Background:

Functional classification offers many advantages to the current diagnostic systems that serve children with disabilities. It evaluates all children within the same structure and metric, regardless of diagnosis. It highlights a child’s unique strengths and needs for the purpose of directing interventions. This is particularly advantageous in the case of spectrum diagnoses such as autism and cerebral palsy in which a label alone is not sufficient to direct service interventions. A functional assessment of the child provides a more complete picture that enables providers to better match resources and needs. Functional classification also looks at individuals within the context of their social and physical environment, taking into account the impact of human and technological supports on an individual’s “activities and participation”. Further, functional classification catalyzes interdisciplinary communication and collaboration by providing a common structure and language for discussion.

The World Health Organization (WHO) has assumed the major leadership role in developing tools to assess function in individuals with disabilities. In 1980, the WHO introduced the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). This assessment tool classified disability in terms of its functional impact, using an underlying conceptual framework that indicates disability is a linear result of disease. In 1992, the ICIDH was significantly revised and renamed the International Classification of Functioning, Disability, and Health (ICIDH-2). The ICIDH-2 reflected the evolution of healthcare from a medical model to a bio-psycho-social model by classifying a person’s disability or impairment within a social and physical environment. In 2000, the assessment tool was again revised with a greater emphasis on an individual’s activities and participation and renamed the International Classification of Functioning, Disability, and Health (ICF). The ICF is intended as a companion to the International Statistical Classification of Diseases and Related Health Problems (ICD-10), a well known manual on its 10th revision. The ICF is based on a non-linear model which emphasizes the impact that impairments have on an individual’s “activities and participation” and vice versa. The model also includes the impact of social and environmental factors on any point in the schematic. The ICF is intended for research, clinical, and service purposes (www3.who.int/icf/).

Advocacy and research surrounding the use of functional classification to describe children lags behind that of adults. The sheer number of articles written about the functional classification of adults overshadows the few articles that discuss how functional classification is used to serve children. Those few articles appear to be divided very generally into two categories: 1) articles that discuss the functional classification of children with a specific diagnosis such as cerebral palsy (Ketelaar, Vermeer et al. 1998) or juvenile rheumatoid arthritis (Howe, Levinson et al. 1991), 2) articles researching the use of very general pediatric assessment tools (Ottenbacher, Msall et al. 2000).

Three issues beg attention in regard to the functional classification of children with disabilities. First, is the lack of research and use of functional classification in the field of pediatric medicine. Second, the numerous functional assessment tools designed for children with a specific disability or diagnosis are useful at a level of very detailed analysis of the child’s functional capacities within the scope of a particular disability. However, these detailed assessments are intrinsically incapable of realizing some of the benefits that functional classification offers such as interdisciplinary communication, provider accountability, and rational resource allocation. Third, the general, non- diagnosis specific assessment tools currently used to assess children’s functioning have several inadequacies including age limitations and a lack of assessment of learning abilities (Simeonsson, Lollar et al. 2000).

UCLID Center Projects

• Expanding the Concept of Diagnosis: An Introduction to Functional Classification for Consumers, Clinicians, and Policy Makers.
  This 30-minute CD-ROM can be used for pre-service or in-service education about the benefits of functional classification. The material was based on a conference entitled Service with Labels, hosted by the UCLID Center in 2001. Please contact the UCLID Center to purchase the CD.
  
• The Maze of Federal Services & Resources: A Companion Guide to the CD-ROM.
  This brochure shows the variations in eligibility criteria for federal health and education programs
  
• Applying Functional Classification in the Evaluation of Children with Disabilities.
  Functional classification will be included in all assessments in the clinical program of the UCLID Center. Students and fellows will practice the PEDI and other functional assessment tools and will use them to monitor children over time.
  
• The Benefits of Functional Classification for Children with Disabilities.
  This research project will examine the benefits of functional classification in terms of expanding services for children and improving interdisciplinary collaboration.