ICF-CY and early childhood development

By: Lamiaa Elrashidy
Assistant lecturer of child health – Kindergarten Faculty-
Alexandria University

Content
Importance of
early
childhood
period
The current
status of early
childhood
development
Developmental
Delay
(definitions
and risk
factors)
International
classifications
ICF-CY
applications
Early
childhood
intervention
services

,
which spans the period
up to 8 years of age, is
critical for cognitive,
social, emotional and
physical development.
The formative years: UNICEF’s work on measuring early childhood [internet]. 1st ed. New York: UNICEF; 2014 [cited 14 March
2017]. Available from:
https://data.unicef.org/wp-content/uploads/2015/12/Measuring-ECD-Brochure-HR-10_8_116.pdf.

Brain
plasticity
Genetics
Environment
Optimal brain development requires a stimulating
environment, adequate nutrients and social
interaction with attentive caregivers.
Child
development
Nature
( genetics-
biomedical risks)
Nurture
( the caregiving
environment)

4.2 By 2030, ensure that all girls and boys have access to
quality early childhood development, care and pre-primary
education so that they are ready for primary education.
Target, 4.2, has two indicators:
- Proportion of children under 5, who are developmentally on track in health, learning, and psychosocial
well-being.
- Participation rate in organized learning, and that is essentially pre-primary education during the year
before official primary schooling begins.

https://data.unicef.org/wp-content/uploads/2017/04/SDGs-publication-SPREADS-WEB.pdf

(MICS4)
ECD Index is a measurement tool consisting of a set of 10
questions that assess child development across four
domains:
Learning
Literacy/Numeracy
Physical Development
Social/Emotional Development
https://www.unicef.org/earlychildhood/files/MICS4_Regional_Data_Analysis_-_MENA_-_12_July_2013.pdf

▪In the majority of the 58 countries with available data, more
than half of children aged 3 to 4 are developmentally on
track.
▪In all countries with comparable data, more than 85 per cent of
children this age are considered to be on track in their physical
development.
▪With regard to learning and social-emotional development,
the proportions of children on track vary widely but are above
50 per cent in nearly all countries.
▪Children are least likely to be considered on track in the area of
literacy-numeracy.

▪ Available data indicate that children who attend ECCE
programmes are more likely to be developmentally on track
than those who do not.
▪ Children from the poorest quintile continue to be disadvantaged
in access to quality ECCE, and data from 43 countries show
they are less likely to achieve relevant milestones in literacy-
numeracy

➢The true prevalence of developmental difficulties in children aged 0–3
years is unknown.
➢The percentage of children screening positive for, or at risk of,
disability in Multiple Indicator Cluster Surveys (MICSs) carried out in
18 countries in 2005–2006 was a median 23% (range 3–48%) of
children aged 2–9 years screened positive for disability (Gottlieb et al.,
2009).
Developmental difficulties in early childhood: Prevention, early identification, assessment and intervention in low- and middle-
income countries [internet]. 1st ed. Geneva: WHO; 2012 [cited 14 March 2017]. Available from:
http://www.who.int/maternal_child_adolescent/documents/development_difficulties_early_childhood/en/.

• Developmental disabilities are common and were reported in ∼1 in
6 children in the United States in 2006–2008.
• The number of children with selected developmental disabilities
(autism, attention deficit hyperactivity disorder, and other
developmental delays) has increased, requiring more health and
education services.
Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan M. Trends in the prevalence of
developmental disabilities in US children, 1997-2008. Pediatrics. 2011;127(6):1034–42.

In Egypt, children under 9 years old constitute 21.8% of total
population (11.3% are under five years old) in 2015.
unfortunately, there are no population based specific data about early
childhood developmental difficulties and the only early childhood
development indicators that had been examined, were:
• prenatal care
• skilled attendant at
delivery
• neonatal mortality
• infant mortality
• fully immunized
• stunting/height-for-age
• salt iodization
• early childhood care and
education.
Early childhood development in Egypt [Internet]. World Bank. 2017 [cited 14 March 2017]. Available from:

47 48 47
34
50
total male female poorest 20% richest 20%
Attendance in early childhood
Education 2005–2014*
Attendance in early childhood development
https://data.unicef.org/country/egy/
https://data.unicef.org/resources/state-worlds-children-2016-report/
4 4 4
7
2
total male female poorest 20% richest 20%
Children left in inadequate care 2005–2014*
Children left in inadequate care 2005–2014*

“Developmental delay” is often defined as a deviation of
development from the normative milestones in the areas of
cognitive, language, social, emotional and motor functioning.

The Adaptive Developmental Quotient (DQ) is a ratio of the
functional age to the chronological age. It is a means to simply express
a developmental delay.
• developmental quotient =
((developmental age) / (chronological age)) * 100
Developmental Quotient Interpretation
=>85 normal
71-84 mild-to-moderate delay
=<70 severe delay (- 2 SD)
http://www.meducator3.net/algorithms/content/developmental-quotient-dq

• Global developmental delay was defined as a significant delay
in two or more developmental domains (gross/fine motor,
cognition, speech/language, personal/social, or activities of daily
living).
• Motor delay was defined as a significant delay in gross and/or
fine motor skills with preservation of age appropriate
performance in other developmental domains.
• Developmental language disorders (DLD) were defined as a
significant delay restricted to speech and language skills with
normal performance in other developmental domains.
http://reseauconceptuel.umontreal.ca/rid=1MWJVHPQ1-Q7RY39-
1D0/GDD_Etiologic%20determination%20of%20childhood%20developmental%20delay.pdf

Biological & psychosocial
Categorical
DC 0-3R: “psychosocial and environmental stressors”
The Bright Futures guidelines (Council on Children with
Disabilities, 2006): risks related to the child, family and
community

Fitness Function Family
Fun Friendship Future
Kraus de camargo o. Children are the future - their development matters report. BJMHH : ResearchGate; 2016.
(vol. 4, no. 1). Available from: https://www.researchgate.net/publication/298731861_children_are_the_future_-
_their_development_matters_report_first_international_developmental_pediatrics_congress
https://www.canchild.ca/en/research-in-practice/f-words-in-childhood-disability

An in-depth knowledge of the functioning and needs of
the child, family and community is often more important
than the category of the pathology.

▪ The WHO Family of International Classifications (WHO-FIC) is
comprised of classifications that have been endorsed by the World
Health Organization to describe various aspects of the health and the
health system in a consistent manner.
▪ The development of the WHO-FIC is managed by the Family
Development Committee (FDC) on behalf of the WHO-FIC Network.
▪ The FDC meets twice a year in April and October for face-to-face
discussions to review and advise on the development of the Family of
Classifications.
http://www.who.int/classifications/en/FamilyDocument2007.pdf

Types of Classifications in the WHO Family
Related
Classification
International Classification of
Primary Care (ICPC)
External Causes of Injury
(ICECI)
The Anatomical, Therapeutic,
Chemical (ATC) classification
system with Defined Daily
Doses
ISO 9999 Technical aids for
persons with disabilities
Reference
Classifications
International
Classification of
Diseases (ICD)
International
Classification of
Functioning, Disability
and Health (ICF)
International
Classification of Health
Interventions (ICHI)
Derived
Classifications
Diseases for Oncology, Third
Edition (ICD-O-3)
The ICD-10 Classification of
Mental and Behavioural
Disorders
Application of the ICD to
Dentistry and Stomatology,
Third Edition (ICD-DA)
Application of the ICD to
Neurology (ICD-10-NA)
ICF Version for Children and
Youth (ICF-CY)
http://www.who.int/classifications/en/FamilyDocument2007.pdf

The DC: 0-3 was published by Zero to Three in 1994, as a
systematic, developmentally based approach to classification of
mental health and developmental disorders in infancy and early
childhood.
A revised version of DC: 0-3, DC: 0-3R, was published in 2005.
DC:0–5™ was published in 2016

• The ICD is a disease-oriented categorical system
• The ICD-10 is currently being updated to the ICD-11 to be released
in 2017.
• the ICD-10 contains a section entitled Behavioural and Emotional
Disorders with Onset Usually Occurring in Childhood and
Adolescence.
• The ICD, however, does not capture all the clinical information that
is necessary to define and classify developmental difficulties.
• Furthermore, healthy developmental functioning cannot be classified
using the ICD system alone.
• Currently, researchers and advocates of the WHO classification
systems are recommending:
ICD ICF-CY

➢It was previously the International Classification of Impairments,
Disabilities, and Handicaps (ICIDH), which was first published by
WHO for trial purposes in 1980.
➢ICF; it was endorsed for international use by the Fifty-fourth World
Health Assembly in 2001.
➢The ICF version for children and youth (ICF-CY) has recently been
derived from the ICF, WHO, 2007)

▪ The ICF is based on the biopsychosocial model of functioning.
▪ Essential to the biopsychosocial model is that an individual’s level of
functioning is the outcome of a complex interaction between health
condition,
• body functions (b) (physiological functions of body systems) and
• body structures (s) (anatomical parts of the body),
• Activities (d)(execution of a task)and Participation (d)(involvement
in life situations),
• environmental factors (e) (physical, social, and attitudinal
environment), and
• personal factors (features intrinsic to the individual).

http://article.sciencepublishinggroup.com/pdf/10.11648.j.ijnpt.20160201.12.pdf

contributes in serving individuals with intellectual
and developmental disabilities as it is:
1. a unifying framework for interdisciplinary work,
2. a classification of dimensions of functioning and health,
3. profiles of functional characteristics and limitations,
4. clarification of diagnoses and comorbidity, functional
indicators for framing intervention and outcomes,
Simeonsson R. ICF-CY: A universal tool for documentation of disability. J Policy Pract Intellect Disabil. 2009 [cited 15 March
2017];6(2):70-72.

5. identification of environmental barriers and facilitators,
6. continuity of documentation in transitions across services and
time,
7. Common language for data management and health informatics
and
8. Standard reference for defining rights of children and adults with
disabilities.

Linking ICF-CY to data systems within and across services
and sectors
Design and use of checklists or screening tools
Use in intervention
Core sets
Code sets

Linking the early
development
instrument with
the ICF-CY
An ICF-CY-based content analysis of the
Vineland Adaptive Behavior Scales-II

• 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 and on which
assessment tools (e.g. questionnaires, interviews, observation
scales, checklists) are based.
• For example:
- ICF Core Set for CP for CY
- ICF Core Set for Autism Spectrum
- ICF Core Set for ADHD

ICF-CY Developmental Code Sets
• Identify limited ICF-CY codes by expert consensus to
document essential physical and developmental
characteristics, functions and skills of children by four
developmental age groups (0-2, 3-5, 6-12, 13-17)
Birth-2
3-5
6-12
13-17
Ellingsen K, Simeonsson R. ICF-CY developmental code sets [Internet]. WHO ICF-CY
developmental code sets. 2011 [cited 8 March 2017]. Available from:
http://www.icfcydevelopmentalcodesets.com/.

https://www.icf-training.eu/index.php?menupos=1

https://www.icfcy-meduse.eu/index.php?menupos=2

Development and validation of the ICF-CY-Based Functioning
Scale of the Disability Evaluation System—Child Version in
Taiwan (FUNDES-Child) (6.0–17.9 years).
Matrix of Assessment of Activities and Participation – MAAP
(up to 6 years of age) (ASD- other developmental disabilities-
typical children)
http://www.sciencedirect.com/science/article/pii/S092966461500354X
http://www.tandfonline.com/doi/abs/10.3109/17518423.2013.806963?journalCode=ipdr20

Early Intervention services are designed to meet the developmental
needs of children, from birth to three or five years of age, who
have a delay in physical, cognitive, communicative, social, emotional
or adaptive development or have a diagnosed condition that has a
high probability of resulting in developmental delay.
EI
services
Home
based
Centre
based
EI
services
Services
to the
child
Services
to the
family

Diagnosis of health problems, needs assessment and development of an EI plan
Family education
Physical therapy
Psychological and psychiatric support and treatment for child and family
Nutritional support
Nursing care services
Orthoses and prosthetics

Special education
Occupational therapy
Audiological services
Speech and language therapy
Special care for visual and hearing impairment
Transportation services to EI.
Coordination of care

ICF-CY and early childhood development

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