The queues for investigation of autism and adhd, especially within child and adolescent psychiatry, are long and those who are treated with medication are increasing.
But the diagnoses are complex and the question is whether we are wrong? One of Sweden's leading experts in the field, Sven Bölte, is involved in a comprehensive research project where another classification system is being investigated. The purpose is to develop an alternative and complement to today's diagnoses.
People have different challenges and need different support and adaptation. But today's focus on diagnoses misses the person's daily functions and concrete needs. We would need to think completely differently, but it's tough, he says.
Recommended by authority
In fact, there is already a system, ICF, developed by the World Health Organization (WHO) and ratified by 190 countries. ICF focuses not on a diagnosis but on what opportunities and challenges each individual has and how the environment affects. It is already recommended today by the National Board of Health and Welfare, but implementation in Sweden has been slow. Sven Bölte believes it is because the tradition of making diagnoses is so incredibly strong.
ICF is also a fairly blunt tool. But we have, in an international research project, developed shorter versions adapted for autism and adhd that are easier to use, he says.
Together with other researchers, he is driving a study that investigates how these shortlists can be used as an instrument to classify people with ICF.
Not just a care issue
Sven Bölte believes that a shift in focus from diagnoses would mean several benefits. One is that autism and adhd can stop being treated as just a matter for healthcare. Some need medication, but not all and not all the time.
There is a naive belief that if we just shorten the queues to the child and adolescent psychiatry, it will be fine. But this is an issue that concerns the entire society, from school to working life.
Another is that we can become better at seeing the function, the individual's strengths and abilities. Diagnoses are quite unsuitable in today's complex society.
How does a person function in their daily life? Does someone think that school is fun but the classroom is messy? What can we do to adapt? It shouldn't need a diagnosis to meet those needs, but that's how reality looks today.
Fact: New classification
TT
ICF is one of WHO's three major classification systems It includes 1,700 function descriptions in different areas: Body functions – the physiological functions of the body systems, including psychological functions (such as attention) Body structures – anatomical parts of the body, such as organs, limbs, and their components (such as the brain) Activity – a person's performance of a task or action (such as reading, writing) Participation – a person's engagement in a life situation (such as going to school) Environmental factors – the environment in which the person lives and acts, both physically, socially, and attitudinally (such as accessibility and quality of care) Personal factors – other characteristics that can affect function, such as sex, age, and lifestyle Source: Karolinska Institute
