An American Editor

September 9, 2013

The Pluraling of Plurals

Before there is a mad rush to point out that pluraling is not a word, rest assured I know it — I created the word just for this article. I do realize that pluralizing might have been a better choice, but pluraling just struck me as appropriate.

I recently edited some medical material in which the term activities of daily living was used. The authors, after giving the expanded version of the term, used the initialism ADL, which is correct. ADL appears in Merriam Webster’s Collegiate 11e, American Heritage 5e, and Dorland’s Illustrated Medical Dictionary 32e; it does not appear in Stedman’s Medical Dictionary 28e — at least not as ADL; in Stedman’s it is ADLs. In the AMA Manual of Style 10e, it appears as ADL with a parenthetical “(but: 1 ADL, 6 ADLs).” The Scientific Style and Format (CSE Manual) 7e doesn’t specifically say anything about ADL, but it does say, “If the abbreviated term is itself a plural, do not add the ‘s’.”

Alas, the usage bible, Garner’s Modern American Usage, says nothing about ADL, but does say this about the baseball initialism RBI (runs batted in): “three RBIs” is correct and “three RBI” is incorrect based on long-time use.

In the book I was editing, the authors sometimes used ADL and sometimes ADLs, presumably to distinguish between the singular activity and the plural activities. I changed every instance of ADLs to ADL. After all, one doesn’t have activities of daily livings, activities is already plural, and, most importantly, the authors correctly defined (expanded) ADL as activities, not activity. Unsurprisingly, I suppose, the in-house editor insisted that where the authors used ADLs it was to be left as ADLs, although the in-house editor did ask for my justification for making the change.

The Dorland’s, Collegiate, and American Heritage dictionaries offer only ADL, not ADLs, and define ADL as activities, not activity; Stedman’s also uses activities in the definition, but does so for ADLs — Stedman’s doesn’t offer ADL as an option. The AMA Manual is the only source that offers both ADL and ADLs. The in-house editor cited AMA Manual as the authority for having both usages.

And this is the problem: When is pluraling of a plural OK?

When you read an initialism, you read the letters of the initialism individually. Some believe that reading each letter individually (i.e., A-D-L) is the proper way to deal with an initialism. For example, when we see MRI, we read it as M-R-I, not as magnetic resonance imaging, even though that is the expanded form of MRI. Others think that with initialisms, the proper thing to do is to read it as magnetic resonance imaging, not M-R-I. In other words, the conflict is between reading an abbreviation as letters versus reading it in its expanded form or as a word.

That difference is what determines whether ADLs is acceptable. We already know that ADL is a plural by its very definition. Even the AMA Manual defines it as a plural. But the AMA Manual, in this one exception, advocates pluraling a plural. Interestingly the AMA Manual is somewhat contradictory. In the same list of terms where it plurals the already plural ADL, it defines the initialism ACS as acute coronary syndromes. Should it not be ACSs by the same logic as ADLs? What if there is only one syndrome? What would its initialism be?

The AMA Manual adds no special note to the initialism YLD (years living with disability) or YPLL (years of potential life lost) as it did with ADL. Presumably, in the case of YLD, it is because the subject of the phrase is not years but disability, which is singular, and so YLDs‘ expanded form would be years living with disabilities. Similarly, with YPLL the subject is not years but life, so, conceivably, it could be made plural as YPLLs, or years of potential lives lost.

The pluraling of YLD and YPLL makes sense because the subjects are not already plural. But in activities of daily living, the subject — activities — is already plural. The AMA Manual asks that we plural a plural.

The radical, but logical, solution is to redefine ADL as the singular activity of daily living. Just as the AMA Manual has arbitrarily determined that ADLs is correct, it could arbitrarily redefine ADL.

With all of this arguing over ADL versus ADLs and whether we are pluraling a plural, we have not gotten to any kind of rule to govern when (or if) a plural should be pluraled. I suspect that is because the rule already is that — except in the case of ADL — plurals should not be pluraled. The justification for ADL is that readers read this initialism as A-D-L when they come to it rather than expand it mentally to activities of daily living.

Alright, the argument is a bit obtuse, scattered, trying to put a square peg in a round hole, etc., but the one question that the in-house editor and the AMA Manual have so far failed to answer is this:

If ADL is universally defined as activities [plural] of daily living, what is the universally agreed upon definition of ADLs [pluraled plural]?

This is important because when editing, we need to define acronyms/initialisms at first use and I can’t come up with a definition that I can point to that separates ADL from ADLs — unless I use the outlier, Stedman’s. Stedman’s doesn’t recognize ADL, only ADLs, and it defines ADLs as activities [plural] of daily living, which leaves ADL to mean activity [singular] of daily living.

I view the pluraling of ADL much like pluraling of common units of measure — we don’t do it and it shouldn’t be done. The abbreviation oz is used for both ounce and ounces. The same is true of other measures, like L (liter/liters), mL (milliliter/milliliters), in (inch/inches), etc. In the case of ADL (and other similar plurals), I find little logic to pluraling a plural.

What do you think? How would you defend the in-house editor’s decision?



  1. Can scientists, then, not speak of an activity of daily living as one of the ADL/ADLs? Just curious.


    Comment by Alison Parker — September 9, 2013 @ 4:50 am | Reply

    • They can. They usually either use the expanded form or predefine ADL as the singular. Neither was done in the instant case. The point is that the “authorities” define it as plural and with the exception of Stedman’s, which defines the pluralized initialism as the plural activities, and the parenthetical in AMA Manual, which simply says “but”, there is no recognition of “ADLs” or separate definition.


      Comment by americaneditor — September 9, 2013 @ 4:55 am | Reply

  2. I’m betting everyone in the profession speaks of ADLs, so that’s how I would leave it in the book, especially as this is supported by the in-house editor. The initialism is in effect a separate singular word that is a synonym for “activities of daily living”. This may not be totally logical but it is how language works.

    The comparison with units of measurement is irrelevant. For one thing the full word is generally used in speech even if it is abbreviated in print.


    Comment by Jim Hart — September 9, 2013 @ 4:57 am | Reply

  3. I would concede to the in-house editor’s preference, since it’s something he/she cares about and it appears to reflect the audience’s usage and understanding. The fact that different reference works vary their position suggests that the usage is flexible.

    It’s common in my work for publisher clients to specify “use this dictionary and that style guide except for these items and circumstances, which are our house exceptions.” So I see this ADL/ADLs conundrum one of those exception items appropriate for a style sheet.


    Comment by Carolyn — September 9, 2013 @ 6:24 am | Reply

  4. I think this is one of those initialisms that has taken on a life of its own. If you go to a physical rehab department of a major hospital or a physical rehab center, you’re likely to find a room or department called the ADL Room or ADL Department. In that sense, the A stands for activities, no dispute about that. If the doctors or therapists, when conferring with one another or speaking with patients, though, and they want to refer to one activity of daily life, they’ll use ADL, and they’ll use ADLs to distinguish the singular from multiple, as in something like “Mr. Jones has no trouble with most ADLs, but there is one ADL that he needs help with.”

    This is the common usage, from my experience in real-life phys rehab departments, but it doesn’t help us as copyeditors. In the case Rich cited, because the authors felt that there needed to be a distinction between one or more ADLs, I’d be tempted to define ADL as activity (etc.) and ADLs as activities (etc.) and give an explanation on my style sheet as to why. After all, the style sheet serves as a guide to all the terms in a given work that are nonstandard. (I’m assuming here that the authors want to distinguish between one ADL or more ADLs, not that they are all referring to the plural but using different terms — a fun part of working on a contributed text with many authors!)


    Comment by Teresa Barensfeld — September 9, 2013 @ 2:14 pm | Reply

  5. I’d probably have let the client have their way, as long as the usage was consistent – having it both ways would confuse readers. It’s one of those awkward items that become accepted-event-though-grammatically-wrong, like RBIs (oh, lordy, we’re using sportswriting/sportspeak as a style guide!).

    When I see an initialism like RBI or ADL, I pronounce the letters, not the words. For that reason, I tend to add the s just because it looks and sounds weird without, even though I know it’s already essentially a plural.


    Comment by Ruth E. Thaler-Carter — September 9, 2013 @ 5:54 pm | Reply

  6. I edit in the occupational therapy field, and we use both ADL and ADLs. It often comes down to a noun/adjective distinction: e.g., “ADL goals” vs. “impairment in ADLs.” Plural context = ADLs, singular context = ADL. It doesn’t confuse the readers, and everyone in the field seems to use it this way.


    Comment by Caroline — September 10, 2013 @ 8:51 am | Reply

  7. I’m with Ruth: if one normally pronounces the letters of an initialism rather than using the full name, the plural will normally take an ‘s’ even when it would not be logical to do so with the full name. One exception I can think of is psi; can anyone think of another plural measure that behaves in the same way?


    Comment by Estelle Wolfers — September 10, 2013 @ 11:12 am | Reply

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