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Ambul Pediatr. 2007 Jan-Feb;7(1 Suppl):132-9.

Using the international classification of functioning, disease and health in attention-deficit/hyperactivity disorder: separating the disease from its epiphenomena.

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World Health Organization, Geneva, Switzerland.


This paper discusses the description of attention-deficit/hyperactivity disorder (ADHD) as a possible "disease entity" and the "disabilities" associated with it. It builds on the nosological descriptions of ADHD from International Classification of Disease (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) perspectives and introduces the distinct disability dimension from the International Classification of Functioning, Disability and Health (ICF) perspective. It advocates for separating assessment of disease and disability dimensions and then utilizing these constructs jointly by using both the ICD and ICF classifications. The ICF analyzes functioning in relation to a health condition in terms of 1) body functions and body structures, 2) activities of the person and participation of the person in society, and 3) contextual factors such as environmental factors and personal factors. The separation of signs/symptoms and consequences permits better understanding of the disease pathophysiology on the one hand and the consequences (eg, its impact on the person, family, peers, school, work, and social life) on the other hand. It will therefore enable us to better understand the nature of ADHD because the core body functions associated with the disorder will be better delineated. In addition, capturing environmental factors may help people with ADHD by modifying their environments. The ICF provides a good outcome monitoring and evaluation tool for the assessment of treatment response. As in many other disorders, diagnosis alone is not a sufficient predictor of health care needs, utilization, costs, or outcomes. When one adds disability as a predictor, our capacity to predict these parameters is increased dramatically. It is therefore suggested that the ICF framework be considered in future ADHD research activities.

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