Content Analysis of Psycho-Educational Intervention Goal for Young Children with Autism within the ICF-CY Framework.
Effort has been made to use the ICF taxonomy as a way to improve service delivery in health and education (WHO, 2001, 2007), in line with recent advances in research concerning neuro-developmental disabilities demonstrating the usefulness of a functional approach to ASD (Gillberg, 2010). The fact that children with Autism Spectrum Disorders manifest divers pattern of behaviors and level of performance. Such variability with in a broad spectrum challenges the decision-making process of individualized intervention goals, that should include the promotion of a broad range of children’s life skills, that are developmentally appropriate and include information on the environmental support (Wilczynski et al., 2007). The ICF-CY based Matrix for Assessment of Activities and Participation (MAAP, Castro & Pinto, 2013) was designed to capture the nature and severity of the limitations of functioning in children with autism spectrum disorders, allows for a developmental norm-referenced rating of each specific skill performance and assesses environmental factors that are scene-setters for the occurrence of forms of participation. Thus, the instrument elicits teaching goals to be included in intervention curricula.
Mapping learning objectives of early intensive behavioral intervention onto the MAAP assessment tool within the ICF-CY framework, to document the extent individual functional domains documented in the assessment process are included in the individualized intervention goals and thus frame the child’s current developmental status.
This study analyzed the learning objectives of 24 psycho-educational intervention programs developed for pre-schoolers aged 2-6 years with autism, enrolled in early intensive behavioral intervention services in Italy. Individual functioning patterns and aspects of the environment relevant to the child’s engagement in daily routines were identified utilizing the MAAP tool. The MAAP comprises 45 items corresponding each to a ICF-CY dimension that was regarded as essential for the assessment-intervention process of children with autism from birth to 6 years of age (ASD core set; Castro & Pinto, 2012, Pinto et al., 2013). Analysis of the overlap of functional dimensions from assessment to intervention goals were carried out through deductive content analysis. The process of analysis has followed a set of sequential steps using the ICF-CY linking rules (Cieza et al., 2005) on the identification of meaningful concepts. Coding was conducted by two independent researchers. Inter-rater reliability was calculated using Kappa Coefficients.
Results illustrate the majority of functional domains addressed in intervention goals mapped to the Activities and Participation component of the ICY-CY, representing the execution of tasks and forms of involvement in life situations. Nearly all functionality domains identified as essential for children with autism were included both in assessment data and in the intervention goals. Nevertheless, very few Environmental factors were addressed.
The results suggests that interventions for young children with autism are focused essentially on children’s skills and on directly observed performance. Missing consideration of environmental characteristics in which the child is embedded, underrate the multidimensional nature of child development, specifically in program promoting parent, peer and classroom inclusion.