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9 Oct 2015

de Schipper E et al. Eur Child Adolesc Psychiatry 2015; 24: 1509-1521.

Experts agree on key concepts of ability and disability to herald a standard diagnosis for ADHD in a worldwide survey.

The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) was developed to function as a framework for the components of functioning and disability for all health-related conditions. The ICF was designed to be used in combination with the International Classification of diseases and health-related problems (ICD) to create a comprehensive description of an individual’s health (using ICD) and functioning (using ICF).

The ICF provides detailed classifications of ability and disability in the areas of body functions, body structures, activities, participation and environmental factors.* For each of these areas, aspects of functioning are described with up to four categories of increasing detail which has meant that the Children and Youth version of the ICF (ICF-CY) is impractical for daily clinical use and research purposes as it contains >1600 categories.

To address this issue an email-based survey was completed by 174 ADHD experts from 45 different countries to identify the main features of ADHD pertaining to a standardised model of diagnosis, in order to recommend content for ICF “Core Sets” currently under development, which include a selection of the ICF-CY categories considered most relevant to individuals with ADHD. In addition, positive ADHD functional abilities and associated gender differences were investigated through specific questions. The subsequent results of the survey were converted into “meaningful concepts” of ADHD functioning,which could be linked to ICF categories.

The analysis identified 7615 meaningful concepts, which translated to 83 key ICF categories that were reported by at least 5% of experts surveyed (range: 5–85%). These identified categories came from all four ICF components: body functions (n=30), activities and participation (n=30), environmental factors (n=20) and body structures (n=3). In addition, the majority (93%) of experts identified positive abilities associated with ADHD, including creativity, energy, flexibility, resilience and multitasking. Furthermore, 65% of experts identified differences in gender in the presentation of ADHD, with key differences being that males were more likely to present with the hyperactive-impulsive subtype and externalising behaviour problems, whilst females were more likely to present with the inattentive subtype and internalising behaviour problems. Importantly, this observation demonstrates why females with ADHD may be under-diagnosed.

This study effectively presents the views of a large population of experts from diverse backgrounds and therefore aid the development of an ICF Core Set for ADHD. The range of abilities and disabilities identified by experts demonstrates that ADHD impacts many areas of daily life. One of the key challenges of this type of study, was identifying the ICF categories from the meaningful concepts, which can lead to loss of information; however, despite this, the surveyed experts did identify a number of key concepts for the assessment of functioning.

Read more about the outcome of the survey here


*Body functions (physiological functions of body systems); Body structures (anatomical parts of the body); Activities (execution of tasks); Participation (involvement in life); Environmental factors (physical, social and attitudinal environment)
Meaningful concepts were identified as concise descriptions of specific behaviours, skills or other aspects of functioning

de Schipper E, Mahdi S, Coghill D, et al. Towards an ICF core set for ADHD: a worldwide expert survey on ability and disability. Eur Child Adolesc Psychiatry 2015; 24: 1509-1521.

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