Reconciling the seemingly irreconcilable: The WHO's ICF system integrates biological and psychosocial environmental determinants of autism and ADHD

Abstract

Neurodevelopmental disorders (NDDs), such as autism and ADHD, are behaviorally defined adaptive functioning difficulties arising from variations, alterations and atypical maturation of the brain. While it is widely agreed that NDDs are complex conditions with their presentation and functional impact underpinned by diverse genetic and environmental factors, contemporary and polarizing debate has focused on the appropriateness of the biomedical as opposed to the neurodiverse paradigm in framing conceptions of these conditions. Despite being largely overlooked by both research and practice, the International Classification of Functioning Disability and Health (ICF) endorsed by the World Health Organization in 2001 views functioning dynamically, offering a framework for investigating, assessing and treating NDDs holistically. Exemplified by autism and ADHD, we argue that the ICF provides not only a multitude of opportunities in accounting for the environmental determinants in researching and clinically managing NDDs, but opportunities for harmonizing the seemingly irreconcilable biomedical and neurodiverse paradigms. Also see the video abstract here: https:

Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism science

“…We already see sign of that third possibility in the World Health Organisation’s International Classification of Functioning Disability and Health (ICF), as described in a recent review by Bölte et al. ( 2021 ), and in recent developments regarding the importance of optimising the person‐environment fit (Lai, Anagnostou, Wiznitzer, Allison, & Baron‐Cohen, 2020 ; Mandy & Lai, 2016 ).…”

“…Milton, 2014a; Pellicano, 2020; Raymaker, 2020). It is also beginning to be reflected in academic discussions, with a flurry of review papers, perspective pieces and edited books published in the last 12 months alone (Bertilsdotter Rosqvist et al., 2020; Bölte, Lawson, Marschik, & Girdler, 2021; Davis & Crompton, 2021; Kapp, 2020; Leadbitter, Buckle, Ellis, & Dekker, 2021; Mitchell et al., 2021; Walker & Raymaker, 2020). This is a major shift that has revealed fundamental problems in the conventional medical account – and its inability to explain away what Kuhn (1962) called the ‘anomalies’ at its core – and the possibilities imminent in the neurodiversity paradigm.…”

Childhood Stuttering: Case-Based Examples of Multidimensional Treatment

“…12 13 Furthermore, the likelihood of stuttering cooccurring with other conditions, disorders, and communication challenges (e.g., autism spectrum disorder [ASD], language, articulation and/or phonological delays or disorders, and attention deficit hyperactive disorder) has broadened our understanding of relations between a wide range of characteristics and the need to address them integratively. 14 15 This process presents challenges as we endeavor to interweave knowledge and methods from our own and other disciplines to maximize our clients' participation in and enjoyment of communication and its many qualities in the contexts of their everyday lives.…”

“…12 13 We have chosen a field that is becoming increasingly divergent and where the complexities of the epigenesis of neurodevelopmental disorders, including stuttering, increasingly inform our practice. 4 15 We further recognize the need to look beyond traditional medical or pathology-based approaches to embrace social disability or strengths-based ability models that highlight the real-life contexts, hopes, goals, and preferences of our clients and their families. 10 15 The authors of the manuscripts in this volume have clearly risen to the challenge of multidimensionally and holistically assessing and treating those who stutter, clutter, and/or have concomitant challenges.…”

“…4 15 We further recognize the need to look beyond traditional medical or pathology-based approaches to embrace social disability or strengths-based ability models that highlight the real-life contexts, hopes, goals, and preferences of our clients and their families. 10 15 The authors of the manuscripts in this volume have clearly risen to the challenge of multidimensionally and holistically assessing and treating those who stutter, clutter, and/or have concomitant challenges. Their integration of available research and implementable strategies, through case-based examples, provide the background, rationale, and clear guidance for immediate clinical application to positively impact the communication abilities of our clients.…”