Susana Castro

Identification of core functioning features for assessment and intervention in Autism Spectrum Disorders

Purpose: Framed within a biopsychosocial approach, this study aimed to identify the main functionality dimensions that experts in the field of child development and child psychopathology considered as essential in the assessment-intervention process with young children with Autism Spectrum Disorders (ASD), using the International Classification of Functionality, Disability and Health for Children and Youth. Method: The Delphi method was used to obtain consensus among experts regarding the essential functionality features for the rehabilitation of young children with ASD. Therefore, web-based three-round survey was developed. Results: There are more functionality features identified as more essential for the age group 3–6 than from the group birth-2 years of age. 49.4% of activities and participation dimensions were regarded as essential by experts, while only 13.9% of body functions were selected. 39.9% of environmental factors were also marked by experts as essential. Conclusions: Pervasive Developmental Disorders (PDD) are classified in diagnostic manuals-DSM-IV-TR and ICD-10. These classifications are valuable to detect signs/symptoms of health conditions; however, they are often not sufficient to develop individualized interventions. More functional information is needed to complement diagnostic data. The identified functionality dimensions of the ICF-CY complement diagnosis by differentiating relevant functioning aspects in all life domains, according to the biopsychosocial model and should always be addressed in the process of rehabilitation of young children with ASD. Implications for Rehabilitation The biopsychosocial approach is the most complete way of conceptualizing human development and disability; combining medical, social and functional perspectives. The ICF-CY specifies strengths and areas for improvement in the functionality of each individual, according to the biopsychosocial model of disability. This paper identifies core functioning features for the rehabilitation of young children with Autism Spectrum Disorders, in all dimensions of life, according to the biopsychosocial approach to disability.

Linking autism measures with the ICF-CY: functionality beyond the borders of diagnosis and interrater agreement issues.

Purpose: This study aims to: (1) link measurements used in the diagnosis of children with autism spectrum disorders (ASDs) with the International Classification of Functioning, Disability and Health – Children and Youth Version (ICF-CY) and (2) analyse issues relating with interrater agreement within this process. Method: Three instruments for ASD diagnosis were linked with the ICF-CY using deductive content analysis. Results: Correspondences between items’ content and ICF-CY dimensions were identified for all ICF-CY components, except for environmental factors. Interrater agreement varied with the content of the units analyzed. Conclusion: The linkage between the ICF-CY and the analyzed measures provides a way to document assessment–intervention outcomes using a common language, as well as to integrate diagnostic and functional data. Diagnostic measurements provide functional information beyond the diagnostic criteria defined for autism. A functional perspective is added to diagnostic outcomes, thus better informing educational and rehabilitation practices for children with ASD.

Content analysis of Portuguese individualized education programmes for young children with autism using the ICF-CY framework

This study analysed 33 Individualised Education Programmes developed for pre-schoolers with autism, attending inclusive special education services in North Portugal, based on the International Classification of Functioning, Disability and Health for Children and Youth. The study identified dimensions of functioning addressed in the Individualised Education Programs and the correspondence between the assessment data on childrens functionality and the intervention goals. The extent, to which the functioning dimensions overlap with the dimensions considered as essential to the assessment-intervention of children with autism, was also analysed. Results illustrate: the majority of domains addressed in the Portuguese Individualised Education Programmes relates to Activities and Participation; few domains are included both at the assessment and at the intervention level; Environmental Factors are not included in intervention goals; on average, the Individualised Education Programmes included only 32.8% of the dimensions considered to be essential; none of the eight essential Environmental Factors were included in any of the analysed Individualised Education Programmes, demonstrating a lack of consistency in assessment-intervention and difficulties in shifting paradigm. Results are discussed in light of the Ecological models of development and of the Diffusion of Innovation Theory.

Matrix for assessment of activities and participation: Measuring functioning beyond diagnosis in young children with disabilities

Abstract Objective: (i) To study the functioning patterns of young children with disabilities compared with typically developing children, using a new ICF-CY based tool – the Matrix for Assessment of Activities and Participation; (ii) study the factors that predict these functioning patterns. Methods: The MAAP tool was administered to three groups of children: (i) with autism, (ii) with other types of disabilities and (iii) typically developing. Results: Cluster analysis showed that children group according to the severity of their functioning profile and not according to the diagnostic category in which they were classified. Multiple regression analysis showed that a model comprising the environmental factors and the level of engagement in different routines of the child is a good predictor of these children’s functioning patterns. Conclusion: These results support a functional approach to disability instead of the traditional medical model approach, underlining the role of engagement and environment in determining functioning.

The Relationship between Classroom Quality-Related Variables and Engagement Levels in Swedish Preschool Classrooms: A Longitudinal Study.

ABSTRACT Child engagement has been defined as active participation in classroom routines, appropriate interactions with the environment and it also predicts academic achievement. Therefore, it is necessary to identify predictors of engagement over time. Moreover, cross-cultural data is needed to provide a global picture of the quality of Early Childhood Education and Care (ECEC) across countries. This study aims to describe the quality of Swedish preschool classrooms and its relationship with students’ engagement over time. Data was collected from 165 preschool teachers in 55 preschool units in Sweden. Results show that all classroom-related variables (Emotional Support, Instructional Support and Classroom Organisation) have increased levels over time, while engagement remained stable. Three groups of preschool classroom units were identified with similar patterns of classroom quality over time (higher emotional support and lower instructional practice) and similar differences in level. Emotional Support was found to be the best predictor of student engagement over time.

Mind the Gap: The New Special Educational Needs and Disability Legislation in England

With the introduction of the Children and Families Act 2014, changes to the process of assessment and identification of children in need of special support in England and Wales have been introduced. These changes are regarded as the most significant in two decades, with consequent implications for service provision. In this paper we suggest that there is a gap between the theoretical approach to disability portrayed in the new policy, and many of the practical changes consequently introduced. To examine this mismatch, a sequence of arguments is presented, as a critical analysis of the approach introduced by the new policy, in light of a framework recognised worldwide for conceiving and classifying disability – the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Although the ICF-CY is not mentioned in the new policy for special educational needs and disability, possible links between the two are presented, with implications for service provision.

Identification of functional domains in developmental measures: An ICF-CY analysis of Griffiths developmental scales and Schedule of Growing Skills II

Abstract Objective: This study aims to identify functioning categories of the International Classification of Functionality, Disability and Health for Children and Youth covered by the Griffiths developmental scales and the Schedule of Growing Skills II (SGS-II), as well as to analyse levels of agreement between coders when assigning its items to the ICF-CY classification system. Methods: Items were linked to the ICF-CY following a content analysis procedure and the published linking rules. Agreement was calculated with Cohen’s Kappa Coefficient. Results: All SGS items assess mostly Activities and Participation, alike most of the Griffiths’ scales except for the Language and Eye-hand coordination scales, which assess mostly Body Functions. Consistently with previous studies, agreement levels between coders vary considerably, thus being highly dependent on the nature of the concept analysed. Conclusion: Although necessary from a capacity-driven approach to assessment, information collected with these instruments should be complemented with other assessments in order to cover all aspects of the child’s life, in line with a systemic approach.

Preliminary investigation of the psychological sense of school membership scale with primary school students in a cross-cultural context

The Psychological Sense of School Membership (PSSM) scale has been used for more than 20 years to measure students sense of school belonging, yet its psychometric properties have had limited examination with pre-adolescent children. This study investigated the utility and psychometrics of the PSSM in three primary school samples from the United States, China, and the United Kingdom. Exploratory factor analysis revealed good fit for a unidimensional factor structure in the US sample, which was subsequently confirmed in all three samples. Partial invariance across all three samples and full invariance across pairwise samples (United States and United Kingdom; United Kingdom and China) was found. Path analyses revealed significant positive relations of the PSSM total belonging score with gratitude and prosocial behavior, and significant negative relations with symptoms of distress. Future directions and implications are discussed.

Linking the early development instrument with the ICF-CY

Objective: The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) provides a universal taxonomy to describe functioning. One of the most relevant applications of the ICF has been the development of code-sets for particular contexts/situations, such specific age groups. An important step in research around child assessment and intervention is to identify extant measures that can assess the essential functioning features for each age range. This study aims to map the Early Development Instrument (EDI) with the ICF-CY and to identify the functioning dimensions regarded by experts as essential in the age range 3–5 that are covered by this instrument. Method: A systematic deductive content analysis procedure was used in the mapping process. Results: Most of EDI items were mapped to Activities and Participation and the majority of Activities and Participation regarded as essential from 3 to 5 years are assessed by the EDI; only some essential Environmental Factors and Body Functions are covered. Conclusion: The mapping process between the EDI and the ICF has shown that the EDI should be complemented with other measures with a focus on Body Functions and Environmental Factors, in order to facilitate a holistic description of the child.

Capturing the Voices of Children in the Education Health and Care Plans: Are We There Yet?

The need for a focus on the voice of children with special educational needs and disabilities (SEND) has received increased recognition internationally both in policy and research. In England, this was emphasized in the new special educational needs framework introduced in 2014. As part of this new policy, children with disabilities and/or additional needs can receive an Education Health and Care (EHC) plan. The EHC plan is a single document that should describe the children’s strengths and needs in a multi-disciplinary and holistic way. Section A of the EHC plan must include the child’s own perspective. In this context there is much need for evidence on the quality of these new plans and in particular on the quality of the depictions of children’s voices. The aim of this study was to address this knowledge gap by analysing the depictions of children’s voices and the process by which these were gathered in 184 EHC plans of children with SEND attending mainstream and special schools in the Greater London area. The content analysis of the section concerning the children’s voices was conducted using the categories of a multi-dimensional classification system, which includes aspects relating to the child herself, but also to her environment and relationships – the International Classification of Functioning, Disability and Health (ICF). The findings revealed high levels of variability in the way the voices of children were captured, including the methods used to ascertain their views. Additionally, the type of school that the child was attending seemed to play a significant role on how his/ her voice was captured, favouring mainstream schools. The findings of the present study provide the first set of evidence-based data concerning the quality of the content of the newly introduced EHC plans and are discussed in light of the implications they have for policy, practice and further research in the area.