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The study of developmental disabilities, not being confined to one medical field, poses a challenge in evaluating outcomes research. It is a multidisciplinary area of study which encompasses health-care, rehabilitation, psychosocial, educational, and biotechnology specialties and involves biological, social, and behavioral effects of intervention. Consequently, there is a lack of consistency in what has been studied, how the outcomes have been measured, and where these results have been recorded. Naturally, these disparate outcomes data need to be consolidated in such a way that comparison of treatments can be made, within and across professional disciplines. In an attempt to facilitate this, the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) is committed to providing critical and useful appraisal of the scientific literature to help clinicians keep abreast in their own as well as other relevant disciplines 1. The Academy has explored several classification systems to consolidate and interpret data, and has established a two-part conceptual framework (1) to aggregate treatment outcomes and construct evidence tables based on a model of disablement which classifies treatment outcomes by the dimension in which they have an effect; and (2) to determine the degree of confidence that can be placed in the scientific evidence available in support of an intervention. Classification systems and models of disablement Before selecting a classification system, the AACPDM examined and carefully considered the merits of the most prominent classification in disablement models in rehabilitation as well as a system currently used to classify effects of orthope-dic surgery. The rehabilitation models were found to be more applicable to the multidisciplinary nature of developmental medicine. In 1980, the World Health Organization (WHO) developed a model of disablement; this model has had the most universal influence on rehabilitation. The model is described in two companion publications: the International Classification of Disease (ICD-10) 2 which classifies diseases, disorders or injuries; and the International Classification of Impairment, Disability and Handicap (ICIDH) 3 which describes the consequences of health conditions. The WHO model describes a key concept which is the basis of its classification system, i.e. that the consequences of disease occur at different levels: disease at the level of molecules and cells; impairment at the level of organs; disability at the level of individuals; and handicap at the level of society. The WHO's use of the term handicap for one of these levels became the subject of vigorous international debate. Consequently, the US Institute of Medicine (IOM) 4 and the US National Center for Medical Rehabilitation Research (NCMRR) 5 chose not to use the language of the ICIDH. Instead, they adopted the classification language of a conceptually similar model which was proposed by Nagi in 1969 6. Table I shows that this concept of reference levels is central to all the rehabilita...

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