Reconciling the seemingly irreconcilable: The WHO's ICF system integrates biological and psychosocial environmental determinants of autism and ADHD: The International Classification of Functioning (ICF) allows to model opposed biomedical and neurodiverse views of autism and ADHD within one framework
Open accessAbstract
Neurodevelopmental disorders (NDDs), such as autism and ADHD, are behaviorally defined adaptive functioning difficulties arising from variations, alterations and atypical maturation of the brain. While it is widely agreed that NDDs are complex conditions with their presentation and functional impact underpinned by diverse genetic and environmental factors, contemporary and polarizing debate has focused on the appropriateness of the biomedical as opposed to the neurodiverse paradigm in framing conceptions of these conditions. Despite being largely overlooked by both research and practice, the International Classification of Functioning Disability and Health (ICF) endorsed by the World Health Organization in 2001 views functioning dynamically, offering a framework for investigating, assessing and treating NDDs holistically. Exemplified by autism and ADHD, we argue that the ICF provides not only a multitude of opportunities in accounting for the environmental determinants in researching and clinically managing NDDs, but opportunities for harmonizing the seemingly irreconcilable biomedical and neurodiverse paradigms. Also see the video abstract here: https://youtu.be/YwuWPDUOs5k
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We already see signs of mutual accommodation in the World Health Organisation's International Classification of Functioning Disability and Health (ICF), as described in a recent review by Bölte et al., and in recent developments regarding the importance of optimising the person-environment fit.
“We already see sign of that third possibility in the World Health Organisation’s International Classification of Functioning Disability and Health (ICF), as described in a recent review by Bölte et al. (2021), and in recent developments regarding the importance of optimising the person‐environment fit (Lai, Anagnostou, Wiznitzer, Allison, & Baron‐Cohen, 2020; Mandy & Lai, 2016).”
From Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism science (2022) · cites this paper as Bölte et al., 2021
The change is also beginning to be reflected in academic discussions, with a flurry of review papers, perspective pieces and edited books published in the last 12 months alone.
“It is also beginning to be reflected in academic discussions, with a flurry of review papers, perspective pieces and edited books published in the last 12 months alone (Bertilsdotter Rosqvist et al., 2020; Bölte, Lawson, Marschik, & Girdler, 2021; Davis & Crompton, 2021; Kapp, 2020; Leadbitter, Buckle, Ellis, & Dekker, 2021; Mitchell et al., 2021; Walker & Raymaker, 2020).”
From Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism science (2022) · cites this paper as Bölte, Lawson, Marschik, & Girdler, 2021
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Self-citation
- Authors
- Bölte, S., Lawson, W. B., Marschik, P. B., & Girdler, S.
- Affiliations
- Curtin University (AU)
- Medical University of Graz (AT)
- The University of Western Australia (AU)
- Corresponding author
- Bölte, Sven
- Venue
- BioEssays
- Publisher
- Wiley
- Published
- 2021-04
- Volume
- 43
- Issue
- 9
- Pages
- e2000254-e2000254
- ISSN
- 0265-9247 (ISSN-L)
- 1521-1878
- OpenAlex
- W3141783342
- Cited by
- 99
- References
- 67
- Citations by year
- 2026: 21 · 2025: 21 · 2024: 28 · 2023: 17 · 2022: 10 · 2021: 2
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BioEssays (publishedVersion, cc-by-nc-nd)
- UWA Profiles and Research Repository (UWA) (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Safety Research › Disability Rights and Representation
- Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
- Keywords
- International Classification of Functioning, Disability and Health, autism spectrum disorder, attention deficit hyperactivity disorder, neurodevelopmental disorders, biomedical model, neurodiversity paradigm, biological determinants, adaptive behavior, disability classification, World Health Organization
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Fertilization, Humans, World Health Organization, International Classification of Functioning, Disability and Health
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