*3.5. Profile of Functioning Using TEA-CIFunciona Version 1.0 (n = 100 Children with ASD)*

Table 3 shows the frequency of the impairments, limitations, and restrictions in daily functioning in the corresponding components of body functions, activities and participation, and environmental factors. In the component body functions, intrapersonal functioning (b125) was considered to be a moderate or severe problem in 61% of the children. A moderate-to-complete problem was observed in reception of language (b1670) in 45% and in expression of language (b1671) in 73%.

In activities and participation, almost 20% of caregivers reported that their children had severe problems in relation to toileting (d530) and eating (d550). Education, considering school and preschool education (d815 and 820), appeared to be a problem in 40% of the sample, with different levels of severity. Speaking (d330) and conversation (d350) were considered moderate to complete problems in 33% and 79% of the children, respectively. Maintaining a relationship (d720 and d7500) and the use of leisure time (d920) were common functional challenges.

Regarding environmental factors, although the majority of parents considered attitudes of people in positions of authority (e430) a facilitator, many (24%) found it to be a barrier. Immediate family (e310) was a facilitator in 97% and health professionals (e355) in 61% of the sample.

Parents most often described problems in dispositions and intra-personal functions (b125), attention functions (b140), perceptual functions (b156), and eating (d550). Overall, support from parents' associations (for example NGOs) was seen as facilitators but appear to be an underused resource for families.

Figure 2A,B summarize the profiles of functioning of children with ASD under 6 years and ≥6 to 16 years, using TEA-CIFunciona version 1.0. As shown, there are many commonalities among the groups; however, each age-group shows unique functional characteristics and environmental factors, for example, in areas of receptive language, coordination of movements, copying skills, speaking, producing non-verbal messages, conversation, and using or accessing products and technologies for communication. Using TEA-CIFunciona, we were able to show that younger children with ASD have greater impact on functioning and less access to products and technology for communication. This information can guide interventions as well as modifications of the environment.


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(**A**)

**Figure 2.** *Cont*.


(**B**)

**Figure 2.** (**A**) Profile of functioning of children with ASD (autism spectrum disorder) < 6 years of age using TEA-CIFunciona version 1.0. (**B**) Profile of functioning of children with ASD 6 to 16 years of age using TEA-CIFunciona version 1.0.

ICF Qualifiers in body functions, body structures and activities and participation: 0 = no problem; 1 = mild problem; 2 = moderate problem; 3 = severe problem; and, 4 = complete problem. ICF Qualifiers in environmental factors: 0 = no barrier/facilitator; +1 = mild facilitator; +2 = moderate facilitator; +3 = substantial facilitator; +4 = complete facilitator; 1 = mild barrier; 2 = moderate barrier; 3 = substantial barrier; and 4 = complete barrier. The component personal factors (pf) does not have ICF categories assigned, therefore it is recommended to add themes representing personal factors to complement the profile of functioning.

The ICF qualifiers used to create the profile of functioning of this study sample represent the qualifiers that have the highest percentage within each ICF category. This profile of functioning was built using the ICF-based documentation form on this web page https://icf-core-sets.org/es/page0.php (accessed on 1 April 2019), courtesy ICF Research Branch. P (performance): describes what an individual does in his or her current environment. C (capacity): describes an individual's ability to execute a task or an action, meaning the highest probable level of functioning that a person may reach in a "standardized" environment.

### **4. Discussion**

This study describes the creation of a novel ICF-based instrument called TEA-CIFunciona version 1.0. This is the first study conducted in Latin America that describes functioning in children with ASD. The contributions of this study are multiple, as follows: (1) identification of the most relevant areas of functioning and disability to standardize assessments of children with ASD in Argentina; (2) proposing a toolbox with standardized scales and questionnaires to operationalize the categories selected; (3) description of the profile of functioning of a large sample of children with ASD (*n* = 100) in the region using the ICF universal language.
