Application of the international classification of functioning, disability, and health in autism and attention-deficit hyperactivity disorder: A scoping review.
Lovisa Alehagen, Sven Bölte, Melissa H Black
PMID 39183470WHAT IT FOUND
Across 78 studies, the ICF framework helped clinicians map autism and ADHD functioning to daily life contexts like school and work.
Most interventions still ignored environmental barriers, focusing only on changing the patient. Using ICF Core Sets can shift assessment toward participation and context.
Key findings
01Most studies applied the ICF conceptually to guide data collection or analysis, rather than as a strict measurement tool.
02In employment and education, existing interventions rarely targeted environmental factors, focusing instead on modifying the individual's behavior.
03Commonly used functioning measures captured only a limited range of ICF domains, often missing environmental and participation details.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review is restricted to articles published in English and Swedish, potentially excluding relevant global perspectives. Most included studies focused on children and youth, so findings may not apply to adults or older people with autism or ADHD. The ICF itself does not have a WHO-endorsed classification for personal factors (like gender or coping style), which limits how fully these can be assessed within the framework. Many studies used the ICF loosely or conceptually, so the quality of application varied, and some did not adhere to the ICF's underlying biopsychosocial principles.
Declared interests
The authors declared no conflict of interest related to the work. However, one author (Sven Bölte) has acted as a consultant or lecturer for Medice and LinusBio, receives royalties from several publishers, and is a partner in NeuroSupportSolutions International. The work was funded by Trygg Hansa, FORTE, Folksam, Horizon Europe, and UKRI.
The easy way to misread this
Do not assume that using the ICF automatically makes your practice neurodiversity-affirming. The review found that many studies used ICF domains superficially while still focusing primarily on symptoms or deficits, ignoring the framework's core emphasis on environmental interaction and strengths.