Assessment of the functioning of a child with a disability due to autism (clinical case)

Authors:

Ponomarenko Gennadiy Nikolaevich — Corresponding Member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Grand PhD in Medical sciences (Dr. Med. Sci), Professor, Director General of the Albrecht Federal Scientific and Educational Centre of Medkal and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Head of the Department of Physical and Rehabilitation Medicine of the North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: ponomarenko_g@mail.ru; https://orcid.org/0000-0001-7853-4473.

Limankin Oleg Vasilievich — Grand PhD of Medical Sciences (Dr. Med. Sci), Chief Expert Psychiatrist of Roszdravnadzor for the North-Western Federal District of the Russian Federation, Vice-President of the Russian Society of Psychiatrists, Honored Health Worker of the Russian Federation, Chief Physician of St. Petersburg State Budgetary Institution “P.P. Kashchenko Hospital” of the Ministry of Health of Russia, 10 Menkovskaya Street, Nikolskoye village, Gatchina district, 188357 Leningrad region, Russian Federation; Professor, Department of Psychotherapy, Sexology and Medical Psychology, North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevsky Ave, 195067 St. Petersburg, Russian Federation; e-mail: hospital@kaschenko-spb.ru.

Chistyakova Natalia Petrovna — Associate Professor, Department of Social Psychiatry and Psychology, Institute of Further Professional Education, Albrecht Federal Scientific and Educational Centre of Medkal and Social Expertise and Rehabilitation, 11/12 Bolshoi Sampsonievsky Ave, 194044 St. Petersburg, Russian Federation; e-mail: npch74@mail.ru; https://orcid.org/0000-0002-7841-0953.

Annotation:

Introduction. The relevance of this study is determined by the high rates of morbidity and primary childhood disability due to autism, as well as the high social significance of measures for comprehensive rehabilitation and habilitation of children with this pathology.

Aim. Conduct a comprehensive assessment of the functioning of a child with autism spectrum disorder (ASD) according to the International Classification of Functioning, Disability and Health (ICF, 2001) core set domains.

Materials and methods. Based on the methods of expert and rehabilitation diagnostics, taking into account the age of the child, as well as the use of adapted questionnaires World Health Organization disability assessment schedule (WHO DASH) and ICF CHECKLIST, dimensional assessment of the domains of the basic set of ICF for children with ASD of three age periods (0-5 years, 6-16 years, 17 years and older) using ICF determinants was performed. The study included 224 children aged 2 to 17 years who were initially recognized as disabled due to childhood and atypical autism in St. Petersburg in the period from 2016 to 2021; the mandatory criterion for inclusion in this group was the presence of comorbid autism symptoms (speech, intellectual, cognitive, neurological disorders).

Results. The main domains of functions, body structures, activity and participation, and environmental factors that play the greatest role in the functioning of a disabled child with ASD were identified and quantitatively evaluated. In the structure of organism functions, severe impairment of mental functions prevailed (56.8 %), most pronounced in the sphere of impaired social interaction and communication (domain b122) and in the cognitive sphere (domains b140, b144, b1603). Problems in the intellectual sphere (domain b117) of varying degrees of severity were found in 99.1 % of children in this group. In 100 % of cases, intellectual disorders were combined with voice and speech disorders (domains b16700, b16710); moderate problems prevailed in the case of pediatric autism (47.6 %), and severe problems prevailed in the case of atypical autism (53.6 %). The assessment of activity and participation categories revealed impairments in the domains corresponding to the categories “Learning” (in 100 % of cases), “Communication” (in 100 % of cases), “Self-care” (in 73.1 % of cases) and “Main areas of life, interpersonal relationships” (in 95.0 % of cases). The limiting (barriers) and facilitating (facilitators) environmental factors affecting the functioning of a child with ASD were identified. Based on the results of the study, an example of a comprehensive assessment of the functioning of a child aged 7 years with the diagnosis of “Childhood Autism” is given.

Discussion. The given clinical case and the expert rehabilitation diagnosis of the child’s functioning based on the domains of the basic set of the ICF for RAS showed the presence of disorders at all levels of life activity (organism — personality — society).
A clear description of the child’s functioning and resources is presented in the categorical profile, where each category is a separate measure to achieve the rehabilitation goal.

Conclusion. Comprehensive expert rehabilitation diagnostics of autism in accordance with the domains of the basic set of ICF is aimed at all aspects of the child’s functioning, which allows it to be applied at various age periods of the child’s development at all stages of the rehabilitation cycle (the stage of assessing the initial state, setting the goal of rehabilitation, intervention and evaluation of the result).

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