A COTA® in an outpatient psychosocial program sets goals with a client to improve motivation for completing basic ADLs. Which diagnosis is the client MOST likely experiencing?

The most likely diagnosis for a client experiencing challenges with motivation for completing basic activities of daily living (ADLs) is major depression. This condition is characterized by significant depressive symptoms, including low energy, feelings of worthlessness, and a notable loss of interest and motivation in daily activities. Clients with major depression often struggle with initiating self-care and may find it difficult to engage in and complete ADLs, which aligns directly with the goals set by the COTA®.

In contrast, while schizophrenia can also impact daily functioning, its symptoms tend to include hallucinations and delusions that might distract from completing ADLs, rather than solely a lack of motivation. Obsessive-compulsive personality disorder involves a preoccupation with orderliness and perfectionism, which may lead to rigidity in completing tasks rather than a lack of motivation. Substance abuse disorder can also impair motivation, but the specific symptoms and behaviors differ, focusing more on the compulsive behavior to use substances rather than the general withdrawal and lack of drive seen in major depression. Therefore, major depression is the most fitting diagnosis in this context.