From Diagnosis to Functioning: Identifying Process-Sensitive Constructs for ICF-Based Practice in Severe Intellectual Disability

This working paper is Part of the Casa Santa Rosa resources and tools ecosystem (https://www.casasantarosa.it/risorse-e-strumenti), Abstract (in English): In severe adult intellectual disability, conditions of chronicity and profound functional impairment limit the applicability of categorical diagnoses and outcome-oriented assessment models. In such contexts, the International Classification of Functioning, Disability and Health (ICF) is often acknowledged at a theoretical level but remains difficult to operationalize in everyday clinical practice. Through a comparative framework, this paper proposes a conceptual and methodological reflection on how process-sensitive constructs may support the implementation of the ICF in severe intellectual disability, with specific reference to activity and participation. By contrasting traditional clinical and behavioral constructs with process-oriented alternatives, the paper argues that constructs such as active engagement and emotional regulation may offer a more ecologically valid lens for interpreting functioning in highly supported settings. Chronicity is framed not as a marker of therapeutic failure, but as a stable condition of functioning requiring sustainable, person-centered, and process-based forms of intervention.