The Gestalt of functioning in autism revisited: First revision of the International Classification of Functioning, Disability and Health Core Sets

"I made friends a lot more easily": children and families' experiences of social group programs for children on the autism spectrum

BACKGROUND

Social Skills Group Programs (SSGP) target the social communication and interaction skills of children on the autism spectrum. This qualitative study explored lived experiences of children and families who participated in a randomised controlled trial (RCT) evaluating the efficacy of KONTAKT™ adapted for younger children (8 to 12 years) in comparison to an active control social art group (ART Legends).

METHODS

Semi-structured interviews were conducted online with parents (n = 37) and children (n = 35) who participated in the RCT, immediately following the interventions. Interview questions were designed to elicit responses relating to program content, structure, and experiences. The data were analysed using a deductive coding framework.

RESULTS

Findings suggest SSGPs such as KONTAKT™, implementing multiple teaching strategies, and less structured social group activities such as ART Legends can both have a perceived positive influence on outcomes. More children in the KONTAKT™ group reportedly improved their social skills than those in the art group. Overall, participants' experiences were predominantly positive. Both barriers (e.g., session timing, distance from home) and facilitators (e.g., support of family members) to participation were identified; feelings towards individual aspects of the groups were dependent on a range of personal factors (e.g., existing commitments).

CONCLUSION

This study describes experiences of organised social group participation from the perspectives of children on the spectrum and their families, supporting the positive influence of such contexts for autistic youth. Suggestions made by participants to improve social groups are presented, contributing to ongoing development of SSGPs for children on the spectrum.

TRIAL REGISTRATION

(1) Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000994189, registered 12 July 2019, anzctr.org.au; (2) ClinicalTrials.gov: NCT04024111 registered 1 December 2019, https://clinicaltrials.gov .

Sensory Profile-2 in Autism Spectrum Disorder: An Analysis within the International Classification of Functioning, Disability and Health Framework

Autism spectrum disorder (ASD) is characterized by impairments in many functional areas requiring long-term interventions to promote autonomy. This study aims to map The Sensory Profile™ 2 (SP-2), one of the most widely used assessment tools in children with ASD, with the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), developed by the World Health Organization (WHO). This will allow the identification of the functional dimensions covered by this instrument and the comparison with the ICF shortlist proposed for autism (ICF Core Set [ICF-CS]). The deductive content analysis described in the ICF Linking Rules was followed, along with a systematized process including statistical and reasoning techniques that could contribute to the improvement of ICF linking studies (Cohen's Kappa and percentage of agreement). 218 codes were identified, 71% of them were codes related to the body functions chapters, mainly linked to perceptual functions (b160), emotional functions (b152), and temperament and personality functions (b126). Concerning activities and participation chapters (29%) the most frequently used codes were: focusing attention (d160), carrying out daily routine (d230), and walking (d450). Even though the SP-2 items do not assess most of the functional features regarded as essential in the ASD ICF-CS, SP-2 encompasses a majority of problems concerning body functions. This instrument may be considered as part of a multidimensional assessment approach, to complement other sources that are more likely to assess activity and participation dimensions and guide a functional intervention.

Feasibility of the TRANSITION program as an add-on to regular daily living support for young adults: an open mixed-methods study

PURPOSE

TRANSITION is a structured behavioral and educational program to support young adults with mental, behavioral, and neurodevelopmental conditions transitioning into adulthood. This study investigated its feasibility as an add-on to regular daily living support in social services.

MATERIALS AND METHODS

A non-randomized single-arm mixed method design was used. Twenty-eight service users, aged 19-29, were enrolled to participate in the program for 20 weeks alongside their support workers. They rated their engagement and satisfaction and reported any adverse effects. Eighteen support workers received training in the program. A subsample of service users (n = 11) and support workers (n = 9) was interviewed about their experiences. Qualitative content analysis using an abductive approach and quantitative analyses with descriptive statistics was integrated and mapped to specific feasibility areas in a joint display.

RESULTS

Service users completing the study (n = 26) generally rated satisfaction and engagement highly. While some service users experienced stress related to their participation, no serious adverse events were reported. Service users and support workers highlighted the program's clear structure and focus on specific goals as particularly valuable.

CONCLUSIONS

The results indicate that TRANSITION is a feasible complement to regular support in social service settings. Further evaluation of the program is justified.Implications for rehabilitationThe TRANSITION program is a feasible add-on to regular support in daily living for young adults with mental, behavioral, and neurodevelopmental conditions.Support workers can deliver the program, although training, practice, and regular supervision are needed.Service users perceive that the program adds clarity and valued direction to their support.The program may help service users and support workers become more aware of the inherent benefits of user engagement in daily living support.

Social cognition in autism and ADHD

Social cognition is a crucial capacity for social functioning. The last decades have seen a plethora of social cognition research in neurodevelopmental conditions, foremost autism and, to a lesser extent, ADHD, both characterized by social challenges. Social cognition is a multifaceted construct comprising various overlapping subdomains, such as Theory of Mind/mentalizing, emotion recognition, and social perception. Mechanisms underpinning social cognition are complex, including implicit and explicit, cognitive and affective, and hyper- and hypo-social information processing. This review explores the intricacies of social cognition in the context of autism and ADHD. Research indicates altered performance on social cognition tests in autism, compared to neurotypical groups, with social cognition alterations having a small but robust effect on the defining features of autism. The nature of such alterations in autism appears primarily in relation to implicit processing. ADHD groups show intermediate social cognition performance, appearing to be influenced by executive function difficulties. Social cognition varies with intellectual and verbal abilities and seems to improve with age in autism and ADHD. Social skills interventions in autism, and stimulant medication in ADHD have been shown to improve social cognition test performance, while mentalizing training effects in autism are less conclusive. A limitation of the field is that social cognition constructs and tests are not well delineated. Further, most research has been embedded in a nativist approach rather than a constructivist approach. The former has been questioned for ignoring environmental contributions, especially the dimension of mutual miscommunication between neurodivergent and neurotypical individuals.

Application of the international classification of functioning, disability, and health in autism and attention-deficit hyperactivity disorder: A scoping review

LAY ABSTRACT

The International Classification of Functioning, Disability, and Health (ICF) is a framework designed by the World Health Organization (WHO) to help different sectors, such as healthcare, social services, education, and policy, understand how people with health-related issues function (do the things they want to and need to do) in their daily lives. This framework has also been used to guide clinical practice and research in autism and attention-deficit hyperactivity disorder (ADHD). To make it more practical, shorter versions of the ICF called Core Sets have been developed. We wanted to explore how the ICF and the ICF Core Sets have been used in research relating to autism and ADHD. We looked at the research that had been previously published on this topic by conducting a systematic search and review. Seventy-eight studies meeting our criteria were included in our review. Results show that the ICF has been applied in many ways across various contexts. However, most of the research has focused on autism, mainly involving children. The review highlights that although the ICF was used in some studies, the underlying philosophies of the framework were not always followed. The medical perspective still influenced the way research was done and interpreted. Nevertheless, using the ICF in the right way can help shift research on neurodevelopmental conditions like autism and ADHD toward a more holistic approach, moving away from solely focusing on medical aspects.

Operationalizing the ICF Core Sets for Autism and ADHD: A Multiple-Methods Feasibility Study

The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization's (WHO) standard for assessing individual functioning. Over the last decade, the ICF has been made more accessible for autism and ADHD through the development and validation of tailored shorter ICF versions for these diagnoses, ICF Core Sets. To further enhance their applicability in research and practice, these Core Sets have been operationalized and implemented on an online platform, the ICF CoreSets platform. Here, we describe the iterative development process of the CoreSets platform. This multiple-methods study examines user feedback on the operationalization of the Core Sets and the feasibility of the CoreSets platform as a functional assessment for autism and ADHD. We collected a total of 678 assessments from the CoreSets platform. Individuals diagnosed with autism and/or ADHD, their relatives, participants from the general population, and professionals completed and provided feedback on the usability of the CoreSets platform. Qualitative feedback via interviews and focus groups were also collected. Qualitative data were analysed via content analysis, while quantitative data were examined using univariate and descriptive techniques. Findings show that the ICF CoreSets platform is feasible and user-friendly, but areas for improvement were also indicated, leading to additional refinement of the operationalization and platform. The operationalization of the ICF Core Sets and their implementation in the CoreSets platform appears adequate for use in research and practice, particularly after revisions indicated by future users, and is now ready for psychometric standardization.

From Symptomatology to Functioning - Applying the ICF to Autism Measures to Facilitate Neurodiversity-Affirmative Data Harmonization

PURPOSE

A considerable number of screening and diagnostic tools for autism exist, but variability in these measures presents challenges to data harmonization and the comparability and generalizability of findings. At the same time, there is a movement away from autism symptomatology to stances that capture heterogeneity and appreciate diversity. The International Classification of Functioning, Disability and Health (ICF) provides a classification system that can support content harmonization of different screening and diagnostic tools for autism while enabling the translation of diagnostic information into functioning.

METHOD

Here we linked commonly used screening and diagnostic measures within the field of autism to the ICF to facilitate the unification of data obtained from these measures.

RESULTS

As expected, screening and diagnostic measures primarily focus on body functions and activities and participation domains of the ICF, and much less on environmental factors, reflecting biomedical and adaptive behavior operationalizations of autism derived from diagnostic manuals.

CONCLUSION

By translating symptomology-based information to the continuous and diagnostically neutral view of functioning, the ICF linking presented here may provide a means to harmonize measures of autism characteristics while enabling diagnostic information to be re-examined through a more neurodiversity-affirmative lens.