Possibilities of using the basic set of ICF for autism spectrum disorders in the practice of medical and social expert assessment

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. High rates of primary childhood disability due to autism, as well as the actively developing system of comprehensive rehabilitation in the Russian Federation of modern rehabilitation technologies. In this regard, there is a need for more individualized (personalized) selection of different types of rehabilitation and rehabilitation services to each disabled child with autism. Basic sets of ICFs for autism spectrum disorders (BAS ICFs for ASD) and formation of a categorical profile on their basis provides a comprehensive and personalized description of the child’s functioning state based on the child’s age, clinical presentation, and environmental factors. However, in in the domestic practice of medical and social expert assessment, the ICF technologies are used to development of an optimal individual program of rehabilitation (habilitation) (IPRA) of a disabled person is practically not used.

Aim. Implementation of the domains of the ICF brief core set for autism spectrum disorders in the practice of medical and social expert assessment institutions in order to develop IPRA, as well as analysis of the barriers arising in its application.

Materials and methods. The theoretical basis for the interdisciplinary work of medical and social expert evaluation (MSE) specialists was a brief basic set of ICFs in RAS for three age periods (0-5 years, 6-16 years, 17 years and older). Using the method of expert rehabilitation diagnostics, the most significant domains of the IFC BN were identified, and they were assessed using IFC qualifiers. The study involved 224 children aged 2 to 17 years, initially recognized as disabled due to infantile and atypical autism in the city of St. Petersburg for the period from 2016 to 2021.

Results. Personalized categorical profiles reflecting the functional status and needs of a disabled child with RAS at different age periods, as well as general and specific rehabilitation goals, were developed on the basis of the domains of the ICF BN for RAS. The categorical profiles of disabled children with RAS were tested at the stage of IPRA development.

Discussion. On the basis of the obtained data, the need for various types of rehabilitation measures for children with disabilities with autism was studied, and a three-level model of the system of medical and social rehabilitation measures based on the ICF was formulated. The advantages and problems in the application of a brief basic set of the ICF for ASD in medical and social expert assessment institutions are identified and described.

Conclusion. The use of categorical profiles of disabled children with ASD at different age periods in ITU institutions significantly simplifies expert rehabilitation diagnosis, setting rehabilitation goals and objectives, justification of the need for different types of rehabilitation, selection of rehabilitation directions within the IPRA, as well as evaluation of rehabilitation effectiveness. In the process of approbation of categorical profiles for autism spectrum disorders, a number of barriers were identified, first of all, the lack of normative legal regulation in the application of ICF in medical and social expert assessment institutions of the Russian Federation.

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