Operationalizing the ICF Framework in Adults with Severe Intellectual Disability: A Targeted Scoping Review and Selection of Process-Oriented Assessment Tools

This working paper is part of the Casa Santa Rosa resources and tools ecosystem (https://www.casasantarosa.it/risorse-e-strumenti), Abstract: In adults with severe intellectual disability, chronicity and profound functional impairment limit the clinical usefulness of categorical diagnoses and outcome-oriented assessment models. Although the International Classification of Functioning, Disability and Health (ICF) is widely endorsed as a conceptual framework, its implementation in everyday clinical practice remains challenging, particularly in high-support settings. This paper presents a conceptual and methodological reflection on how the adoption of process-sensitive constructs may support the operationalization of the ICF in adults with severe intellectual disability, with specific reference to the domains of activity and participation. Two core constructs are examined: emotional regulation and active relational engagement. These constructs are theorized as foundational conditions that enable or constrain meaningful participation, rather than as outcomes to be achieved. A focused scoping review was conducted using the APA PsycINFO database to identify observational or proxy-based assessment tools aligned with these constructs and applicable to adult populations with severe intellectual disability. The review highlights a marked scarcity of instruments specifically designed to capture process-level changes in everyday functioning. Existing adaptive behavior scales (e.g., ABAS-3, Vineland-3) show partial relevance for emotional regulation but remain limited in their sensitivity to in-session and context-dependent variations. No clinically feasible, ICF-compatible tools were identified for the direct assessment of active engagement in routine care settings. The findings underscore a persistent methodological gap between the theoretical endorsement of the ICF and its practical application in chronic care contexts. The paper argues for a shift from outcome-based evaluation toward process-oriented assessment and calls for the development of ecologically valid, practice-friendly tools capable of capturing micro-level changes in functioning among adults with severe intellectual disability.