Constructs of Social Communication in ASD Measures, Categorized by the Who's International Classification of Functioning, Disability and Health (ICF)

Background: The ICF provides a standard framework to describe health state in terms of functioning. Over the last decade, researchers have established standard rules to map health and clinical outcome measures onto the ICF to contribute to outcome research. This can assist with defining the construct(s) of functioning that underlie a measure and are thought to be meaningful. Such information can be valuable in selecting appropriate measures for intervention and for understanding common characteristics of how measures are conceptually related. ‘Social communication’ is evaluated in various ways in ASD, but is unclear how this construct relates to a child’s overall functioning. If we can identify common characteristics across measures of social communication in ASD, we will be able to provide a better picture of what defines social communication functioning for children with ASD. 

Objectives:  (i) To describe how to link measures of social communication used for preschool children with ASD to the ICF child and youth version (ICF-CY). (ii) To apply established ICF ‘linking rules’ to prominent social communication measures in ASD in order to identify common characteristics across these measures.

Methods: Measures of social communication in preschool children with ASD were identified from a scoping review of the literature, including the Autism Diagnostic Interview-Revised (ADI-R), Autism Diagnostic Observation Schedule (ADOS), Communication and Symbolic Behavior Scales, Early Social Communication Scales, and the Social Communication Questionnaire. These measures and their manuals (when available) were accessed and underwent a qualitative content analysis procedure to examine the meaning of each item and response option. Applying published “ICF Linking Rules”, these measures were linked to the ICF-CY by pairs of investigators who independently undertook this systematic linking process. Inconsistencies in item linking with ICF-CY codes were discussed by team members to reach consensus. The team consisted of Speech-Language Pathology and Occupational Therapy investigators with expertise in the ICF and ASD. Frequency counts for each ICF-CY chapter level (1 to 3) were examined to understand common social communication constructs across measures. 

Results: Linking items at the ICF-CY chapter level showed good interrater reliability, but linking to second and third levels was challenging. Common trends were evident in terms of ICF-CY codes across measures. Chapters most frequently linked with social communication were (in ranked order): Communication; Learning and Applying Knowledge; and Interpersonal Interactions and Relationships. Several unspecified item codes were identified across measures, indicating that codes on the ICF were not always available to map on some characteristics of social communication in ASD. 

Conclusions: Core constructs across social communication measures mapped onto ‘Communication’ but not as prominently on ‘Interpersonal Interactions and Relationships’. Common gaps were observed across measures whereby not all characteristics of social communication in ASD were specified by the ICF-CY. We identified areas and gaps in the construct of social communication that are important to our understanding of functioning in preschool children with ASDs.