Alehagen, Bölte, and colleagues conducted a feasibility study to develop and user-test an online platform for the ICF Core Sets for autism and ADHD. The study found that the platform was easy to use, acceptable to participants, and capable of capturing the diversity of functioning profiles, with iterative revisions addressing user feedback. The tool is now ready for psychometric validation.
Assessment of Individual Functioning
Traditional assessment in autism and ADHD has often relied on diagnostic categories, missing the heterogeneity and contextual factors that influence daily functioning. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) offers a biopsychosocial framework for describing functioning, including strengths and environmental factors. ICF Core Sets have been developed for autism and ADHD, but uptake has been limited due to the absence of practical, accessible tools. Existing measures are often deficit-focused, and do not fully align with the perspectives or needs of neurodivergent people.
A meaningful assessment needs to capture not just diagnoses, but context and lived experience.
ICF Core Sets
Alehagen et al. developed and piloted a digital platform to operationalize the ICF Core Sets for autism and ADHD. The platform provides self-report and proxy-report options across different age groups and uses an 11-point scale for rating challenges and strengths. Environmental factors are rated from -5 (very hindering) to +5 (very facilitating), and each item allows for qualitative comments.
The study involved 678 completed assessments from autistic and ADHD individuals, their relatives, the general population, and professionals in Sweden and the UK. Participants generally found the platform easy to use and visually clear. The main strengths reported were the comprehensive coverage of functioning, the inclusion of strengths and environmental factors, and the opportunity for user feedback. Professionals viewed the platform as a way to move beyond diagnosis and toward individualized assessment.
Feedback also identified areas for improvement, such as the length and repetitiveness of item sets, the need for better age-specific adaptation, and accessibility features like colour-blind design and screen reader compatibility. Participants emphasized the value of including neurodivergent perspectives, recognition of behaviours such as stimming, and attention to issues like masking and energy regulation. Based on feedback, the platform was revised to include items on masking and energy regulation, expand free-text options, and clarify scale wording. Some changes, such as the inclusion of personal factors not currently covered by the ICF, were not possible within the present framework.
Digital ICF Core Sets let users describe what helps and hinders them in everyday life.
Going forward
The authors suggest that, while the revised platform was well received, further work is needed to establish its psychometric properties and expand its application across different countries and cultures. They note the importance of balancing adherence to the ICF model with the preferences and needs of neurodivergent users, relatives, and professionals. The authors recommend further research to develop norms for the tool in diverse settings, and to consider the future integration of personal factors as the ICF framework evolves.
Next steps: validate the tool and ensure its relevance for diverse communities.
Conclusions
The study concludes that operationalizing the ICF Core Sets for autism and ADHD in an online platform is feasible and acceptable to a range of users. The platform allows for the assessment of functioning in a holistic and individualized way and is now ready for further psychometric validation.
A holistic, user-informed assessment can support better planning and inclusion.
NB this blog has been peer-reviewed
References
- Alehagen, L., Hasslinger, J., Wessman, E., Black, M., Lundin Remnélius, K., Helander, J., Zander, E. & Bölte, S. (2025). Operationalizing the ICF Core Sets for Autism and ADHD: A Multiple-Methods Feasibility Study. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-024-06717-4
- Bölte, S., Mahdi, S., de Vries, P. J., Granlund, M., Robison, J. E. & Halladay, A. (2019). The Gestalt of functioning in autism spectrum disorder: Results of the international conference to develop functioning constructs using the ICF framework. Autism, 23(2), 253–263. https://doi.org/10.1177/1362361318755522
- de Schipper, E., Mahdi, S., de Vries, P., Granlund, M., Holtmann, M., Karande, S., & Bölte, S. (2015). Functioning and disability in autism spectrum disorder: A worldwide survey of experts. Autism Research, 8(6), 782–796. https://doi.org/10.1002/aur.1583
- de Schipper, E., Mahdi, S., Bölte, S., et al. (2016). Towards an ICF core set for ADHD: A worldwide expert survey on ability and disability. European Child & Adolescent Psychiatry, 25(8), 927–936. https://doi.org/10.1007/s00787-015-0815-5
- Mahdi, S., Viljoen, M., Massuti, R., Selb, M., Almodayfer, O., Karande, S., … & Bölte, S. (2018). An international qualitative study of ability and disability in ADHD using the WHO-ICF framework. European Child & Adolescent Psychiatry, 27(10), 1305–1319. https://doi.org/10.1007/s00787-018-1106-3
- Mahdi, S., de Vries, P. J., Franz, L., et al. (2018). An international qualitative study of ability and disability in autism spectrum disorder using the WHO-ICF framework. Journal of Autism and Developmental Disorders, 48(6), 2148–2163. https://doi.org/10.1007/s10803-018-3509-3
- World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: WHO. https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
Where next?
This conference, brings together four leading experts to explore distinct yet interconnected topics: early detection, co-occurring mental health challenges, participatory approaches, and evidence-based supports for adolescents and young adults. With a focus on practical tools, emerging models, and inclusive innovation, this conference is essential for professionals working to improve outcomes for autistic children, teens, and their families.
A phenomenal line-up includes: Professor Sven Bölte, Professor Geraldine Dawson, Associate Professor Georgia Pavlopoulou, and Professor Susan White.
Use the interactive programme below to gain an overview of the topic, meet the speakers, test your knowledge, and a whole lot more!
About the author
Professor Francisco Musich, PhD is a Clinical Psychologist, Professor of Childhood Psychiatric and Neurological Disorder at Universidad Favaloro, Argentina, Head of the Department of Child and Adolescent Psychology at the Institute for Cognitive Neurology – INECO – Argentina, and Head of the Department of Psychopathology and Differential Diagnosis – ETCI – Argentina.
