SHORT REPORT

Classification of Functioning and Impairment: The Development of

ICF Core Sets for Autism Spectrum Disorder
Sven Blte, Elles de Schipper, John E. Robison, Virginia C.N. Wong, Melissa Selb, Nidhi Singhal,
Petrus J. de Vries, and Lonnie Zwaigenbaum

Given the variability seen in Autism Spectrum Disorder (ASD), accurate quantification of functioning is vital to studying
outcome and quality of life in affected individuals. The International Classification of Functioning, Disability and Health
(ICF) provides a comprehensive, universally accepted framework for the description of health-related functioning. ICF
Core Sets are shortlists of ICF categories that are selected to capture those aspects of functioning that are most relevant
when describing a person with a specific condition. In this paper, the authors preview the process for developing ICF Core
Sets for ASD, a collaboration with the World Health Organization and the ICF Research Branch. The ICF Children and
Youth version (ICF-CY) was derived from the ICF and designed to capture the specific situation of the developing child. As
ASD affects individuals throughout the life span, and the ICF-CY includes all ICF categories, the ICF-CY will be used in this
project (ICF(-CY) from now on). The ICF(-CY) categories to be included in the ICF Core Sets for ASD will be determined
at an ICF Core Set Consensus Conference, where evidence from four preparatory studies (a systematic review, an expert
survey, a patient and caregiver qualitative study, and a clinical cross-sectional study) will be integrated. Comprehensive and
Brief ICF Core Sets for ASD will be developed with the goal of providing useful standards for research and clinical practice
and generating a common language for functioning and impairment in ASD in different areas of life and across the life
span. Autism Res 2014, 7: 167172. 2013 International Society for Autism Research, Wiley Periodicals, Inc.

Keywords: neurodevelopmental disorders; autistic disorder; assessment; children and youth; psychiatry; mental health; health
care; ICF; ICF Core Set

Background [Orsmond, Wyngaarden Krauss & Mailick Seltzer

Autism Spectrum Disorder (ASD) is a neurodevelopmental
disorder of complex origin, with an estimated prevalence
of about 1% [Baird et al., 2006; Idring et al., 2012]. Accord-
ing to the International Classification of Diseases (ICD-10)
[World Health Organization, 1992a] of the World Health
Organization (WHO), ASD (F84) is a pervasive develop-
mental disorder characterized by impairments in social
interaction and in communication, alongside restricted,
repetitive, and stereotyped patterns of behaviors, interests,
and activities. These core features are associated with
alterations in cognitive and emotional functioning [Levy,
Mandell, & Schultz, 2009], high rates of psychiatric
comorbidity [Joshi et al., 2012; Simonoff et al., 2008],
difficulties with forming and maintaining relationships
2004], poor adaptive skills [Kanne et al., 2011], and lower
rates of health-related quality of life, both self-reported
and parent/caregiver reported [Kuhlthau et al., 2010;
Shipman, Sheldrick, & Perrin, 2011; Travernor, Barron,
Rodgers, & McConachie, 2012]. Therefore, classification
solely by categorical diagnosis does not provide sufficient
information on the impact of ASD on individual function-
ing and quality of life. Although the multiaxial classifica-
tion of a disorder in ICD-10 [World Health Organization,
1992b]/DSM-IV-TR [American Psychiatric Association,
2000] includes a global rating of psychosocial and func-
tional problems, the Global Assessment of Functioning
Scale (GAF), and DSM-5 introduces a new system for
assessing functional impairment independent of diagnos-
tic symptoms, the World Health Organization Disability

From the Neuropsychiatric Unit, Department of Womens and Childrens Health, Center of Neurodevelopmental Disorders (KIND), Stockholm, Sweden
(S.B., E.S.); Division of Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden (S.B.); Interagency Autism Coordinating
Committee, US Department of Health and Human Services, Washington, DC (J.E.R.); Division of Pediatric Neurology, Developmental Behavioral
Paediatrics and NeuroHabilitation, Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China (V.C.N.W.); ICF
Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil,
Switzerland (M.S.); Swiss Paraplegic Research (SPF), Nottwil, Switzerland (M.S.); Action for Autism, New Delhi, India (N.S.); Division of Child and
Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa (P.J.V.); Department of Pediatrics, University of Alberta, Edmonton, Alberta,
Canada (L.Z.)
Received April 17, 2013; accepted for publication September 3, 2013
Address for correspondence and reprints: Elles de Schipper, Gvlegatan 22B, plan 8 113 30 Stockholm. E-mail: elles.de.schipper@ki.se
The development of ICF Core Sets for ASD is supported by the Swedish Research Council (grant nr. 523-2009-7054), and the Swedish Research Council
in partnership with FAS, FORMAS and VINNOVA (cross-disciplinary research program concerning childrens and youths mental health, grant nr.
259-2012-24).
Conflict of interest: The authors declare that they have no conflict of interest related to this work.
Published online 3 October 2013 in Wiley Online Library (wileyonlinelibrary.com)
DOI: 10.1002/aur.1335
2013 International Society for Autism Research, Wiley Periodicals, Inc.

INSAR Autism Research 7: 167172, 2014 167

Assessment Schedule (WHODAS 2.0), these tools do not
provide a comprehensive profile of an individuals level of
functioning in face of a certain disorder. A complementary
system for a more comprehensive and standardized assess-
ment of functioning across various contexts is needed to
improve research, inter- and transdisciplinary communi-
cation, for intervention planning, and for the health eco-
nomic cost analysis for support in ASD.
The WHO International Classification of Functioning,
Disability, and Health (ICF)
The WHO has developed the International Classification
of Functioning, Disability and Health (ICF) [World Health
Organization, 2001], among other reasons, to standardize
the assessment of functioning in light of a health condi-
tion. The ICF is based on the biopsychosocial model of
functioning [Rauch, Lckenkemper, & Cieza, 2012], an
integration of the medical model, which views disability as
a problem of the individual and a direct consequence
of a health condition, and the social model, which sees
disability as a socially created problem which can be
resolved by the full integration of the individual into
society. Essential to the biopsychosocial model is that an
individuals level of functioning is the outcome of a
complex interaction between health condition, body func-
tions (physiological functions of body systems) and body
structures (anatomical parts of the body), activities (ex-
ecution of a task) and participation (involvement in life
situations), environmental factors (physical, social, and
attitudinal environment), and personal factors (features
intrinsic to the individual). The interaction among these
components is dynamic and bidirectional; changes in
one component may influence one or more of the other
components. This interactive model is shown in Figure 1.
Derived from the ICF in 2007, the ICF Children and
Youth version (ICF-CY) [World Health Organization,
2007] was designed to capture the particular situation of
the developing child by adding child-relevant categories
and expanding on the descriptions of existing ICF
categories.
Figure 1. The integrative biopsychosocial model of functioning,
disability, and health.
168 Blte et al./ICF Core Sets for ASD
The ICF and the ICF-CY are part of the WHOs family of
international classifications, which has been developed
to provide a comprehensive and universally accepted
framework to classify the experience of health in indi-
viduals as well as populations. Although the ICD-10 is the
most widely used classification within this family, there is
a growing interest in the use of the ICF and ICF-CY in
international health care, with regards to both physical
disabilities [Cerniauskaite et al., 2011; Fayed, Cieza, &
Bickenbach, 2011; Kostanjsek, 2011; Stucki & Cieza,
2008] and psychiatric disorders [lvarez, 2012; Stucki &
Cieza, 2008]. Field trials have demonstrated the feasibility
of the ICF-CY for intervention planning in children
affected by different disabilities and its acceptance among
health care professionals [Ibragimova, Granlund, &
Bjrck-kesson, 2009]. Few studies have investigated the
feasibility of the ICF-CY in ASD. Castro & Pinto [2013]
conducted a Delphi exercise among child development
and ASD experts, resulting in a selection of ICF-CY cat-
egories to be considered essential for intervention plan-
ning in young children with ASD. They found that
ICF-CY categories from all different components of the
biopsychosocial model were relevant to ASD. In another
study, Castro, Ferreira, Dababnah & Pinto [2013] demon-
strated links between the Autism Diagnostic Observation
Schedule (ADOS), Autism Diagnostic Interview-Revised
(ADI-R), Childhood Autism Rating Scale (CARS), on one
hand, and the ICF-CY, on the other. Associations between
ADOS, ADI-R, and CARS items and ICF-CY categories
were found for all ICF-CY components, except for envi-
ronmental factors. In another effort to use the ICF-CY in
ASD, Gan, Tung, Yeh & Wang [2013] developed and vali-
dated an ICF-CY based tool for the assessment of the
functional profile of preschool children with autism.
The ICF-CY consists of over 1,400 categories providing
an exhaustive classification of an individuals function-
ing. Although the comprehensiveness of the ICF-CY can
be seen as a strength, the ICF-CY is ultimately too exten-
sive to be useable in daily clinical practice. To address this
issue, the development of ICF Core Sets was initiated
[Stucki & Grimby, 2004; stn, Chatterji, & Kostanjsek,
2004]. ICF Core Sets are shortlists of ICF categories that
are considered most relevant to individuals with a certain
health condition and on which assessment tools (e.g.
questionnaires, interviews, observation scales, checklists)
[Klitz, Heijde, Cieza, Boonen, Stucki, stn & Braun,
2011; Peyrin-Biroulet et al., 2012] are based. The aim of
this project is to provide a method to describe function-
ing in individuals with ASD by developing standardized
ICF Core Sets for ASD. As ASD affects individuals through-
out the life span [Billstedt, Gillberg, & Gillberg, 2007;
Seltzer et al., 2003], and the ICF-CY includes all ICF cat-
egories, the ICF-CY will be used in this project (referred to
as ICF(-CY) from now on). This project differs from the
previous ICF studies in ASD in that it is a collaboration
INSAR
with WHO and the ICF Research Branch in cooperation
with the WHO Collaborating Centre for the Family of
International Classifications in Germany (at DIMDI), and
that it follows a rigorous scientific process that was devel-
oped by WHO and the ICF Research Branch. It ensures
that multiple perspectives are captured and that a com-
prehensive picture of functioning is formed, and that the
universal character of the ICF-CY is preserved by involv-
ing experts, clients, and clinicians from multiple profes-
sional backgrounds and from all six WHO regions.
Moreover, this project adds to the existing research by
developing ICF Core Sets for ASD that are applicable to
children, adolescents, and adults alike. This makes it pos-
sible to follow the functional development of individuals
with ASD using the same tool across the entire life span.
The objective of this paper is to give a preview of the
process that will be used to develop ICF Core Sets for ASD.
Methods
This project is conducted in conformity with the ethical
principles of the Declaration of Helsinki. ICF Core Sets for
ASD are developed in a scientifically structured three-
phase process: preparatory phase, phase I (consensus con-
ference resulting in the first version of the ICF Core Sets
for ASD), and phase II (validation of the ICF Core Sets);
this process is illustrated in Figure 2.
Preparatory Phase
The preparatory phase will consist of four scientific
studies, each providing a different perspective to inform
the selection of ICF(-CY) categories relevant to function-
ing in ASD:
Figure 2. ICF core set for ASD development process.
INSAR Blte et al./ICF Core Sets for ASD
Systematic literature review (researcher perspective): A
systematic review of studies published since 1992 will be
performed (1) to identify outcome measures in ASD
research, and (2) to link the concepts in these measures to
the ICF(-CY) using established linking rules [Cieza et al.,
2005].
Expert survey (opinion leader perspective): To gather
the expertise of an international pool of ASD opinion
leaders regarding aspects of functioning that are relevant
to ASD, an internet-based survey will be performed. The
pool will include experts from various disciplines and
from each of the six WHO regions (Europe, the Americas,
Africa, Eastern-Mediterranean, South-East Asia, and
Western Pacific). The concepts named by the experts will
be linked to ICF(-CY) categories using established linking
rules [Cieza et al., 2005].
Qualitative study (client and related perspectives):
Focus groups with individuals with ASD, caregivers,
teachers, and spouses/partners will be conducted to
explore and understand which aspects of functioning are
important to individuals with ASD. A set of questions
covering the components of the biopsychosocial model
(e.g. If you think about your daily life, what are your
challenges?) will be employed to guide the discussion
and to determine significant aspects of functioning. If a
selected individual is unable to participate in a focus
group due to the severity of the condition, an individual
interview will be conducted. To gain the perspective of
nonverbal individuals, focus groups with their caregivers,
teachers, and spouses/partners will be held. Aspects of
functioning identified in the focus group discussions and
individual interviews will be linked to ICF(-CY) catego-
ries, using established linking rules [Cieza et al., 2005].
Empirical cross-sectional study (clinical perspective): A
cross-sectional study will be conducted to describe the
169
functioning of individuals with ASD in a clinical setting.
Based on information from client records, observations,
and semi-structured interviews, clinicians from study
centers in at least two different countries will rate the
functioning of their clients using a case record form (CRF)
based on the extended ICF Checklist 2.1a [World Health
Organization, 2003]. Output from the four preparatory
studies will be a list of ICF(-CY) categories with corre-
sponding absolute and relative frequencies.
Phase I
Findings from the preparatory phase will be presented at
an international ICF Core Set Consensus Conference,
planned for spring 2016. During the Conference, a group
of 2125 experts from all WHO regions will follow a
formal decision-making process to arrive at a consensus
on the ICF(-CY) categories to be included in the Compre-
hensive and Brief ICF Core Sets for ASD. This decision-
making process will involve alternating work group and
plenary sessions, during which participants will discuss
and vote on the categories to be included in the Compre-
hensive ICF Core Set. After the Comprehensive ICF Core
Set is decided, a ranking process will be followed to select
the categories for the Brief ICF Core Set.
Phase II
Phase II will consist of reliability and validity studies of
the ICF Core Sets for ASD in various settings (clinic,
school, home, workplace). Specific aims of this Phase II
study include: (1) to confirm whether categories included
in the ICF Core Sets for ASD describe the entire spectrum
of typical problems encountered by individuals with ASD
from a global perspective; (2) to identify possible relevant
categories missing from the ICF Core Sets for ASD; and (3)
to examine the applicability of the categories of the ICF
Core Sets in different contexts, for different purposes, and
from different perspectives. An international, cross-
sectional, multicenter validation study with individuals
with ASD will be conducted to study the content validity
and feasibility of the ICF Core Sets for ASD.
Conclusion
The complex nature of ASD requires a multidisciplinary
and multilevel approach to assessment and intervention
aimed at improving functioning and quality of life.
Developing ICF Core Sets for ASD aims to meet this need
by providing research and clinical practice with terminol-
ogy and definitions of functioning that are universally
applicable and understandable irrespective of country
and cultural borders. ICF Core Sets for ASD are designed
to be used as a guide for the practical use of the ICF(-CY)
170 Blte et al./ICF Core Sets for ASD
in the context of ASD. In this project, both Comprehen-
sive and Brief Core Sets will be developed. The Compre-
hensive Core Set will include those ICF(-CY) categories
that reflect the entire spectrum of challenges that indi-
viduals with ASD may encounter and should provide
clinicians with a basis for a thorough and interdisciplin-
ary assessment of functioning, for the formulation of
intervention goals, and for the evaluation of progress in
treatment. The Brief Core Set will be derived from the
Comprehensive Core Set and will capture the essence of
functioning in ASD with a smaller number of categories.
It is intended to be the starting point for basic clinical
documentation and the minimal standard for describing
functioning in ASD in clinical and epidemiological
studies.
Certain challenges need to be taken into account in the
process described here, and they have been met with an
international Steering Committee (SC). The SC consists of
experts in the field of ASD from different disciplines and
WHO regions who guide the development process of ICF
Core Sets for ASD. One of the pivotal issues to tackle is
that ASD persists across the life span, and both symptoms
and needs may vary in nature and severity with age
[Billstedt et al., 2007; Seltzer et al., 2003]. The SC decided
that the Comprehensive ICF Core Set for ASD should be
applicable across the life span, while two or more Brief
ICF Core Sets for ASD could be developed specific to
developmental stages, if needed. The four preparatory
studies will be decisive in determining if several Brief ICF
Core Sets will be necessary in ASD, and if so, for which
specific developmental stages. The results from the pre-
paratory studies will be grouped according to develop-
mental stages: childhood, adolescence, and adulthood.
This is preferred over a grouping according to age,
because the ages for developmental stages differ across
countries and cultures. Depending on the ICF(-CY) cat-
egories included in the different groups, the SC will be
able to decide on the adequate number of meaningful
brief ICF Core Sets for ASD, and the developmental stages
to which they should apply. These Comprehensive and
Brief ICF Core Sets for ASD will then be determined by a
group of independent experts during the international
Consensus Conference.
The SC also addressed another well-known challenge
in ASD research: the common co-occurrence of other
neurodevelopmental and psychiatric disorders [Joshi
et al., 2010, 2012] that may lead to functional impair-
ments which are difficult to distinguish from those result-
ing directly from ASD. Since the ICF Core Sets for ASD
will be designed to be representative of the majority of
the population with this specific disorder, it was decided
that any functional impairment that is commonly expe-
rienced by individuals with ASD, whether or not it results
directly from the disorder, should be included in the ICF
Core Sets for ASD in order for them to be representative
INSAR
tools and to be in accordance with the biopsychosocial
model on which the ICF(-CY) is based. In conclusion, the
Consensus Conference will provide us with a first version
of the ICF Core Sets for ASD, and subsequent testing and
validation will be needed before a standardized and uni-
versally accepted tool for the classification of functioning
in ASD is available. The project described in this paper
forms a crucial step toward the development of ICF Core
Sets for ASD.
Acknowledgments
The development of the ICF Core Sets for ASD is a coop-
erative effort between WHO, the ICF Research Branch, a
partner of the WHO Collaboration Centre for the Family
of International Classifications in Germany (at DIMDI),
the International Society for Autism Research (INSAR),
and the Center of Neurodevelopmental Disorders at the
Karolinska Institutet (KIND) in Sweden.
Guidance on this project is provided by a Steering
Committee comprised of key opinion leaders in the
field of ASD from all six WHO regions. This Steering
Committee consists of the coauthors of this paper, as
well as Mats Granlund, Judith Hollenweger, Omar
Al-Modayfer, Susan Swedo, Bruce Tonge, Cory Shulman,
and Bedirhan stn.
References
lvarez, A.S. (2012). The application of the international classi-
fication of functioning, disability, and health in psychiatry:
Possible reasons for the lack of implementation. American
Journal of Physical Medicine and Rehabilitation, 91(Suppl),
S69S73. doi:10.1097/PHM.0b013e31823d4f1c.
American Psychiatric Association. (2000). Diagnostic and statis-
tical manual of mental health disorders (4th ed. text rev.).
Washington, DC: Author.
Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., et al.
(2006). Prevalence of disorders of the autism spectrum in a
population cohort of children in South Thames: The Special
Needs and Autism Project (SNAP). Lancet, 368, 210215.
doi:10.1016/S0140-6736(06)69041-7.
Billstedt, E., Gillberg, I.C., & Gillberg, C. (2007). Autism in
adults: Symptom patterns and early childhood predictors.
Use of the DISCO in a community sample followed from
childhood. Journal of Child Psychology and Psychiatry, 48,
11021110. doi:10.1111/j.1469-7610.2007.01774.x.
Castro, S., Ferreira, T., Dababnah, S., & Pinto, A.I. (2013). Linking
autism measures with the ICF-CY: Functionality beyond the
borders of diagnosis and interrater agreement issues. Devel-
opmental Neurorehabilitation, 16, 321331. Early Online.
doi:10.3109/17518423.2012.733438.
Castro, S., & Pinto, A.I. (2013). Identification of core functioning
features for assessment and intervention in Autism Spectrum
Disorders. Disability & Rehabilitation, 35, 125133. doi:
10.3109/09638288.2012.690494.
INSAR Blte et al./ICF Core Sets for ASD
Cerniauskaite, M., Quintas, R., Boldt, C., Raggi, A., Cieza, A.,
et al. (2011). Systematic literature review on ICF from 2001
to 2009: Its use, implementation and operationalisation. Dis-
ability and Rehabilitation, 33, 281309. doi:10.3109/
09638288.2010.529235.
Cieza, A., Geyh, S., Chatterji, S., Kostanjsek, N., stn, B., &
Stucki, G. (2005). ICF linking rules: An update based on
lessons learned. Journal of Rehabilitation Medicine, 37, 212
218. doi:10.1080/16501970510040263.
Fayed, N., Cieza, A., & Bickenbach, J.E. (2011). Linking health
and health-related information to the ICF: A systematic
review of the literature from 2001 to 2008. Disability and
Rehabilitation, 33, 19411951. doi:10.3109/09638288.2011
.553704.
Gan, S.M., Tung, L.C., Yeh, C.Y., & Wang, C.H. (2013). ICF-CY
based assessment tool for children with autism. Disability &
Rehabilitation, 35, 678685. doi:10.3109/09638288.2012
.705946.
Ibragimova, N., Granlund, M., & Bjrck-kesson, E. (2009). Field
trial of ICF version for children and youth (ICF-CY) in
Sweden: Logical coherence, developmental issues and clinical
use. Developmental Neurorehabilitation, 12, 311. doi:10
.1080/17518420902777001.
Idring, S., Rai, D., Dal, H., Dalman, C., Sturm, H., et al. (2012).
Autism spectrum disorders in the Stockholm youth cohort:
Design, prevalence and validity. PLoS ONE, 7, e41280.
doi:10.1371/journal.pone.0041280.
Joshi, G., Petty, C., Wozniak, J., Henin, A., Fried, R., et al. (2010).
The heavy burden of psychiatric comorbidity in youth with
autism spectrum disorders: A large comparative study of a
psychiatrically referred population. Journal of Autism and
Developmental Disorders, 40, 13611370. doi:10.1007/
s10803-010-0996-9.
Joshi, G., Wozniak, J., Petty, C., Martelon, M.K., Fried, R., et al.
(2012). Psychiatric comorbidity and functioning in a clini-
cally referred population of adults with autism spectrum
disorders: A comparative study. Journal of Autism and Devel-
opmental Disorders, 43, 13141325. doi:10.1007/s10803-
012-1679-5.
Kanne, S.M., Gerber, A.J., Quirmbach, L.M., Sparrow, S.S.,
Cicchetti, D.V., & Saulnier, C.A. (2011). The role of adaptive
behavior in autism spectrum disorders: Implications for func-
tional outcome. Journal of Autism and Developmental Dis-
orders, 41, 10071018. doi:10.1007/s10803-010-1126-4.
Klitz, U., van der Heijde, D., Cieza, A., Boonen, A., Stucki, G.,
et al. (2011). Developing and validating an index for measur-
ing health in patients with ankylosing spondylitis. Rheuma-
tology (Oxford, England), 50, 894898. doi:10.1093/
rheumatology/keq315.
Kostanjsek, N. (2011). Use of The International Classification of
Functioning, Disability and Health (ICF) as a conceptual
framework and common language for disability statistics and
health information systems. BMC Public Health, 11(Suppl 4),
S3. doi:10.1186/1471-2458-11-S4-S3.
Kuhlthau, K., Orlich, F., Hall, T.A., Sikora, D., Kovacs, E.A., et al.
(2010). Health-related quality of life in children with autism
spectrum disorders: Results from the autism treatment
network. Journal of Autism and Developmental Disorders,
40, 721729. doi:10.1007/s10803-009-0921-2.
171
Levy, S.E., Mandell, D.S., & Schultz, R.T. (2009). Autism. The
Lancet, 9701, 16271638. doi:10.1016/S0140-6736(09)61376-3.
Orsmond, G.I., Wyngaarden Krauss, M., & Mailick Seltzer, M.
(2004). Peer relationships and social and recreational activi-
ties among adolescents and adults with autism. Journal
of Autism and Developmental Disorders, 34, 245256.
doi:10.1023/B:JADD.0000029547.96610.df.
Peyrin-Biroulet, L., Cieza, A., Sandbom, W.J., Coenen, M.,
Chowers, Y., et al.; International Programme to Develop New
Indexes for Crohns Disease (IPNIC) Group. (2012). Develop-
ment of the first disability index for inflammatory bowel
disease based on the international classification of function-
ing, disability and health. Gut, 61, 241247. doi:10.1136/
gutjnl-2011-300049.
Rauch, A., Lckenkemper, M., & Cieza, A. (2012). Introduction
to the international classification of functioning, disability
and health. In J.E. Bickenbach, A. Cieza, A. Rauch, & G. Stucki
(Eds.), ICF Core Sets: Manual for clinical practice (pp. 413).
Gttingen: Hogrefe Publishing.
Seltzer, M.M., Krauss, M.W., Shattuck, P.T., Orsmond, G., Swe, A.,
& Lord, C. (2003). The symptoms of autism spectrum dis-
orders in adolescence and adulthood. Journal of Autism
and Developmental Disorders, 33, 565581. doi:10.1023/
B:JADD.0000005995.02453.0b.
Shipman, D.L., Sheldrick, R.C., & Perrin, E.C. (2011). Quality
of life in adolescents with autism spectrum disorders: Reli-
ability and validity of self-reports. Journal of Developmental
& Behavioral Pediatrics, 32, 8589. doi:10.1097/DBP
.0b013e318203e558.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., &
Baird, G. (2008). Psychiatric disorders in children with autism
spectrum disorders: Prevalence, comorbidity, and associated
factors in a population-derived sample. Journal of American
172 Blte et al./ICF Core Sets for ASD
Academy of Child and Adolescent Psychiatry, 47, 921929.
doi:10.1097/CHI.0b013e318179964f.
Stucki, G., & Cieza, A. (2008). The international classification of
functioning, disability and health (ICF) in physical and reha-
bilitation medicine. European Journal of Physical and Reha-
bilitation Medicine, 44, 299302.
Stucki, G., & Grimby, G. (2004). Applying the ICF in medicine.
Journal of Rehabilitation Medicine, 36 (Suppl. 44), 56.
doi:10.1080/16501960410022300.
Travernor, L., Barron, E., Rodgers, J., & McConachie, H. (2012).
Finding out what matters: Validity of quality of life measure-
ment in young people with ASD. Child: Care, Health
and Development, 39, 592601. doi:10.1111/j.1365-
2214.2012.01377.x.
stn, B., Chatterji, S., & Kostanjsek, N. (2004). Comments from
WHO for the Journal of Rehabilitation Medicine special supple-
ment on ICF Core Sets. Journal of Rehabilitation Medicine, 36
(Suppl. 44), 78. doi:10.1080/16501960410015344.
World Health Organization. (1992a). International statistical
classification of diseases and related health problems, 10th
Revision (ICD-10). Geneva: WHO.
World Health Organization. (1992b). International classification
of diseases: Diagnostic criteria for research (10th ed.). Geneva:
WHO.
World Health Organization. (2001). International classification
of functioning, disability and health: ICF. Geneva: World
Health Organization.
World Health Organization. (2003). ICF checklist version 2.1a,
clinicians form for international classification of functioning,
disability and health. Geneva: World Health Organization.
World Health Organization. (2007). International classification
of functioning, disability and health: Children and youth
version: ICF-CY. Geneva: World Health Organization.
INSAR