Daily Functional Characteristics of Adolescents With Neurodevelopmental Disabilities According to the International Classification of Functioning,Disability and Health Model

Abstract

Date Presented 4/19/2018

Adolescents with executive function deficits experience difficulties in their daily functioning that are not always visible. Some of them are diagnosed and some are not. This study highlighted these adolescents’ difficulties by comparing their performance with that of typically developing peers.

Primary Author and Speaker: Yael Fogel

Contributing Authors: Sara Rosenblum, Naomi Josman

RATIONALE AND BACKGROUND: The purpose of this study was to compare the functional characteristics of adolescents with neurodevelopmental disabilities (NDD) to those of adolescents with typical development (TD).

Adolescents with NDD, which include learning disabilities, attention deficit disorders, and developmental coordination disorder, demonstrate poor performance and activity and participation challenges in different occupational areas. Difficulties in metacognitive components, particularly executive functions (EF), may be the underlying mechanisms of these disabilities and challenge the daily functioning of this population. Knowledge about the daily functional difficulties they experience is scarce. This knowledge is necessary to enable occupational therapy practitioners to tailor evaluation and intervention for these adolescents.

DESIGN: This comparative study examined adolescents with and without NDD who experienced difficulties in daily functioning and EF. Three levels of functioning were evaluated according to the World Health Organization (2001) International Classification of Functioning, Disability and Health (ICF) model: body functions (metacognition—EF and awareness), daily activities, and participation.

METHOD: Eighty-one adolescents aged 10–18 met the inclusion criteria. The NDD group (n = 41) comprised adolescents with EF deficits according to parent report on the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000; score of ≥65 in one of the indexes). The TD control group (n = 40) included age- and gender-matched adolescents with typical daily EF according to the BRIEF (scores of <50 in the indexes).

Extensive information on the medical, developmental, personal, educational, and functional history of the participants was gathered using a parent questionnaire. Differences between adolescents with and without NDD were examined according to the ICF levels. EF components were assessed using WebNeuro (Brain Resource, San Francisco, CA) neuropsychological testing and the BRIEF–Self-Report (BRIEF–SR; Guy et al., 2004). Performance of daily activities was measured through preparation of a cake and a drink, part of the Children’s Cooking Task (Chevignard et al., 2009), and a paragraph copying task. Participation was assessed with the Participation and Environment Measure for Children and Youth (Coster et al., 2012). A multivariate analysis of variance was performed with IBM SPSS Statistics Version 21 (IBM Corp., Armonk, NY) to examine group differences.

RESULTS: Significant group differences were obtained for all ICF levels. Adolescents with NDD showed significantly more difficulties in EF on both WebNeuro, F(6, 74) = 11.84, p < .001, η² = .49, and the BRIEF–SR, F(8, 68) = 9.03, p < .001, η² = .51, and in the process of writing, F(3, 77) = 5.47, p < .01, η² = .17. A Mann–Whitney U test indicated that adolescents with NDD erred more in preparing the cake and drink and needed more performance time than TD adolescents. Adolescents with NDD showed significantly less participation in daily activities in the home, F(5, 72) = 22.78, p < .001, η² = .61; at school, F(5, 72) = 27.69, p < .001, η² = .65; and in the community, F(5, 72) = 12.16, p < .001, η² = .45, than TD adolescents.

CONCLUSION: Results reflect significant difficulties at all levels for adolescents with NDD. Hidden disabilities present many challenges in all environments. The presence of EF difficulties in adolescents hinders their daily functioning and contributes to the gap between them and their peers at all levels.

IMPACT STATEMENT: At the research-scientific level, this study provides an innovative database describing the daily functioning of adolescents with disabilities. Additionally, data from this study may contribute to the recognition of the needs of this population, to educators’ and therapists’ understanding of the functioning of adolescents with NDD, and to the development of prevention programs to reduce the risks associated with these difficulties.

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