
Relies on a parent or aide for self-care and hygiene.
Always needs adapted transportation and/or communication methods.
Emotional Functioning
Emotional functioning refers to a child’s mental health, coping skills, and ability to build and maintain relationships. This encompasses emotional well-being, emotional regulation, and social interactions with peers, family, and the community.
Mild Needs
Good functioning overall at home, school, and with peers.
Any symptoms are temporary and typically associated with stressors or developmental stages.
Maintains friendships and understands rules and consequences (age-appropriate).
May benefit from counseling, but does not require medication.
Moderate Needs
Symptoms interfere with functioning but can be managed with support.
May display: anxiety, depression, conflicts with peers/adults, fighting, lying/theft, withdrawal, or difficulty maintaining friendships.
Struggles at times to communicate needs appropriately or recognize consequences.
May require therapy, counseling, or medication.
Severe Needs
Significant impairment in school, social, or family life.
Persistent risk of harm to self or others, recurrent violence, or cruelty to animals.
May show hallucinations, delusions, or extreme withdrawal.
Inability to maintain hygiene or relationships.
Requires intensive psychiatric care, hospitalizations, or 24-hour monitoring.
Prognosis for independence may be poor without ongoing support.
Cognitive Functioning
Cognitive functioning refers to intellectual abilities, problem-solving, and learning capacity. Impairments usually appear before age 18 and can affect communication, self-direction, social judgment, safety, and use of community resources.
IQ scores can be influenced by factors such as trauma, loss, environment, and bias. They should be viewed alongside observed abilities, not in isolation.
Mild Needs
IQ: 71–84.
Can live independently with some guidance.
Able to hold a job and manage most daily routines.
Moderate Needs
IQ: 51–70.
May achieve partial self-support, often in sheltered work settings.
Requires ongoing supervision.
Likely needs long-term support in a group home or family environment.
Severe Needs
IQ below 50.
May participate in some self-care but always requires daily, close supervision.
Needs lifelong assistance for routines and safety.
Learning Functioning
Learning functioning describes how a child performs in school and grasps new concepts. It includes classroom functioning, special education needs, and future vocational potential.
Mild Needs
Generally successful in school and at home.
Can participate in mainstream classes with support (tutoring, resource room, accommodations).
Shows mild learning challenges but progresses with help.
Moderate Needs
Consistent academic struggles that affect school and possibly home life.
Requires long-term special education services.
May struggle to keep pace with peers without structured interventions.
Severe Needs
Significant and ongoing learning challenges across various environments.
Learning disabilities affect academics, social-emotional growth, and career potential.
Requires intensive, specialized education and support throughout school years.
A Final Note
Children are more than their challenges. Functioning levels help describe the types of support a child may need, but they do not define who the child is or what they are capable of becoming. With patience, consistency, and the love of a committed family, children can learn, grow, and thrive at every stage of life.