ICF-CY: A New Tool to Enrich the Diagnosis of Specific Learning Difficulties in Children and Adolescents. A Case Study (thesis in English)

The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) is a derived version of the International Classification of Functioning, Disability and Health designed to record characteristics of the developing child and the influence of environments surrounding the child.
The ICF-CY belongs to the "family" of international classifications developed by the World Health Organization (WHO) for application to various aspects of health in children and adolescents. ICF belongs to the WHO family of international classifications, the best known member of which is the ICD-10 (the International Statistical Classification of Diseases and Related Health Problems). ICD-10 gives users an etiological framework for the classification, by diagnosis, of diseases, disorders and other health conditions. By contrast, ICF classifies functioning and disability associated with health conditions. The ICD-10 and ICF are therefore complementary, and users are encouraged to use them together to create a broader and more meaningful picture of the experience of health of individuals and populations. Information on mortality (provided by ICD-10) and information about health and health-related outcomes (provided by ICF) can be combined in summary measures of population health.In short, ICD-10 is mainly used to classify causes of death, but ICF classifies health.
From a medical and psychological point of view, Specific learning difficulties (SPLDS) represent a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, speak, read, think, write, spell, or do mathematical calculations.In everyday life we can find different specific terms which label these difficulties: Dyslexia (difficulty with written language, particularly with reading and spelling), Dysorthographia (disorder of learning characterized by an important and durable defect of assimilation of grammatical rules), Dyscalculia (difficulty in learning or comprehending arithmetic and calculations), and Dysgraphia (deficiency in the ability to write).The tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) defines the specific learning difficulties of scholastic skills in.The traditional systems of ICD and DSM represent an important resource for all clinicians and psychologist who works in health services with children with specific learning difficulties. They are the primary reference for the diagnosis and they permit to have a comparison among children data and specific impairments.
But the new clinical trends in childhood research also suggest to integrate the categorical classification of ICD and DSM with the information of the new classification of functioning (ICF and ICF-CY, especially for children) in order to draw up a more complete profile of competences and impairments in the specific context’s life of the child.Two important risks in using ICD /DSM are an oversimplified judgment in clinical diagnosis and the incapacity to keep in consideration the complexity of clinical elements.
‘Complexity’ has several meanings. ‘Complexity’ can refer to multiple factors associated with the child, their circumstances, the service provider and context, all impacting on service processes and outcomes.In the case of Specific Learning disability, ‘complexity’ might include severity, co-occurring conditions, parental problems, cultural background, adherence, and could include clinician variables and service context (particular skills, availability of appointments, clinic rooms).Further, important elements of ‘complexity’ may not be known for some time, if at all, after clinician involvement: a history of exclusion and poor social participation may not emerge until the individual feels confident to speak. ‘Complexity’ in this latter sense is important because of its potential impact on resources required and effectiveness. Indexing ‘complexity’ would enable more relevant characterization of resource usage or requirements.In this direction, ICF/ICF-CY can become a support to the traditional diagnosis; it can be an important integrative solution with ICD 10 and DSM IV in clinical work of specific learning difficulties. A functional approach, as embodied in ICF/ICF CY, articulates a view that includes but goes beyond diagnosis and recognizes the importance of taking account of the impact of dysfunctions on the individual and their adaptability to and participation in their family and life contexts. Targeting such functional outcomes, as well as prevention, provides a more comprehensive and relevant orientation for services.