Abilities and Strengths of Individuals on the Autism Spectrum from a Global Perspective: Findings from the ICF Core Sets for Autism Development

Background: Autism Spectrum Disorder (ASD) is associated with a wide range of social, occupational and educational challenges, but also strengths. To date, no standardized, internationally accepted tools exist to assess ASD-related strengths. The WHO’s International Classification of Functioning, Disability and Health (ICF) can serve this need The ICF is based on a bio-psycho-social model of functioning, comprising of over 1600 categories related to various components of health: body functions, body structures, activities, participation and environmental factors. Not all are, however, applicable to a certain condition, which is why the process has been initiated to develop ICF Core Sets for Autism Spectrum Disorder (ASD); lists of generally-agreed-upon ICF categories pertinent to individuals with a certain health condition.

Objectives: We present the results of ASD-related strengths that were identified in our efforts to develop ICF Core Sets for ASD. The efforts included more specifically three cross-cultural and trans-disciplinary studies: an expert survey, a qualitative study and a clinical study.

Methods: The expert survey included 225 international experts representing 11 different disciplines and 43 countries across all six WHO-regions. The survey contained 7 questions related to functioning, of which one inquired about ASD-related strengths. The qualitative study involved focus group discussions and semi-structured interviews with individuals with ASD, family members and professional caregivers from 19 stakeholder groups in 5 countries from 5 WHO-regions. Qualitative content analysis was performed to extract meaningful concepts from survey responses and transcripts. These were then linked to ICF codes (if applicable) following specific linking rules. The ICF linking was not necessary in the clinical study. Instead, an extended version of ICF checklist (containing ICF categories) was used by clinicians to gather data from 122 individuals with ASD recruited at 11 clinical sites in 10 countries in 4 different WHO-regions. Frequency analysis was conducted in all studies to identify most common reported ASD-related strengths

Results: A large majority of experts (n = 207, 92%) indicated at least one ASD-related strength. The most common ones were b126 temperament and personality functions (n = 68, 30%; e.g. strong sense of morality), b140 attention functions (n = 67, 30%; e.g. attention to detail, intense focus) and specific expertise in a field (n = 52; 23%; e.g. video games, geographical facts). All stakeholder groups in the qualitative study identified at least one ASD-related strength, which included b126 temperament and personality functions (n = 8, 42%; e.g. honesty), b140 attention functions (n = 6, 32%; e.g. attention to detail) and b144 memory functions (n = 5, 26% e.g. memory for specific events). The clinical study yielded two ICF categories, namely b140 attention functions (n = 27, 21%) and b144 memory functions (n = 20, 16%).

Conclusions: Irrespective of study methodology and perspective, certain ASD-related strengths (e.g. memory, attention) were found to be recurring and important to functioning. The information on strengths can be meaningful for a variety of purposes. It can serve as basis for developing resource-oriented interventions in clinical settings to matching job assignments with individual strengths in employment services