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. 2025 Jan;55(1):114-129.
doi: 10.1007/s10803-023-06204-2. Epub 2023 Dec 11.

From Symptomatology to Functioning - Applying the ICF to Autism Measures to Facilitate Neurodiversity-Affirmative Data Harmonization

Melissa H Black  1 , Karl Lundin Remnélius  2 , Lovisa Alehagen  2 , Thomas Bourgeron  3 , Sven Bölte  2   4   5
Affiliations

From Symptomatology to Functioning - Applying the ICF to Autism Measures to Facilitate Neurodiversity-Affirmative Data Harmonization

Melissa H Black et al. J Autism Dev Disord. 2025 Jan.

Abstract

Purpose: A considerable number of screening and diagnostic tools for autism exist, but variability in these measures presents challenges to data harmonization and the comparability and generalizability of findings. At the same time, there is a movement away from autism symptomatology to stances that capture heterogeneity and appreciate diversity. The International Classification of Functioning, Disability and Health (ICF) provides a classification system that can support content harmonization of different screening and diagnostic tools for autism while enabling the translation of diagnostic information into functioning.

Method: Here we linked commonly used screening and diagnostic measures within the field of autism to the ICF to facilitate the unification of data obtained from these measures.

Results: As expected, screening and diagnostic measures primarily focus on body functions and activities and participation domains of the ICF, and much less on environmental factors, reflecting biomedical and adaptive behavior operationalizations of autism derived from diagnostic manuals.

Conclusion: By translating symptomology-based information to the continuous and diagnostically neutral view of functioning, the ICF linking presented here may provide a means to harmonize measures of autism characteristics while enabling diagnostic information to be re-examined through a more neurodiversity-affirmative lens.

Keywords: Biopsychosocial; Diagnosis; Functioning; Harmonization; Screening.

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Figures

Fig. 1
Fig. 1
Example of Hierarchical structure of the International Classification of Functioning, Disability and Health (ICF; WHO 2001). The grey box indicates the level of codes presented
Fig. 2
Fig. 2
Distribution of ICF codes across domains for each measure Note. Body structures are not included because no measure was linked to this domain. ABC – Autism Behavior Checklist, ASBQ – Adult Social Behavior Questionnaire, AQ - Autism Quotient, CSBQ - Child Social Behavior Questionnaire, M-CHAT - Modified Checklist for Autism in Toddlers, Q-CHAT - Quantitative Checklist for Autism in Toddlers, SCQ – Social Communication Questionnaire, SRS – Social Responsiveness Scale, ADOS - Autism Diagnostic Observation Schedule-2, M – Module, ADI-R – Autism Diagnostic Interview – Revised, CARS – Childhood Autism Rating Scale, DISCO –Diagnostic Interview for Social and Communication Disorders
Fig. 3
Fig. 3
Number of measures covering second level codes within the body functions Chaps. (17 included measures in total, ADOS represents 4 measures and SRS-2 represents 3 measures). Only linked codes are displayed
Fig. 4
Fig. 4
Number of measures covering second level codes within the activity and participant Chaps. (17 included measures in total, ADOS represents 4 measures and SRS-2 represents 3 measures). Only linked codes are displayed
See this image and copyright information in PMC

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