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The vitality, participation and assessment of
environmental factors of children with disabilities aged
2-18
INSTRUCTION MANUAL
Yerevan, 2017
The following Handbook has been developed in the
framework of the “Community Services for Children with
Disabilities” program.
The Community Services for Children with Disabilities regional project is implemented by Save the
Children in five countries: Albania, Armenia, Bosnia and Herzegovina (northwestern Balkans),
Georgia and Kosovo. The goal of the project is to contribute to the development of children’s
capabilities, the development of independence and inclusion into society. It also aims to support
parents and mobilize communities to promote quality services for children with disabilities. In
Armenia, the project partners are “Full Life” and “Armavir Development Center” NGOs. The project
has been implemented between the years 2016-2018 in the regions of Yerevan, Armavir and Ararat.
The basis for the creation of the manual were the methodological guidelines the “Assessment of D
Codes, Individual Activities and Participation Instruments Designed to Identify Disability Based on
the WHO International Classification of Functioning,” written by M. Harutyunyan, L. Grigoryan, A.
Hayrapetyan, L Yesayan and the “Assessment of E Code, Environmental Factors Established for the
Definition of Disability Based on the WHO International Classification of Functioning” written by
M. Harutyunyan and L. Grigoryan, the creation of which was possible thanks to the technical
assistance and expertise of the United Nations Children’s Fund (UNICEF), United Nations
Development Program (UNDP) and USAID Pension Reform Implementation Program
(USAID/PRIP), with the assistance of the Ministry of Labour and Social Affairs of the Republic of
Armenia. The manuals have been developed and tested in the field of disability in the RA within the
framework of reforms being made within the framework of the WHO ICF.
The Opinion of the Ministry of Labour and Social Affairs
The content of the methodological manual is based on the ideology and principles of the WHO
International Classification of Functioning and is consistent with the fundamental and main trends of
the government of the RA’s reforms in the field of disability, simultaneously stemming from the
decision of the RA government on January 12, 2017, of Protocol No. 1 “On the Approval of the
Complex Program of Social Integration of Persons with Disabilities of 2017-2021 and on approving
the list of measures to ensure the implementation of the program.” Based on the above-mentioned,
the Ministry positively assesses the work done and proposes to organize a comprehensive discussion
of the methodological manual, involving representatives of non-governmental organizations and
other stakeholders, in order to ensure their awareness and position.
This methodological manual is designed to evaluate the
difficulties and barriers to the activities and participation of
children and adolescents aged 2-18 years, and for evaluating
the hindering or supporting environmental factors.
Professional Advisor:
Candidate of Pedagogical Sciences, Associate Professor
Marianna Harutyunyan
Editor:
Nune Pepanyan
“Save the Children” expert:
Gohar Galstyan
A questionnaire for children and adolescents aged 2-18 and a methodological manual was created
and developed within the framework of the Community Services for Children With Disabilities
project, based on the WHO ICF principles, the Independent Living Center and Armavir Development
Center professional teams supported by the “Full Life” NGO.
The Authoring Group:
“D” codes: activity and participation (47 code) “Full LIfe” NGO professional team
Candidate of Psychology Ani Avagyan, psychologist Nune Melikyan, ergotherapists Meri Avetisyan
and Tatevik Ghazaryan, speech therapist Anna Malkhasyan, Grigori Mamyan, social worker Lianna
Harutyunyan, assistant to the professional team Anna Nersisyan.
“E” codes: environmental factors (16 code) “Armavir Development Center” NGO professional team
Director Anahit Nahapetyan, Coordinator Margarit Sedrakyan, social workers Armine Stepanyan,
Haykanush Harutyunyan, art therapist Karmen Vardanyan, speech therapist Varditer Hovhannisyan,
special pedagogist Almast Avagyan, psychologist Naira Mkhitaryan, ergotherapist Syuzanna
Torosyan.
Content Introduction....................................................................................................................................... 7
The WHO ICF ideology
……………......................................................................................................... 9
Application procedure of the methodological manual .................................................................... 16
ICF-CY “E” Codes: Environmental Factors.........................................................................................
19
ICF-CY “D” Codes: individuals’ activities in daily life and participation............................................
35
Questionnaire for the assessment of the lifestyle and environmental factors of children with
disabilities between the ages of 2 and 18........................................................................................ 77
Attachments/ Forms .............................................................................................................. 107
Individual summary of assessment results /profile/............................................................. 108
Specialist’s individual intervention plan................................................................................ 110
Revaluation of the individual intervention programme ............................................................
112
Dictionary....................................................................................................................................... 113
References...................................................................................................................................... 118
INTRODUCTION
An important prerequisite for ensuring equitable and affordable conditions for children with
disabilities in Armenia is the introduction of the social model in the process of defining disability.
The definition of disability should not be limited to the disease, which does not provide a
comprehensive assessment of the needs of an individual. Obviously, different people with the same
diagnosis can have different degrees of participation in social life due to individual and environmental
factors. Depending on the individual and the environment, the disability can have a different impact
on the person’s activities. Therefore, as a result of a comprehensive assessment of the individual, it
is necessary to provide adequate social services in order to secure participation and social inclusion,
according to the individual’s capabilities and needs. In order to eliminate subjective approaches in
the process of defining disability, it was necessary to develop appropriate tools and standards that
would take into account the best international practices, while simultaneously being adapted to the
peculiarities of Armenia.
Since 2016, the “Full Life” and “Armavir Development Center” NGOs, with the financial support of
“Save the Children,” have been implementing a three-year project “Community Services for Children
with Disabilities,” which aims to promote the social inclusion of children with disabilities through
multidisciplinary services, participation in social life, as well as creating an environment for children
to live independently. Aside from all this, it was also necessary to develop a unified monitoring and
evaluation system that will enable the monitoring and evaluation of the effectiveness of the services
provided, to effectively manage the process.
Evaluation is the part of information collection, that enables you to identify visitors’ needs, problems
and their current states (Finlay, 2004). A questionnaire for the evaluation of the vitality, participation
and environmental factors for 218 children has been selected and developed as the method for
evaluating the needs of children with disabilities, where detailed degrees of evaluation show the
extent to which a given factor promotes or hinders an individual’s actions, behaviour and participation
in social relations.
WHO ICF METHODOLOGY
The ICF-CY belongs to the “family” of international classifications developed by WHO for the
application to various aspects of health. The WHO Family of International Classifications (WHO-
FIC) provides a framework to code a wide range of information about health (e.g. diagnosis,
functioning and disability, and reasons for contact with health services), and uses a standardized
language permitting communication about health and health care across the world in various
disciplines and sciences. The ICF can be used in a range of areas, such as social security, regulated
health care assessments, as well as for conducting questionnaires among the population at local,
national and international levels. It offers a conceptual framework for information that is applicable
to personal health care, including prevention, health promotion, and the improvement of participation
by removing or mitigating societal hindrances and encouraging the provision of social supports and
facilitators (ICF, 2001). It is also useful for the study of health-care systems, in terms of both
evaluation and policy formulation. The ICF focuses on the strengths of the person, contributing to
their more active participation in public life, including work activities (ICF, 2001).
ICF classifies health and health-related states. The unit of classification is, therefore, categories
within health and health-related domains. It is important to note, therefore, that in ICF persons are
not the units of classification; that is, the ICF does not classify people but describes the situation of
each person within an array of health or health-related domains. Moreover, the description is always
made within the context of environmental and personal factors.
The advantages of the ICF are:
● The ICF emphasizes the strengths of the individual, contributing to their more active
involvement in active life, including work activity.
● The ICF takes into account the role of environmental factors when defining disability.
● The ICF considers the limitations of a person’s activeness and participation, functionality
and vitality as an interaction or complex relationship between the health condition and
contextual factors (i.e. environmental and personal factors).
● The ICF has an extensive list of environmental factors which helps to assess the
environment’s positive or negative impact on the individual’s activities.
Interactions between the components of ICF
The importance and benefits of the application of the ICF
The importance and potential of the ICF are also valued in the development of a common strategy
for the assessment of the needs of children with disabilities in order to promote their rights and
welfare. The ICF presents a common language which helps to develop more targeted policies and
services, responding adequately to the needs of people with disabilities. The ICF takes into account
the role of environmental factors in defining disability. The ICF considers the limitations of a person’s
activeness and participation, functionality and vitality as an interaction or complex relationship
between the health condition and contextual factors (i.e. environmental and personal factors). The
ICF contains an extensive list of environmental factors which helps to evaluate the positive
(supporting) or negative (hindering) impact of the environment on the individual’s activities. The ICF
is a framework that describes human functionality in an ongoing process. It classifies functions, not
people. The ICF classifies health and health-related indicators, and the latter allows for making the
right choice in describing a person in a given situation. Moreover, this description can be made in the
context of environmental and individual factors.
The International Classification of Functioning, Disability and Health for Children and Youth (ICF-
CY) is a derived version of the International Classification of Functioning, Disability and Health
(ICF, WHO, 2001) designed to record characteristics of the developing child and the influence of
environments surrounding the child. The age range covered by the ICF-CY is from birth to 18 years
of age and can be used by all persons dealing with the health, education and well-being of children
and youth. It can be viewed as a common and universal language for clinical, public health and
research applications to facilitate the documentation and measurement of health and disability in
children and youth (ICF, 2001). The classification builds on the ICF conceptual framework and uses
a common language and terminology for recording problems involving functions and structures of
the body, activity limitations and participation restrictions manifested in infancy, childhood and
adolescence and relevant environmental factors.
The ICF uses a coding system
● Body Function: the functions of the body are denoted with the code “b.”
● Body Structure: the anatomical parts of the body (organs, limbs and their components); is
denoted with the code “s,”
● Activities/Participation: the execution of a task or action by an individual and involvement
in a life situation; is denoted with the code “d,”
● Environmental Factors: the physical and social environment; is denoted with the code “e,”
● Assessment involves gathering information as part of trying to understand the needs of
individuals, their problems and their situations (Finlay, 2004). The degrees of the assessment
show the extent that factors support or hinder actions, behaviour and participation in social
relations. The ICF uses four degrees of assessment, these are:
0 – the individual is able to perform the task without difficulty,
1 – mild: the individual is able to perform a given task independently but with difficulty,
2 – moderate: the individual is able to perform the given task with a certain amount of help, in the
case of the presence of a suitable item or with some support from another person,
3 – severe: when the difficulty/issue is severe and the individual can only perform a task with the help
of another person,
4 – extreme: when an individual cannot perform the action altogether or does not participate at all,
even in the case of assistance.
1. The following chapters are on the activities and participation
component: Chapter 1. Learning and applying knowledge
Chapter 2. General tasks and demands
Chapter 3. Communication
Chapter 4. Mobility
Chapter 5. Self-Care
Chapter 6. Domestic life
Chapter 7. Interpersonal interactions and relationships
Chapter 8. Major life areas
Chapter 9. Community, social and civic life
● Activity: the execution of a task or action by an individual.
● Participation: involvement in a life situation.
● Activity limitations: difficulties an individual may have in executing activities.
● Participation restrictions: problems an individual may experience in involvement in life
situations.
2. The following chapters are on the environmental factor. Chapter 1. Products and technology
Chapter 2. Natural environment and human-made changes to the environment
Chapter 3. Support and relationships
Chapter 4. Attitudes
Chapter 5. Services, systems and policies
Environmental factors are those physical and social environments in which people live and conduct
their lives, as well as the attitude that society shows towards them. These factors are external to
individuals and can have a positive or negative influence on the individual’s performance as a
member of society, on the individual’s capacity to execute actions or tasks, or on the individual’s
body function or structure.
APPLICATION PROCEDURE OF THE
METHODOLOGICAL MANUAL
This procedural guideline is a benchmark for evaluators, where the steps are presented in a sequence
and with a purpose.
Before proceeding to the evaluation process, the evaluator should be familiar with the methodology,
in order to have a clearer understanding of each code.
During the evaluation, firstly each specialist has a conversation with a parent regarding the questions
present in the questionnaire, then each specialist (occupational therapist / ergotherapist, psychologist,
speech therapist, social worker) separately evaluates the child through didactic materials and games,
after which the questionnaire is filled out, based on the qualifiers of the methodological manual.
Step 1
Make an assessment by using/filling out the questionnaire on the vitality, participation and
environmental factors for children aged 2-18.
The purpose of this questionnaire is to get information about the current situation of the child. The
questionnaire consists of two parts. The first part contains information on how much the child’s
environment promotes or hinders the individual’s activities and participation and gives an opportunity
to clarify which environmental factors are obstacles to the individual, depending on his or her
situation.
Step 2
Form 1: Fill out the child’s results and personal summary (profile).
The goal of the profile is to find out the child’s basic issues according to the degrees of 2-moderate,
3-severe, 4-extreme, and to find out through the profile what kind of services a child needs, which is
also taken note of in the profile.
Upon filling in the personal summary evaluation (profile) of the evaluation results, the specialist uses
the questionnaires outlined above and completes the objectives set out in the ICF after revealing the
issues and qualifiers. Then, the result indicators are written according to the ICF assessment results,
for example, if the child has a moderate qualification, the programme plans to change it from
moderate to mild.
Step 3
Form 2: Each specialist drafts the child’s professional intervention programme. In order to compile
this form, each specialist can carry out a narrow professional assessment so they can create a more
detailed support programme.
The objective of a professional intervention programme is to provide a conclusion from a specialist
on the current status of the child on the basis of the ICF assessment and to identify and implement
long-term and short-term goals.
The professional intervention programme is completed on the basis of the ICF, however, the specialist
also writes a few qualifiers, if it is determined that it is also necessary to work with the presence of
those qualifiers. After the conclusion is written in the first part of the form, a detailed description of
the child’s participation/activity /d/ and environmental factors /e/ problems is written with the
appropriate code. Then the end result of the intervention /code/, that is, the code specified by the
specialist as a result of the evaluation and the result of the intervention planned on the basis of that
code. A description of the short-term intervention is written in the next column, a detailed description
of the short-term intervention planned by the specialist, which can be 3 small goals through which
the above-mentioned results can be achieved. The specialist will also fill in all those methods,
approaches and steps which will be taken throughout the entire intervention process. The outcome
indicators for the completion of the short-term intervention and a clear timetable for the intervention
programme are also indicated.
Step 4
Form 3: Each specialist reassesses the child’s individual intervention programme. Once each
specialist completes their intervention programme, they also perform a reassessment based on the
goals that were set. The short-term goals of the intervention are written on this form, and the results
of the short-term intervention carried out by the specialist are summarized.
ICF- CY “e” CODES: ENVIRONMENTAL
FACTORS Environmental factors are those physical and social environments in which people live and conduct their
lives, as well as the attitude that society shows towards them. (Katherine A. and Meri V., 2002). These
factors can have varying effects on the individual’s participation, activity, body function and structure. The
physical and social environment surrounding an individual has a unique effect on the functionality of the
former. In the case of a positive impact, the results of the individual’s activity are higher than expected, and
in the case of negative effects, the results of the individual’s activity are lower than expected. When the
environmental factor improves the individual’s activity it is coded as facilitating or supporting, and
hindering when it is an obstacle (WHO, 2007).
The impact of environmental factors should be assessed from the point of view of the person with whom the
interview is being conducted.
The WHO ICF has singled out the following five areas included as environmental factors:
1. Products and technology,
2. Natural environment and human-made changes to the environment,
3. Support and relationships,
4. Attitudes,
5. Services, systems and policies.
Environmental factors have an impact on all components of functioning and disability and are organized in
sequence from the individual’s most immediate environment to the general environment. (ICF, 2001).
e 115. Products and technology for personal use in daily living
General products and technology for personal use in daily living as well as specially designed equipment,
products and technologies adapted for general purpose, which are located within the body, on the body or the
vicinity of, including general purpose intended for personal use and assistive products and technology with
the exception of products and technologies for personal indoor and outdoor mobility and transportation.
● e 115.0. No Obstacles
● e 115.1. Mild obstacles: In terms of acquiring and/or using assistive products and technology for
personal use in daily living, the individual has difficulties which they overcome one their own.
● e 115.2. Moderate obstacles: In terms of acquiring and/or using assistive products and technology
for personal use in daily living, the individual has difficulties, and in order to overcome them,
requires the partial support of others.
● e 115.3. Severe: In terms of acquiring and/or using assistive products and technology for personal
use in daily living, the individual has difficulties which interfere with their vitality and they always
require the help of others.
● e 115.4. Complete obstacles: In terms of acquiring and/or using assistive products and technology
for personal use in daily living, the individual has extreme obstacles that cannot be overcome at all,
either independently or with the help of others.
e 120. Products and technology for personal indoor and outdoor mobility and
transportation.
Equipment, products and technologies used by people in activities of moving inside and outside buildings,
including those adapted or specially designed, located in, on or near the person using them.
● e 120.0. No Obstacles
● e 120.1. Mild Obstacles: In terms of using equipment, products and technologies used by people in
activities of moving inside and outside buildings, the individual faces some obstacles, but manages
to move independently in the building and outside of the building, overcoming the obstacles on
their own.
● e 120.2. Moderate Obstacles: In terms of using equipment, products and technologies used by
people in activities of moving inside and outside buildings, the individual faces some obstacles,
such as a lack of ramps, a lack of handrails, no adapted elevators, as a result of which there is a
need for partial assistance from other people for moving in and out of the building.
● e 120.3. Severe Obstacles: The use of equipment, products and technologies in activities of
moving inside and outside buildings, allow the individual to move freely in the apartment, but they
cannot leave the house because of the disadvantages of the building conditions and they always
need help from other people.
● e 120.4. Complete Obstacles: Equipment, products and technologies in activities of moving inside
and outside buildings are absent, which makes it impossible for a person to move, even with the
help of another person.
e 125. Products and technology for communication
Equipment, products and technologies used by people in activities of sending and receiving information,
including those adapted or specially designed, located in, on or near the person using them (for example,
orthopedic prosthesis).
● e 125.0. No Obstacles
● e 125.1. Mild Obstacles: In terms of the use and/or adaptation for products and technologies for
telecommunications, the individual faces difficulties, but is able to overcome the obstacles that they
have to deal with.
● e 125.2. Moderate Obstacles: In terms of the use and/or adaptation for products and technologies
for telecommunications, the individual faces difficulties, which sometimes require the help of other
people to overcome.
● e 125.3. Severe Obstacles: In terms of the use and/or adaptation for products and technologies for
telecommunications, the individual faces difficulties, which can only be overcome with the help of
other people and/or special devices.
● e 125.4. Complete Obstacles: In terms of the use and/or adaptation for products and technologies
for telecommunications, the individual faces obstacles, which cannot be overcome at all.
e 130. Products and technology for education
Equipment, products, processes, methods and technology used for the acquisition of knowledge, expertise or
skill, including those adapted or specially designed.
● e 130.0. No Obstacles
● e 130.1. Mild Obstacles: In terms of equipment, products, processes, methods and technology used
for the acquisition of knowledge, the individual faces obstacles, but they can overcome them on
their own; for example, in the case of a problem of weak vision, they use larger fonts.
● e 130.2. Moderate Obstacles: In terms of equipment, products, processes, methods and technology
used for the acquisition of knowledge, the individual faces obstacles, and sometimes needs
technical assistance or partial assistance from others.
● e 130.3. Severe Obstacles: In terms of equipment, products, processes, methods and technology
used for the acquisition of knowledge, the individual has a constant need for supervision and
assistance.
● e 130.4. Complete Obstacles: In terms of the use and/ or adaptation of equipment, products,
processes, methods and technology used for the acquisition of knowledge, the individual cannot
overcome the obstacles by neither by themselves nor with the help of others.
e 150. Design, construction and building products and technology of buildings
for public use
Products and technology that constitute an individual’s indoor and outdoor human-made environment that is
planned, designed and constructed for public use, including the design, construction and adaptation of
interior comforts and signage.
● e 150.0. No Obstacles
● e 150.1. Mild Obstacles: In terms of the formation and adaptation of the environment both inside
and outside of public buildings, the individual faces difficulties, but is able to overcome them
independently.
● e 150.2. Moderate Obstacles: In terms of the use of both inside and outside public buildings, the
individual has a need for an adapted environment or help from another person.
● e 150.3. Severe Obstacles: Both inside and outside public buildings, the individual has a need for
help from another person even in the case of an adapted environment.
● e 150.4. Complete Obstacles: In terms of the formation and adaptation of the environment both
inside and outside of public buildings, the individual faces extreme difficulties which the cannot
overcome neither on their own nor with the help of another.
e 250. Sound
A phenomenon that is or may be heard, such as banging, ringing, thumping, singing, whistling, yelling or
buzzing, in any volume, timbre or tone, and that may provide useful or distracting information about the
world.
● e 250.0. No Obstacles
● e 250.1. Mild Obstacles: In terms of perceiving the phenomenon of sound and responding to its
effects, in life they encounter a small number of obstacles for example, in the case of hearing very
loud noise, the noise causes discomfort, however the individual can overcome the obstacles on their
own, sometimes the negative response to noise is associated with mood and general health.
● e 250.2. Moderate Obstacles: In terms of perceiving the phenomenon of sound and responding to
its effects, in life they encounter some obstacles, which disrupts their activity and participation.
● e 250.3. Severe Obstacles: In terms of perceiving the phenomenon of sound and responding to its
effects, in life they encounter difficult to overcome obstacles, which disrupts the individual’s neuro-
psychological state, causing health problems (headache, insomnia, irritability, etc.). and their
activity and participation are significantly hindered.
● e 250.4. Complete Obstacles: In terms of perceiving the phenomenon of sound and responding to
its effects, in life they encounter extreme obstacles, which disrupts an individual’s neuro-
psychological state and causes health problems (headache, insomnia, nervous spasms etc.,) which
completely disrupts activity or participation, the individual generally refuses to be involved even in
environments which include insignificant amounts of noise.
e 310. Immediate family
Immediate family members who provide practical physical or emotional support, nurturing and protection.
● e 310.0. No Obstacles
● e 310.1. Mild Obstacles: The individual sometimes does not receive enough support from
immediate family members, however that does not disrupt the individual’s vitality and social
inclusion.
● e 310.2. Moderate Obstacles: The individual does not receive support from some immediate
family members, as a result of which the individual’s vitality and social inclusion are disrupted,
depending on the situation.
● e 310.3. Severe Obstacles: The individual rarely receives support from their immediate family
members, as a result of which the individual’s vitality and social inclusion are often disrupted.
● e 310.4. Complete Obstacles: The individual never receives support from their immediate family,
which completely disrupts the individual’s vitality and social inclusion.
e 320. Friends
Individuals who are close and ongoing participants in relationships characterized by trust and mutual
support. The code described does not refer to individuals, but the support which they provide.
● e 320.0. No Obstacles
● e 320.1. Mild Obstacles: The individual experiences some difficulties only when exercising a
small number of activities, and they need support from friends, but it does not result in the
disruption from everyday activities in the social sphere. The individual has friends, often meets
with them, and if necessary asks for and receives the appropriate support from them.
● e 320.2. Moderate Obstacles: In day-to-day social interactions and relationships, an individual
experiences difficulty, needs friends, however, support from the latter is rarely provided or is not
provided at all, they have a small number of friends and neighbors, around 14.
● e 320.3. Severe Obstacles: In day-to-day social interactions and relationships, some individual
experiences difficulties, needs help from friends, however, support from the latter is rarely
provided. As a result, the social sphere of the individual’s life is significantly damaged, leading to
illness and/or passivity.
● e 320.4. Complete Obstacles: In day-to-day social interactions and relationships, an individual
experiences extreme difficulties as a result of not having any friends and/or not receiving any
support from them.
e 410. Individual attitudes of immediate family members
General or specific opinions and beliefs of immediate family members about the person or about other
matters (e.g. social, political and economic issues), that influence individual behaviour and actions.
● e 410.0. No Obstacles
● e 410.1. Mild Obstacles: Due to the positive and/or negative attitudes of immediate family
members, the individual faces difficulties that affect their behaviour, actions and participation,
which the individual can overcome on their own.
● e 410.2. Moderate Obstacles: Due to the positive and/or negative attitudes of immediate family
members, the individual faces difficulties that affect their behaviour, actions and participation,
limiting the individual’s scope of interaction and activity.
● e 410.3. Severe Obstacles: Due to the positive and/or negative attitudes of immediate family
members, the individual faces difficulties that affect their behaviour, actions and participation,
isolating the individual from the environment.
● e 410.4. Complete Obstacles: Due to the positive and/or negative attitudes of immediate family
members, the individual faces difficulties which completely affect their behaviour, actions and
participation. The individual cannot overcome these difficulties either independently or with the
help of others.
e 420. Individual attitudes of friends
General or specific opinions and beliefs of friends about the person or about other matters (e.g. social,
political and economic issues), that influence individual behaviour and actions.
● e 420.0. No Obstacles
● e 420.1. Mild Obstacles: Due to personal attitudes of friends, difficulties arise regarding an
individual’s behaviour, actions and participation, but the individual overcomes these obstacles on
their own and it does not result in the disruption of everyday activities in the social sphere.
● e 420.2. Moderate Obstacles: Due to personal attitudes of friends, difficulties arise as a result of
which an individual’s behaviour, actions, participation and social relationships are partially
disrupted, limiting an individual’s range of interaction.
● e 420.3. Severe Obstacles: Due to personal attitudes of friends, difficulties arise as a result of
which an individual’s behaviour, actions, participation and social relationships are significantly
disrupted, isolating the individual from the environment.
● e 420.4. Complete Obstacles: Due to personal attitudes of friends, difficulties arise as a result of
which an individual’s behaviour, actions, participation and social relationships are completely
disrupted, and the individual refuses to establish social relations with other persons.
e 460. Societal attitudes
General or specific opinions and beliefs generally held by people of a culture, society, subcultural or other
social groups about other individuals or about other social, political and economic issues, that influence
group or individual behaviour and actions
● e 460.0. No Obstacles
● e 460.1. Mild Obstacles: Due to public attitudes, difficulties arise in relation to an individual’s
behaviour, action and participation, but the individual overcomes them independently, and it does
not result in the disruption of everyday activities in the social sphere.
● e 460.2. Mild Obstacles: Due to public attitudes, difficulties arise as a result of which an
individual’s behaviour, actions, participation and social relationships are partially disrupted, for
example, the individual avoids public meetings, parties and events.
● e 460.3. Severe Obstacles: Due to public attitudes, difficulties arise as a result of which an
individual’s behaviour, actions, participation and social relationships are significantly disrupted, the
individual is isolated from the environment, refuses to or does not want to participate in social life
events, and can participate in extreme cases for only short periods of time.
● e 460.4. Complete Obstacles: Due to public attitudes, difficulties arise as a result of which an
individual’s behaviour, actions, participation and social relationships are extremely disrupted, and
in general, the individual refuses to establish social relationships with other people.
e 540. Transportation services, systems and policies
Services and programmes aimed at moving persons or goods by road, paths, rail, air or water, by public or
private transport.
● e 540.0. No Obstacles
● e 540.1. Mild Obstacles: Due to the inadequate adaptation of a vehicle, the individual faces
difficulties, sometimes there is physical and mental tension, however, the individual overcomes
them independently.
● e 540.2. Moderate Obstacles: When using a vehicle, the individual faces difficulties, depending on
the type of vehicle (non-adapted public buses, etc.,) sometimes the individual needs help from other
people.
● e 540.3. Severe Obstacles: When using a vehicle, the individual always needs help from others
(can only be transported via a private car or taxi).
● e 540.4. Complete Obstacles: The individual is not able to use transportation at all.
e 570. Social security services, systems and policies
Services and programmes aimed at providing income support to people who, because of age, poverty,
unemployment, health condition or disability, require public assistance that is funded either by general tax
revenues or contributory schemes, such as services for determining eligibility, delivering or distributing
assistance payments for the following types of programmes: social assistance programmes (e.g. non-
contributory welfare, poverty or other needs-based compensation), social insurance programmes (e.g.
contributory accident or unemployment insurance), and disability and related pension programmes.
● e 570.0. No Obstacles
● e 570.1. Mild Obstacles: Social security services are not available, but the individual can overcome
the problems on their own, and it does not lead to the disruption of their everyday activity or other
social issues.
● e 570.2. Moderate Obstacles: Social security services are not available, the individual has a lack of
information and needs the partial help of others to overcome the existing obstacles.
● e 570.3. Severe Obstacles: Social security services are not available and the needs of the individual
are not being met, the individual always needs help from others.
● e 570.4. Complete Obstacles: Social security services and policies are not accessible at all, the
individual is left out of the sphere of these services, they cannot overcome the difficulties either
independently or with the help of others.
e 580. Health services, systems and policies
Services, systems and policies for preventing and treating health problems, providing medical rehabilitation
and promoting a healthy lifestyle, excluding general social support services, systems and policies.
● e 580.0. No Obstacles
● e 580.1. Mild Obstacles: Health care services are not available when using therapeutic and
preventative measures, the individual experiences minor difficulties, however, they can overcome
them independently, and it does not lead to the deterioration of their health.
● e 580.2. Moderate Obstacles: Health care services are available, however, they do not completely
meet the needs of the individual, they do not provide the necessary therapeutic and preventative
measures for the individual, which leads to the deterioration of the individual’s health. They need
the partial help of others in order to overcome the existing obstacles.
● e 580.3. Severe Obstacles: Health care services are highly unlikely to be available, or are
inadequate for the needs of the individual and for the most part do not provide the necessary
therapeutic and preventative measures for the individual, which leads to the deterioration of the
individual’s health. They always need the help of others to overcome the existing obstacles.
● e 580.4. Complete Obstacles: The aforementioned services, systems and policies in this field are
not available at all, as a result of which the individual's activity and participation in this field are
disrupted.
e 585. Education and training services, systems and policies
Services, systems and policies for the acquisition, maintenance and improvement of knowledge, expertise
and vocational or artistic skills.
● e 585.0. No Obstacles
● e 585.1. Mild Obstacles: Education and training services are available, but the individual is hardly
able to be involved in them, trying to overcome the existing difficulties on their own.
● e 585.2. Moderate Obstacles: Education and training services are not available, which leads to
difficulties dealing with the partial loss of skills and knowledge related to the education of the
individual. In order to overcome difficulties, the individual needs partial help from others.
● e 585.3. Severe Obstacles: Education and training services are not available, they are strictly
unsatisfactory and do not provide the essential services to the individual, which leads to serious
issues dealing with the loss of skills and knowledge related to the education of the individual. In
order to overcome the obstacles, the individual needs constant help from others.
● e 585.4. Complete Obstacles: Education and training services, systems and policies are not
available at all, the individual is out of the scope of services and cannot overcome the obstacles
either independently or with the help of others.
ICF-CY “d” CODES: INDIVIDUALS’
ACTIVITIES OF DAILY LIVING AND
PARTICIPATION Participation is defined as an individual’s “involvement in different life situations,” introducing the public
aspect of functioning (McIntyre A. and Atwal A., 2005). In the ICF-CY, special attention has been paid to
participation, as the nature and environment of the lives of children and youth are essentially different from
the nature and environment of adult life situations. During development, the number and complexity of life
situations go through dramatic changes, from relationships with the main caregiver and a small child playing
on their own, to at an older age, playing games which develop social skills, relationships with their peers and
attending school. The smaller the child, the more likely it is for parents, guardians or service providers to
determine the possibilities of their participation. The role of the family and other people in the immediate
environment, particularly in early childhood is important to get an idea about the child’s participation.
The activity and participation factors include the following nine areas:
1. Learning and applying knowledge
2. General tasks and demands
3. Communication
4. Mobility
5. Self-care
6. Domestic life
7. Interpersonal interactions and relationships
8. Major life areas
9. Community, social and civic life
Each code is evaluated according to the age of the given child.
d 110. Watching
Using the sense of seeing intentionally to experience visual stimuli, such as following an object, watching
any given person, or children playing.
● d 110.0. No Difficulties
● d 110.1. Mild Difficulties: Visual signals from people, objects, events can be perceived by the
individual from 4 metres away.
● d 110.2. Moderate Difficulties: Visual signals from people, objects, events can be perceived by the
individual from 3-2 metres away. Sometimes they need audio and verbal guidance.
● d 110.3. Severe Difficulties: Visual signals from people, objects, events can be perceived by the
individual from 0-2 metres away. They constantly need audio and verbal guidance.
● d 110.4. Complete Difficulties: The individual cannot see, perceive, analyze visual signals
transmitted from humans, objects and events, (is absolutely blind).
d 115. Listening
Using the sense of hearing intentionally to experience auditory stimuli, such as listening to the sound of
someone's voice (lecture, story, conversation) or listening to the radio, music.
● d 115.0. No Difficulties
● d 115.1. Mild Difficulties: Auditory signals transmitted from the outside world, such as a human
voice, music and radio can be perceived in a silent, environment with no sound overload from 612
metres away.
● d 115.2. Moderate Difficulties: Auditory signals transmitted from the outside world, such as a
human voice, music and radio can be perceived in a silent, environment from 45 metres away.
● 115.3. Severe Difficulties: The individual is able to perceive the intrinsic tone of the outside world,
such as a human voice, music, radio and is able to perceive it from 24 metres away in the case of
absolute silence.
● d 115.4. Complete Difficulties: The individual cannot listen, perceive, analyze auditory signals
transmitted from people, objects and events (absolute deafness).
d 120. Other purposeful sensing
Using the body’s other basic senses intentionally to experience stimuli, such as touching and feeling
textures, tasting sweets or smelling flowers and perfume.
● d 120.0. No Difficulties
● d 120.1. Mild Difficulties: Unexpected sound and light signals cause a panic, but it does not affect
the individual’s mood and activity.
● d 120.2. Moderate Difficulties: The individual responds to stimuli from the outside world in an
exaggerated manner, with hypersensitivity. Oral motor deficit is present, in other words, the
individual puts everything in their mouth touches with their mouth. Hunger is not connected with
eating and the individual does not realize how much, when and what they want to eat. In the case of
hypersensitivity, the individual sometimes doesn’t realize what part of their body is being touched
if their eyes are closed. They become aggressive and restless from sudden touch, light, sound and
crowded places.
● d 120.3. Severe Difficulties: The individual cannot keep their balance, especially while moving.
They often slip from a seated position and fall while walking. They avoid touching cold, hot,
slippery objects. They avoid eye contact. They are very sensitive to sounds.
● d 120.4. Complete Difficulties: In general, the individual cannot receive information through any
of the above mentioned senses and/or one of them more purposefully.
d 130. Copying
Imitating or mimicking as a basic component of learning, such as copying a facial expression, gesture, the
letters of an alphabet a sound including directly copying an action or behaviour.
● d 130.0. No Difficulties
● d 130.1. Mild Difficulties: The individual can copy a facial expression, gesture, sound or the letters
of the alphabet after repeating it 12 times.
● d 130.2. Moderate Difficulties: The individual can copy a facial expression, gesture, sound or the
letters of the alphabet with inaccuracies, without paying attention to the details.
● d 130.3. Severe Difficulties: The individual can copy a facial expression, gesture, sound or the
letters of the alphabet with difficulty, after multiple repetitions and directions. Copying, as a rule, is
done with substantial inaccuracies and distortions, with verbal and non-verbal guidance.
● d 130.4. Complete Difficulties: The individual is completely incapable of copying and duplicating.
d 131. Learning through actions with objects
Learning with two or more objects and through simple symbolic games and role-playing games, such as
hitting objects, knocking blocks, and playing with dolls or cars.
● d 131.0. No Difficulties
● d 131.1. Mild Difficulties: The individual can do simple actions with one, two or more than two
objects, can learn with verbal guidance through symbolic games and role-playing games, moreover,
they have a need for instructions while learning through games.
● d 131.2. Moderate Difficulties: The individual can do simple actions with one or two objects, and
has difficulty in cases when there are more than two objects. When learning through symbolic
games and role-playing games, the individual needs hints and physical guidance.
● d 131.3. Severe Difficulties: The individual has difficulties carrying out simple actions with one or
two objects, they cannot engage in symbolic or role-playing games.
● d 131.4. Complete Difficulties: The individual cannot carry out actions with any objects.
d 160. Focusing attention
Intentionally focusing on specific stimuli, such as by filtering out distracting noises.
● d 160.0. No Difficulties
● d 160.1. Mild Difficulties: The individual concentrates attention with a delay, they are inattentive
towards details, but are able to finish the job they started.
● d 160.2. Moderate Difficulties: The individual concentrates attention with a delay, and cannot hear
the what they are being told until the end, or perform the task. They constantly ask additional
questions, are distracted, without a reasonable reason they divert their attention to other factors,
they find it difficult to concentrate on one or two factors at the same time, they complete the
assignment quite later than the allotted time.
● d 160.3. Severe Difficulties: The individual cannot concentrate their attention, they become tired
very quickly, are distracted, has a pathological deviation of concentration, is hyperkinetic, has a
need for help from others as well as hinting.
● d 160.4 Complete Difficulties: The individual cannot concentrate their attention on any factor.
d 161. Directing attention
Intentionally maintaining attention to specific actions or tasks for an appropriate length of time.
● d 161.0. No Difficulties
● d 161.1. Mild Difficulties: The individual maintains attention, however is inattentive to details and
may allow careless mistakes, but is able to finish the job that they started.
● d 161.2. Moderate Difficulties: The individual is unable to pay attention until the end of the
assignment, they cannot hear the what they are being told until the end, or performs the task. They
constantly ask additional questions, are distracted, without a reasonable reason they divert their
attention to other factors, they find it difficult to concentrate on one or two factors at the same time,
they complete the assignment quite later than the allotted time, they need a little hints and support
in order to finish the job they started.
● d 161.3. Severe Difficulties: The individual has a very short attention span, and can barely
maintain attention, they get tired very quickly, are distracted, has a pathological deviation of
concentration, is hyperkinetic, has a need for help from others as well as hinting.
● d 161.4. Complete Difficulties: The individual cannot maintain attention whatsoever.
d 163. Thinking
Formulating and manipulating ideas, concepts, and images, whether goal-oriented or not, either alone or with
others, and other thinking-related activities.
● d 163.0. No Difficulties
● d 163.1. Mild Difficulties: The individual is able to carry out analysis and combination, make
simple judgements, understand the relationships of cause and effects, but finds it difficult to come
to a conclusion based on several judgements without guidance. Sometimes it is possible to see their
thoughts stop; they might repeat the same idea several times. They are able to perform simple
purposeful tasks with objects through trial and error with some difficulty. Can put the parts together
to get a complete image, collecting narrative pictures. Considers and maintains the sequence of
operations and cause-and-effect relationships when working. The individual can with some
difficulties, summarize, classify, compare, analyze and combine.
● d 163.2. Moderate Difficulties: The individual’s thinking is superficial, there are no logical links
between thoughts, they are only able to perceive strictly obvious cause-and-effect relationships.
They find it difficult to make judgements, even with guidance. They might not finish one though
before starting with another. With the partial help of another person, the individual can get
complete images from the parts, collecting narrative pictures, they have difficulties comprehending
the meaning of images, they do not pay attention to details, confuses the sequence. They always
need the help of an adult for the implementation of thoughtful processes, comparison, analysis and
combining. From time to time obsessive thoughts can be observed, compulsive thoughts, delusions.
● d 163.3. Severe Difficulties: The individual can only formulate simple thoughts and ideas. The
object needs to be immediately present in order for them to study it. In addition, words are
meaningless, ideas do not correspond to reality. They have difficulties getting a complete image
from parts, they need hints. Even after multiple attempts with the help of another person, it is
difficult for them to get complete images when collecting narrative pictures, and they cannot
comprehend the meaning of the images, do not pay attention to details and confuse the sequence.
They cannot think about processes, compare analyze and combine even with the help of another
person. They can often be observed having obsessive thoughts, compulsive thoughts, delusions.
● d 163.4. Complete Difficulties: The individual does not show any ability to think or express ideas.
d 166. Reading
Performing activities involved in the comprehension and interpretation of written language (e.g. books,
instructions, newspapers in text or Braille), for the purpose of obtaining general knowledge or specific
information.
● d 166.0. No Difficulties
● d 166.1. Mild Difficulties: The individual doesn’t read very fluently, allowing some errors which
affect the overall speed of reading, quality and sometimes even the ability to perceive, the ability to
interpret what was read, however in the case of reading it again or spending some extra time on it,
the individual is able to overcome the difficulties on their own.
● d 166.2. Moderate Difficulties: The individual reads in syllables, has a difficult time
understanding written material, they interpret the written material through guiding questions and
clue words.
● d 166.3. Severe Difficulties: The individual reads only letter and/or doesn’t know the majority of
the letters, as a result of which they do not understand the meaning of what they are reading and
cannot interpret it.
● d 166.4. Complete Difficulties: The individual cannot read at all; they do not recognize the letters.
d 170. Writing
Using or producing symbols or language to convey information (with typewriters, Braille writers) such as
producing a written record of events or ideas or drafting a letter (with typewriters, Braille writers).
● d 170.0. No Difficulties
● d 170.1. Mild Difficulties: An individual can write, type with a typewriter, write a diction with a
Braille alphabet, copy, write their own ideas down by writing, using a keyboard or using the Braille
alphabet, however slowly, thinking, with pauses. They have difficulties writing long sentences, and
sometimes allow errors, which they can correct on their own after reviewing.
● d 170.2. Moderate Difficulties: The individual can write (type on a typewriter, write with the
Braille alphabet) only short pieces of information, they copy without difficulty (they copy by hand
or using the Braille alphabet), however when writing dictation (by typing on a typewriter or using a
Braille alphabet) flaws, confusions and substitutions are observed. When writing their handwriting
might be unreadable. Omissions of letters, syllables and words are sometimes observed, which they
cannot find and fix on their own. They can make use of tools for writing or sometimes need the
help of another person (to fix their wrist or elbow), to give directions.
● d 170.3. Severe Difficulties: The individual can write or type (type or copy, write or copy with the
Braille alphabet) only individual letters, words and symbols, only with the help of other people
(fixing their wrist or elbow, provide a comfortable table and so on), or to give directions. They
might need to use writing tools.
● d 170.4. Complete Difficulties: The person cannot typically write, type in the Braille alphabet, due
to a lack of recognizing letters and/or physical or mental disabilities.
d 172. Calculating
Performing computations by applying mathematical principles to solve problems that are described in words
and producing or displaying the results, such as computing the sum of three numbers or finding the result of
dividing one number by another.
● d 172.0. No Difficulties
● d 172.1. Mild Difficulties: The individual can count, perform calculations, but needs
interpretations and explanations in order to solve problems. In order to solve word problems, the
individual uses simple mathematical principles, expresses the results, writes or types with a
keyboard without difficulty.
● d 172.2. Moderate Difficulties: The individual can count, perform calculations only with the
availability of didactic materials. They find it difficult to make calculations that relate to word
problems. They find it difficult to solve problems even after interpretations and explanations.
● d 172.3. Severe Difficulties: The individual cannot use simple skills to perform calculations and
simple arithmetic operations (for example, to count up to ten). They are capable of counting objects
provided them only in the presence of other people’s hints and help.
● d 172.4. Complete Difficulties: The individual is not able to count/calculate at all.
d 210. Undertaking a single task
Carrying out simple or complex and coordinated activities related to the mental and physical components of
a single task, such as initiating a task, organizing time, space and materials for a task, pacing task
performance, and carrying out, completing and sustaining a task.
● d 210.0. No Difficulties
● d 210.1. Mild Difficulties: The individual is able to perform simple activities. They face
difficulties when performing complex and coordinated operations, but they are capable of
overcoming those difficulties and completing the task.
● d 210.2. Moderate Difficulties: Out of simple or complex activities the individual can only
perform the activities that they are familiar with, they find it difficult to plan and implement new
actions.
● d 210.3. Severe Difficulties: The individual cannot start and finish simple operations, they select
and use materials and tools for the given task. They need the constant help of another person.
● d 210.4. Complete Difficulties: The individual cannot perform a simple, complex, and coordinated
task at all or take part in them as well as give them an approximate interpretation.
d 230. Carrying out daily routine
Carrying out simple or complex and coordinated activities in order to plan, manage and complete the
requirements of day-to-day procedures or duties, such as budgeting time and making plans for separate
activities throughout the day.
● d 230.0. No Difficulties
● d 230.1. Mild Difficulties: While performing everyday activities, the individual is able to plan and
implement only the usual activities and has difficulties in planning and implementing new
activities.
● d 230.2. Moderate Difficulties: While performing everyday activities the individual can only
implement a part of the usual activities, they find it difficult to plan a combination of time
activities, as well as a sequence of activities.
● d 230.3. Severe Difficulties: While performing everyday activities the individual is able to perform
just one simple action with hints and under supervision, they find it difficult to plan and perform
simple activities.
● d 230.4. Complete Difficulties: The individual is totally unable to plan and manage everyday
activities.
d 250. Managing one’s own behaviour
Carrying out simple or complex and coordinated actions in a consistent manner in response to new
situations, persons or experiences, such as being quiet in a library.
● d 250.0. No Difficulties
● d 250.1. Mild Difficulties: The individual independently manages their own behaviour,
consistently performs simple or complementary activities, has difficulties controlling their
behaviour in new situations and in the presence of other people, becomes emotional and tense when
changing role function.
● d 250.2. Moderate Difficulties: The individual independently manages their own behaviour,
consistently performs simple or complementary activities in new situations or in the presence of
new people. From time to time they can become undone and lose self-control, and may have
difficulties with the assessment and perception of the surrounding environment and manifest
themselves inadequately.
● d 250.3. Severe Difficulties: The individual cannot control their behaviour even when under
supervision, or manages with great difficulty in a short period of time. Their behaviour is not
adequate, they need professional help and supervision.
● d 250.4. Complete Difficulties: The individual is unable to control their behaviour independently,
there is a need for constant supervision by another person.
d 310. Communicating with - receiving - spoken messages
Comprehending literal and implied meanings of messages in spoken language, such as understanding that a
statement asserts a fact or is an idiomatic expression, such as responding and comprehending spoken
messages.
● d 310.0. No Difficulties
● d 310.1. Mild Difficulties: The individual perceives simple and complex messages, but needs
clarification or repetition when perceiving figurative messages.
● d 310.2. Moderate Difficulties: The individual has difficulty responding to actions with simple
verbal messages (two words), such as requests (eg. “give me”) or instructions (for example, “no,”
“come here”). They can only understand simple words, and only when spoken slowly. There is a
need for physical guidance (holding hands and taking a given object and showing where they
should come or go to).
● d 310.3. Severe Difficulties: The individual can only understand instructions made up of one or
two familiar words, they respond to the voice of a person in a very simple way, expressed by
changes in breathing patterns or significant or mild movement in the body.
● d 310.4. Complete Difficulties: In communicating, the individual does not generally perceive
verbal messages.
d 315. Communicating with - receiving - nonverbal messages
Comprehending the literal and implied meanings of messages conveyed by gestures, symbols and drawings,
such as realizing that a child is tired when she rubs her eyes or that a warning bell means that there is a fire.
● d 315.0. No Difficulties
● d 315.1. Mild Difficulties: The individual perceives messages transmitted by gestures, signs and
pictures without difficulty, but they have difficulties grasping non-verbal messages with figurative
meaning, for example, the fact that shaking the head left to right doesn’t necessarily mean “no” but
can express dissatisfaction, or that nodding the head up and down not only means “yes,” but
gratitude, a smile not only joy, but also consent.
● d 315.2. Moderate Difficulties: The individual may find it difficult to perceive the meaning of a
message transmitted by facial expressions, hand gestures or signs, body posture and other body
movements, but manages to receive messages transmitted by signs, pictures and photos.
● d 315.3. Severe Difficulties: The individual perceives only a few simple gestures and signs (such
as “no,” “yes,” or “come”), they are not able to perceive the meaning of messages with hand
gestures or signs, they find it difficult to grasp the meaning of messages presented through pictures
and photos.
● d 315.4. Complete Difficulties: When communicating, the individual cannot perceive non-verbal
messages at all.
d 330. Speaking
Producing words, phrases and longer passages in spoken simple and complex messages with literal and
implied meaning, such as expressing a fact or telling a story in oral language.
● d 330.0. No Difficulties
● d 330.1. Mild Difficulties: The individual freely produces words that are straightforward and
figurative, phrases, paragraphs, but the fluency of the speech is disorderly, they stutter, stammer or
speak too fast, and they have difficulties in producing separate sounds and articulations
(replacements, transfers, omissions, confusion), however these issues are not manifested when they
concentrate or in the case of repetition. Their words are understandable to everyone and it does not
constitute an issue when communicating with other people.
● d 330.2. Moderate Difficulties: The individual finds it difficult to produce sentences comprised of
words containing figurative meaning, longer paragraphs, however they have an easier time saying
and pronouncing short verbal messages with a literal meaning. They may have a difficult time
producing sounds and articulations, nasal tone of voice, repetition of sounds, syllables and words.
The fluency of speech is expressly disorderly (stuttering, stammering or speaking too fast), in
general, it is difficult to understand their speech, or only those which are close to them can
understand.
● d 330.3. Severe Difficulties: The individual can produce verbal messages with a literal meaning,
mainly sentences comprising of one word and/or their speech is difficult to understand, even by
those which are close to them.
● d 330.4. Complete Difficulties: Speech is out of the question, the person communicates with
sounds and noises or through gestures.
d 335. Producing nonverbal messages
Using gestures, symbols and drawings to convey messages, such as shaking one’s head to indicate
disagreement or drawing a picture or diagram to convey a fact or complex idea, this includes producing body
gestures, signs, symbols, drawings and photographs.
● d 335.0. No Difficulties
● d 335.1. Mild Difficulties: The individual is able to produce non-verbal messages using sign
language, pictures and photos, but has difficulties producing messages through diagrams and
symbols.
● d 335.2. Moderate Difficulties: The individual has difficulty producing messages with gestures,
but is able to produce them with the help of signs and pictures, as well as through mimicry, wrist
and hand movements, and body posture (body language).
● d 335.3. Severe Difficulties: The individual has trouble communicating with even a few simple
gestures and signs, is able to compose one simple message through an image.
● d 335.4. Complete Difficulties: The individual cannot produce non-verbal messages whatsoever.
d 350. Conversation
Starting, sustaining and ending an interchange of thoughts and ideas, carried out by means of spoken,
written, sign or other forms of language, with one or more persons one knows or who are strangers, in formal
or casual settings.
● d 350.0. No Difficulties
● d 350.1. Mild Difficulties: The individual is able to continue and finish a conversation, discussion,
however, finds it difficult to initiate and start a conversation in an unfamiliar environment. It takes
them a long time to answer questions during a conversation.
● d 350.2 Moderate Difficulties: The individual cannot start a conversation, discussion, debate, they
have difficulties in continuing it and sometimes doesn’t make it to the end, they give short answers
to questions. Sometimes they need guidance and assistance.
● d 350.3. Severe Difficulties: The individual cannot start, continue and finish a conversation or
dialogue with one or more people, such as participating in a group exchange of thoughts.
● d 350.4. Complete Difficulties: The individual cannot start, continue and finish a conversation at
all.
d 410. Changing basic body position
Getting into and out of a body position and moving from one location to another, such as rolling from one
side to the other, sitting, standing, getting up out of a chair to lie down on a bed, and getting into and out of
positions of kneeling or squatting including changing body position from lying down, from squatting or
kneeling, from sitting or standing, bending and shifting the body’s centre of gravity.
● d 410.0. No Difficulties
● d 410.1. Mild Difficulties: The individual is able to change the position of their body (standing,
lying, sitting, squatting) relying on any nearby object to lean on (furniture, walls, etc.), for example,
they are able to get up from a seated position, to lie down, to sit up from a lying down position, to
stand up, to stand up from a squatting position, to sit down or squat from a standing position.
● d 410.2. Moderate Difficulties: The individual finds it difficult to change the position of their body
(standing, lying, sitting, squatting). They need a helper or an assisting device.
● d 410.3. Severe Difficulties: The individual finds it difficult to change the position of their body
(standing, lying, sitting, squatting). They constantly need a helper, an assisting device or help from
other people.
● d 410.4. Complete Difficulties: The individual is not able to change the basic position of their
body at all.
d 415. Maintaining a body position
Staying in the same body position as required, such as remaining seated or remaining standing for work or
school including maintaining a lying, squatting, kneeling, sitting and standing position.
● d 415.0. No Difficulties
● d 415.1. Mild Difficulties: The individual is able to maintain their body’s position, standing, lying,
sitting, squatting, having difficulty kneeling, sometimes losing their balance but independently
managing and overcoming difficulties.
● d 415.2. Moderate Difficulties: The individual is able to maintain their body’s position by lying,
sitting, standing, squatting, kneeling, with the help of assisting devices (for example adjustable
pillows to reduce bedsores, barriers/covers to prevent the risk of falling from a lying position,
armrests designed to maintain a seated position, canes designed to assist in maintaining a squatting
or kneeling position, crutches that help to maintain balance). Sometimes they need help from
others.
● d 415.3. Severe Difficulties: The individual is able to maintain their body’s position lying, sitting,
standing, squatting only with the help of other people.
● d 415.4. Complete Difficulties: The individual cannot maintain their body’s position at all and are
always in a lying condition.
d 420. Transferring oneself
Moving from one surface to another, such as sliding along a bench or moving from a bed to a chair, without
changing body position.
● d 420.0. No Difficulties
● d 420.1. Mild Difficulties: The individual is able to move freely from one surface to another with
difficulty, they sometimes need to lean on a nearby object.
● d 420.2. Moderate Difficulties: The individual is able to move from one surface to another only
with the help/support of devices.
● d 420.3. Severe Difficulties: The individual manages to move from one surface to another only
with aiding devices, and has the need for constant assistance from another person.
● d 420.4. Complete Difficulties: The individual is unable to transfer themselves at all.
d 440. Fine hand use
Performing the coordinated actions of handling objects, picking up, manipulating and releasing them using
one’s hand, fingers and thumb, such as required to lift coins off a table or turn a dial or knob.
● d 440.0. No Difficulties
● d 440.1. Mild Difficulties: The individual can perform fine hand use on their own, they sometimes
have difficulty picking up small objects.
● d 440.2. Moderate Difficulties: The individual is limited in their fine hand use, they have
difficulties picking up small objects, using them and moving them. They have the need for some
supportive/assistive devices.
● d 440.3. Severe Difficulties: During systematic operations, the individual cannot perform fine hand
use, they cannot pick up objects, use them or let go with the help of their hands, fingers or thumb.
They are in constant need of help from another person.
● d 440.4. Complete Difficulties: The individual is unable to perform fine hand use at all.
d 445. Hand and arm use
Performing the coordinated actions required to move objects or to manipulate them by using hands and arms,
such as pulling or pushing objects, reaching, turning or twisting the hands or arms, throwing, catching an
object.
● d 445.0. No Difficulties
● d 445.1. Mild Difficulties: The individual can make use of their hand and arm independently,
sometimes having difficulties in performing such actions such as styling their hair, lifting objects
above eye level etc., due to shaking or muscle tension in the hand.
● d 445.2. Moderate Difficulties: Hand actions are limited, the individual finds it difficult to pick up
small objects, catch, raise or hold them.
● d 445.3. Severe Difficulties: The individual cannot use their hands and arm when performing the
agreed actions, they cannot pick up, catch or raise small objects, only pulls and pushes them. They
need help from another person.
● d 445.4. Complete Difficulties: The individual cannot use their hand and arm at all.
d 450. Walking
Walking short distances, at home, in the yard, as well as long distances of more than 1 kilometre across a
village or town.
● d 450.0. No Difficulties
● d 450.1. Mild Difficulties: The individual is able to walk 300-500 metres, slowly, with some
disturbances in the coordination of their walking or with a limp.
● d 450.2. Moderate Difficulties: The individual can walk on their own for 100-200 metres, they
need more time, breaks, rest and assisting devices (walkers, cane, handles and etc.).
● d 450.3. Severe Difficulties: The individual cannot walk on their own up to 10 metres without the
help of other people and the use of devices.
● d 450.4. Complete Difficulties: The individual cannot walk independently, even with the help of
another person. They are unable to get the body into a vertical position.
d 455. Moving around
Moving the whole body from one place to another by means other than walking, such as climbing over a
rock or running down a street, skipping, jumping, or running around obstacles.
● d 455.0. No Difficulties
● d 455.1. Mild Difficulties: The individual can climb stairs on their own, however with difficulties,
taking breaks they can climb up 45 floors, or 50-60 stairs. They cannot run fast, they find it difficult
to move around obstacles and jump.
● d 455.2. Moderate Difficulties: The individual can only climb stairs with the help of handrails and
with difficulties up to the 2nd floor or 20-40 stairs. They need additional assisting devices. They
have difficulties running, do not jump or move around obstacles.
● d 455.3. Severe Difficulties: The individual can climb up 1-10 stairs only with the help of another,
with assisting devices or by holding a handrail, taking breaks. They cannot run, jump or move
around obstacles.
● d 455.4. Complete Difficulties: The individual cannot move around.
d 465. Moving around using equipment
Moving the whole body from place to place, on any surface or space, by using specific devices designed to
facilitate moving or create other ways of moving around.
● d 465.0. No Difficulties
● d 465.1. Mild Difficulties: The individual can move freely with the use of wheelchairs, with the
help of a walker or cane, however, there is a need for adaptation, specifically with large doors,
elevators, ramps or tailor-made cars etc.
● d 465.2. Moderate Difficulties: The individual finds it difficult to move using a wheelchair, walker
or cane, and sometimes needs the help of another person.
● d 465.3. Severe Difficulties: The individual can move with the use of a wheelchair, walker or cane
only in the case of getting help from another person.
● d 465.4. Complete Difficulties: The individual cannot move at all using a wheelchair or walker.
d 470. Using transportation
Using transportation to move around as a passenger, such as being driven in a car, bus, private or public taxi.
● d 470.0. No Difficulties
● d 470.1. Mild Difficulties: The individual uses public transportation on their own but requires
certain environmental adaptation, specifically the availability of handles and ramps for being lifted
into and descending from transports.
● d 470.2. Moderate Difficulties: It is difficult for the individual to use a vehicle independently, they
need assistance from either assisting devices or other people.
● d 470.3. Severe Difficulties: The individual is able to use a car or taxi only with the help of another
person.
● d 470.4. Complete Difficulties: The individual is unable to use any type of vehicle at all.
d 510. Washing oneself
Washing and drying one’s whole body, or body parts, using water and appropriate cleaning and drying
materials or methods, such as bathing, showering, washing hands and feet, face and hair, and drying with a
towel, according to age.
● d 510.0. No Difficulties
● d 510.1. Mild Difficulties: The individual is able to wash oneself independently, having difficulty
bathing, but overcomes them independently.
● d 510.2. Moderate Difficulties: The individual can hardly wash and bathe oneself. They need
assistance with assisting devices such as a special bath chair, a fixed shower head at an appropriate
height, a non-slip floor surface or another person’s assistance.
● d 510.3 Severe Difficulties: The individual is able to take a shower and bathe only with the help of
other people and with the use of adapted accessories or environments.
● d 510.4. Complete Difficulties: The individual cannot shower or bathe at all.
d 520. Caring for body parts
Looking after those parts of the body, such as skin, face, teeth, scalp, nails and genitals, that require more
than washing and drying.
● d 520.0. No Difficulties
● d 520.1. Mild Difficulties: The individual is able to take care of their body parts with extra effort.
● d 520.2. Moderate Difficulties: The individual is able to take care of their body parts with
difficulty. Needs assisting devices, such as a customized toothbrush, nail cutter, brush etc., or help
from another person.
● d 520.3. Severe Difficulties: The individual is able to take care of their body parts only with the
help of another person and some help from customized accessories.
● d 520.4. Complete Difficulties: The individual is unable to take care of their body parts at all.
d 530. Toileting
Indicating the need for, planning and carrying out the elimination of human waste (menstruation, urination
and defecation), and cleaning oneself afterwards, according to age.
● d 530.0. No Difficulties
● d 530.1. Mild Difficulties: The individual feels the need to eliminate human waste, after using the
toilet they take more time in order to maintain rules of hygiene.
● d 530.2. Moderate Difficulties: The individual finds it difficult to control the urge to eliminate
human waste, and has difficulty using the toilet. They feel the need for assisting devices, for
example, they need the height of the toilet to adjusted (adjust the height of the toilet seat to hip-
height), place a handle at hip height etc.
● d 530.3. Severe Difficulties: The individual is able only to report about their urges, however,
cannot control the urge to eliminate human waste. They can only use the toilet and clean their body
with the help of another person, they need hygienic accessories such as diapers etc.
● d 530.4. Complete Difficulties: The individual does not feel the urge to eliminate human waste,
does not control those urges, and cannot use the toilet.
d 540. Dressing
Carrying out the coordinated actions and tasks of putting on and taking off clothes and footwear in sequence
and in keeping with climatic and social conditions, such as by putting on, adjusting and removing shirts,
skirts, blouses, pants, undergarments, saris, kimono, tights, hats, gloves, coats, shoes, boots, sandals and
slippers, according to age.
● d 540.0. No Difficulties
● d 540.1. Mild Difficulties: The individual is able to get dressed and undressed on their own. They
have difficulties wearing tight clothing, small buttons, back buttons, tying shoelaces etc.
● d 540.2. Moderate Difficulties: The individual is able to get dressed and undressed on their own,
however, they need extra help, for example, they wear only customized clothing which is wide,
have large buttons or zippers etc., they use customized devices for dressing and undressing or they
need help from another person.
● d 540.3. Severe Difficulties: The individual is able to get dressed and undressed only with the help
of another person and/or with customized accessories, having partial participation in the process of
dressing and undressing. They follow the climatic and social conditions only with the direction of
another person.
● d 540.4. Complete Difficulties: The individual does not take part in the process of getting dressed
and undressed.
d 550. Eating
Indicating the need for, and carrying out the coordinated tasks and actions of eating food that has been
served, bringing it to the mouth and consuming it in culturally acceptable ways, cutting or breaking food into
pieces, opening bottles and cans, using eating implements, having meals, feasting or dining, according to
age.
● d 550.0. No Difficulties
● d 550.1. Mild Difficulties: The individual is able to eat independently, but finds it difficult to bring
food to the mouth, do to muscle spasms, tension or weakness in the wrist.
● d 550.2. Moderate Difficulties: The individual is able to eat independently, however, due to
muscle spasms, tension, or weakness in the wrist they need assisting devices, for example, a
customized spoon, fork, cup, plate or they have the need for the help of another person.
● d 550.3. Severe Difficulties: The individual is able to eat only with the help of another person, they
can chew and swallow food on their own.
● d 550.4. Complete Difficulties: The individual’s ability to swallow is strictly disrupted, they use
specially designed devices to get sustenance.
d 560. Drinking
Indicating the need for, and taking hold of a drink, bringing it to the mouth and consuming the drink in
culturally acceptable ways; mixing, stirring and pouring liquids for drinking, opening bottles and cans,
drinking through a straw or drinking running water, such as from a tap or a spring.
● d 560.0. No Difficulties
● d 560.1. Mild Difficulties: The individual is able to drink independently, but has difficulty/ies in
bringing the cup to the mouth, due to muscle spasms, tension, weakness in the wrist or another
reason.
● d 560.2. Moderate Difficulties: The individual is able to drink independently with difficulty. They
need assisting devices, for example, customized cups, bottles or they need some help from another
person.
● d 560.3. Severe Difficulties: The individual is able to drink only with the help of another person,
they have difficulties swallowing, they are not able to use their hands to hold a cup.
● d 560.4. Complete Difficulties: The action of drinking is strictly disrupted, and the individual uses
specially designed devices to get sustenance.
d 630. Preparing meals
Planning, organizing, cooking and serving simple and complex meals for oneself and others, such as by
making a menu, selecting edible food and drink, getting together ingredients for preparing meals, cooking
with heat and preparing cold foods and drinks, and serving the food, according to age.
● d 630.0. No Difficulties
● d 630.1. Mild Difficulties: The individual is able to prepare simple dishes such as salads, soups,
biscuits, etc., they find it difficult to prepare and serve complex meals.
● d 630.2. Moderate Difficulties: The individual finds it difficult to plan simple and complex meal
preparation, serving them, and using electrical appliances. They can do simple actions such as make
a cup of tea, make a bread and cheese sandwich and so on. Sometimes they need partial help and
guidance from others.
● d 630.3. Severe Difficulties: The individual is able to do elementary actions when preparing food,
they have difficulties planning simple and complex meal preparation, serving them, they have the
need for constant help, visual cards, and guidance from other people.
● d 630.4 Complete Difficulties: The individual is unable to prepare meals at all.
d 640. Doing housework
Managing a household by cleaning the house, washing clothes, using household appliances, storing food and
disposing of garbage, washing counters, walls and other surfaces; collecting and disposing of household
garbage; tidying rooms, closets and drawers; cleaning footwear; using brooms, brushes and vacuum
cleaners․
● d 640.0. No Difficulties
● d 640.1. Mild Difficulties: The individual can do household chores on their own, but easily gets
distracted from various external signals (game, computer, sounds). They return to work with the
direction of another person and continues it again. They can finish the work that they started.
● d 640.2. Moderate Difficulties: The individual can do household chores on their own in part, not
entirely, they mainly carry out the work that they find primarily necessary, they sometimes need
help from other people. They find it difficult to complete the work.
● d 640.3. Severe Difficulties: The individual can do household chores with the use of household
appliances only with the help of others, they can perform only basic elementary actions, such as
wiping the table, shutting off the water, switching off the TV and so on.
● d 640.4. Complete Difficulties: The individual cannot do household chores at all.
d 650. Caring for household objects
Maintaining household objects, including house and contents, clothes, vehicles and assistive devices, and
caring for plants and animals, watering plants.
● d 650.0. No Difficulties
● d 650.1. Mild Difficulties: The individual can take care of the house, household appliances,
equipment, animals, house plants and yard plants independently, they get distracted from various
external signals (game, computer, sounds). They return to work with the direction of another person
and continues it again.
● d 650.2. Moderate Difficulties: The individual can take care of the house, household appliances,
equipment, animals, house plants and yard plants independently partially, not entirely. They mainly
carry out the work that they find primarily necessary
● d 650.3. Severe Difficulties: The individual can take care of the house, household appliances,
equipment, animals, house plants and yard plants with great difficulty, only with the help of another
person, they can perform only basic elementary actions, such as closing the door, shutting the lights
off etc.
● d 650.4. Complete Difficulties: The individual cannot take care of the house, household
appliances, equipment, animals, house plants and yard plants at all.
d 660. Assisting others
Assisting household members and others with their learning, communicating, self-care, movement, within
the house or outside; being concerned about, or drawing other’s attention to, the well-being of household
members and others.
● d 660.0. No Difficulties
● d 660.1. Mild Difficulties: The individual can help family members and others with learning,
communicating, self-care, helping them move within the house or outside independently, with some
breaks according to their mood.
● d 660.2. Moderate Difficulties: The individual can help family members and others with learning,
communicating, self-care, helping them move within the house or outside partially independently,
they need the directions of another person.
● d 660.3. Severe Difficulties: The individual is able to perform simple, familiar actions. They have
a need for assisting devices, help from other people and intervention.
● d 660.4. Complete Difficulties: The individual cannot provide any kind of assistance.
d 710. Basic interpersonal interactions
Interacting with people in a contextually and socially appropriate manner, such as by showing consideration
and esteem when appropriate, or responding to the feelings of others as well as showing respect, warmth,
appreciation, and tolerance in relationships; responding to criticism and social cues in relationships, and
using appropriate physical contact in relationships.
● d 710. 0. No Difficulties
● d 710.1. Mild Difficulties: When establishing interpersonal relationships, the individual is able to
approach and communicate with people with simple behaviours (such as greetings, using
affirmative or negative gestures, inviting them inside) in a manner acceptable to the public. Some
actions may be inappropriate or disrespectful towards others.
● d 710.2. Moderate Difficulties: When establishing interpersonal relationships, the individual is
able to interact only with familiar people in a given situation through specific actions. They have
difficulties showing tolerance in relationships, they can demonstrate unpredictability and
inappropriate behaviour.
● d 710.3. Severe Difficulties: The individual finds it difficult to enter into interpersonal
relationships with even familiar people, they are mainly indifferent or aggressive, they have the
need for guidance or supervision of another person.
● d 710.4. Complete Difficulties: The individual cannot enter into interpersonal relationships at all.
d 760. Family relationships
Creating and maintaining kinship relationships, such as with members of the nuclear family, extended
family, foster and adopted family and step-relationships, more distant relationships such as second cousins,
or legal guardians, including parent-child and child-parent relationships, sibling and extended family
relationships
● d 760.0. No Difficulties
● d 760.1. Mild Difficulties: The individual is able to establish and maintain kinship relationships
with immediate family members and close relatives only with simple behaviours (such as curiosity,
doing an activity together, showing care), and communication. Their actions may be inappropriate
for the situation, they have difficulties initiating, approving and maintaining relationships with
more distant relatives.
● d 760.2. Moderate Difficulties: The individual is able to establish and maintain kinship
relationships with immediate family members and close relatives only with concrete, clear and
simple actions. Their behaviour is unpredictable and does not correspond to the situation. They can
be inappropriate or disrespectful towards family members.
● d 760.3. Severe Difficulties: The individual is able to establish and maintain kinship relationships
with only one-two immediate family member(s), only through physical action that reflect
indifference or aggression, they have the need for supervision and control from others.
● d 760.4. Complete Difficulties: The individual is unable to establish and maintain kinship
relationships at all.
d 810. Informal education
Learning at home or in some other non-institutional setting, such as acquiring non-academic (e.g. crafts) or
academic (e.g. home-schooling) skills from parents or family member in the home or community
● d 810.0. No Difficulties
● d 810.1. Mild Difficulties: The individual is able to participate in an informal education
programme, according to their personal curriculum, overcoming difficulties on their own.
● d 810.2. Moderate Difficulties: The individual is able to partially participate in an informal
educational programme, they need to be guided by another person to perform the tasks.
● d 810.3. Severe Difficulties: The individual is able to participate in an informal education
programme with difficulty, they perform only simple and short-term assignments with the constant
guidance of another person.
● d 810.4. Complete Difficulties: The individual cannot participate in an informal education
programme at all.
d 815. Preschool education
Learning at an initial level of organized instruction in the home or in the community designed primarily to
introduce a child to a school-type environment and prepare the child for compulsory education, such as by
acquiring skills in a day-care or similar setting in preparation for school (e.g. educational services provided
in the home or in community settings designed to promote health and cognitive, motor, language and social
development and readiness skills for formal education).
● d 815.0. No Difficulties
● d 815.1. Mild Difficulties: The individual is able to participate in preschool training provided by
the curriculum, overcoming difficulties independently.
● d 815.2. Moderate Difficulties: The individual needs guidance while participating in preschool
education and performing tasks.
● d 815.3. Severe Difficulties: While learning at the preschool level, the individual cannot
independently participate in the learning process, they constantly need help and guidance from
another person.
● d 815.4. Complete Difficulties: The individual is unable to attend preschool at all.
d 820. School education
Gaining admission to school, education; engaging in all school-related responsibilities and privileges;
learning the course material, subjects and other curriculum requirements in a primary or secondary education
programme, including attending school regularly; working cooperatively with other students, taking
direction from teachers, organizing, studying and completing assigned tasks and projects, and advancing to
other stages of education
● d 820.0. No Difficulties
● d 820.1. Mild Difficulties: The individual is able to participate in the school curriculum, according
to their personal learning plan, having difficulties when performing tasks and collaborating with
other students, but they are able to overcome difficulties independently.
● d 820.2. Moderate Difficulties: The individual participates in a personal learning plan provided by
an educational program, they need guidance and assistance when organizing themselves and
fulfilling tasks.
● d 820.3. Severe Difficulties: The individual fails to participate in elementary or secondary
education programs envisaged by the personal learning plan, they fail to fulfil all responsibilities, to
collaborate with other students, to get tasks from teachers, prepare for other stages of education and
master mandatory components. They need constant help and guidance from another person.
● d 820.4. Complete Difficulties: The individual is unable to participate in school education at all.
860. Basic economic transactions
Engaging in any form of simple economic transaction, such as using money to purchase food.
● d 860.0. No Difficulties
● d 860.1. Mild Difficulties: The individual can make simple economic transactions, for example, go
to the store by themselves to use the money given them to purchase food and only from the list
provided them.
● d 860.2. Moderate Difficulties: The individual is only able to make simple economic transactions
(go to a shop to purchase goods) with the help of cards, only in a familiar store. They need the
supervision of another person (a seller, someone accompanying them).
● d 860.3. Severe Difficulties: The individual has difficulties making even simple economic
transactions, even with the help of cards, they require the mandatory help of another person, for
example in taking them to the store, accompanying them, finding the store, taking the money out,
counting it, paying and going back home.
● d 860.4. Complete Difficulties: The individual is unable to perform any kind of simple economic
transaction.
d 880. Engagement in play
Purposeful, sustained engagement in activities with objects, toys, materials or games, occupying oneself or
with others.
● d 880.0. No Difficulties
● d 880.1. Mild Difficulties: The individual is able to play purposefully, both alone and with others,
but shows shyness in a new environment and when playing with strangers.
● d 880.2. Moderate Difficulties: The individual prefers to play only with familiar people and/or
toys, and/or has difficulties participating in a game independently and sometimes feels the need for
assisting devices and/or people.
● d 880.3. Severe Difficulties: In most cases, the individual plays alone and/or not purposefully, they
refuse to cooperate with other people and/or may be involved in game activities only with the help
of supportive means and/or help from other people.
● d 880.4. Complete Difficulties: The individual is completely indifferent and/or incapable of
engaging in playing games even with assisting devices and/or the help of other people.
d 910. Community life
Engaging in aspects of community social life, such as going to various events, concerts, weddings, parks,
cafes and other public venues.
● d 910.0. No Difficulties
● d 910.1. Mild Difficulties: The individual participates in community social life, but gets very tired
due to physical issues, they generally don’t have the desire or mood to participate.
● d 910.2. Moderate Difficulties: The individual usually participates in community social life for a
short time, gets tired quickly, tenses up, has the need for guidance and assistance or the use of
assisting devices due to physical issues.
● d 910.3. Severe Difficulties: The individual can participate in community social life only in the
case of constant surveillance and assistance.
● d 910.4. Complete Difficulties: The individual cannot participate in community social life, they are
always bedridden.
d 920. Recreation and leisure
Engaging in any form of play, recreational or leisure activity, such as informal or organized play and sports,
programmes of physical fitness, relaxation, amusement or diversion, going to art galleries, museums,
cinemas or theatres; engaging in crafts or hobbies, reading for enjoyment, playing musical instruments;
sightseeing, tourism and travelling for pleasure, including games, sports, arts and culture, crafts, hobbies and
socializing.
● d 920.0. No Difficulties
● d 920.1. Mild Difficulties: When engaging in recreational and leisure activities, the individual gets
tired due to physical issues, they often have no desire or mood to participate in the given action.
● d 920.2. Moderate Difficulties: The individual will participate in recreational and leisure activities
for a limited time due to physical and/or mental issues, they may have mood disorders, nervous
breakdowns, fear of crowds and so on. Sometimes they need the supervision of another person.
● d 920.3. Severe Difficulties: The individual can only participate in recreational and leisure
activities with the constant supervision and support of another person.
● d 920.4. Complete Difficulties: The individual is unable to organize or participate in recreation or
leisure.
Lifestyle and environmental factors of
children with disabilities between the ages of 2
and 18
ASSESSMENT QUESTIONNAIRE
Personal Information
1 First, last and middle name
2 Birthday, month and year
3 Sex (specify) 1. Male 2. Female
4 Place of registration, actual or temporary residence
5 Telephone number
6 Occupation / educational institution
7 If not studying or attending any educational institution
specify the reason
ENVIRONMENTAL FACTORS
Environmental
factors
Does the
individual have
obstacles in the
following
environment?
0
No
obstacl
es
1
Mild
obstacl
es
2
Moder
ate
obstacl
es
3
Severe
obstacl
es
4
Compl
ete
obstacl
es
Other
notes
e115: Products and
technology for
personal use in
daily living
Need for general
products and
technology for
personal use in
daily living as
well as specially
designed
equipment,
products and
technologies
adapted for
general purposes,
such as
appropriate
clothing,
customized
furniture,
household
appliances.
e120: Products and
technology for
personal indoor
and outdoor
mobility and
transportation
Need for products
and technology
for personal
indoor and
outdoor mobility
and
transportation.
Equipment,
products and
technologies used
by people in
activities of
moving inside and
outside buildings.
e125: Products and
technology for
communication
Need for
equipment,
products and
technologies used
by people in
activities of
sending and
receiving
information.
e 130: Products
and technology for
education
Equipment,
products,
processes,
methods and
technology used
for the acquisition
of
knowledge,
expertise or skill,
including those
adapted or
specially designed
as well as general
and assistive
products and
technology for
education.
e150: Design,
construction and
building products
and technology of
buildings for
public use
Products and
technology that
constitute an
individual’s
indoor and
outdoor human-
made environment
that is planned,
designed and
constructed for
public use,
including those
adapted or
specially
designed.
e250: Sound A phenomenon
that is or may be
heard, such as
banging, ringing,
thumping,
singing, whistling,
yelling or
buzzing, in any
volume, timbre or
tone, including
sound intensity,
sound quality.
e310: Immediate
family
The presence or
absence of
immediate family
members who
provide practical
physical or
emotional
support, nurturing
and protection.
e320: Friends Individuals who
are close and
ongoing
participants in
relationships
characterized by
trust and mutual
support. The code
described does not
refer to
individuals, but
the support which
they provide.
e410: Individual
attitudes of
immediate family
members
General or
specific opinions
and beliefs of
immediate family
members about
the person or
about other
matters (e.g.
social, political
and economic
issues), that
influence
individual
behaviour and
actions.
e420: Individual
attitudes of friends
General or
specific opinions
and beliefs of
friends about the
person or about
other matters (e.g.
social, political
and economic
issues), that
influence
individual
behaviour and
actions.
e460: Societal
attitudes
General or
specific opinions
and beliefs
generally held by
people of a
culture, society,
subcultural or
other social
groups about
other individuals
or about other
social, political
and economic
issues, that
influence group or
individual
behaviour.
e540:
Transportation
services, systems
and policies
The availability
and accessibility
of services and
programmes
aimed at moving
persons or goods
by road, paths,
rail, air or water,
by public or
private transport.
e570: Social
security services,
systems and
policies
The availability
and accessibility
of public support
and social security
services, which
are aimed at
providing support
(eg. benefits).
e580: Health
services, systems
and policies
The availability
and accessibility
of services,
systems and
policies for
preventing and
treating health
problems,
providing medical
rehabilitation and
promoting a
healthy lifestyle,
excluding general
social support
services, systems
and policies.
e585: Education
and training
services, systems
and policies
The accessibility
of services,
systems and
policies for the
acquisition,
maintenance and
improvement of
knowledge,
expertise and
vocational or
artistic skills.
ACTIVITIES AND PARTICIPATION
Activities Does the
individual have
any difficulties?
0
Difficu
lties
1
Mild
difficul
ties
2
Moder
ate
difficul
ties
3
Severe
difficul
ties
4
Compl
ete
difficul
ties
Other
notes
d110: Watching Using the sense of
seeing
intentionally to
experience visual
stimuli, such as
following an
object, watching
any given person,
or children
playing.
d115: Listening Using the sense of
hearing
intentionally to
experience
auditory stimuli,
such as listening
to the sound of
someone's voice
(lecture, story,
conversation) or
listening to the
radio, music.
d120: Other
purposeful sensing
Using the body’s
other basic senses
intentionally to
experience
stimuli, such as
touching and
feeling textures,
tasting sweets or
smelling flowers
and perfume.
d130: Copying Imitating or
mimicking as a
basic component
of learning, such
as copying a facial
expression,
gesture, the letters
of an alphabet a
sound including
directly copying
an action or
behaviour.
d131: Learning
through actions
with objects
Learning with two
or more objects
and through
simple symbolic
games and role-
playing games,
such as hitting
objects, knocking
blocks, and
playing with dolls
or cars.
d160: Focusing
attention
Intentionally
focusing on
specific stimuli,
such as by
filtering out
distracting noises.
d161: Directing
attention
Intentionally
maintaining
attention to
specific actions or
tasks for an
appropriate length
of time.
d163: Thinking Formulating and
manipulating
ideas, concepts,
and images,
whether goal-
oriented or not,
either alone or
with others, and
other thinking-
related activities.
d166: Reading Performing
activities involved
in the
comprehension
and interpretation
of written
language (e.g.
books,
instructions,
newspapers in text
or Braille), for the
purpose of
obtaining general
knowledge or
specific
information.
d170: Writing
Using or
producing
symbols or
language to
convey
information (with
typewriters,
Braille writers)
such as producing
a written record of
events or ideas or
drafting a letter
(with typewriters,
Braille writers).
d172: Calculating Performing
computations by
applying
mathematical
principles to solve
problems that are
described in
words and
producing or
displaying the
results, such as
computing the
sum of three
numbers or
finding the result
of dividing one
number by
another.
d210: Undertaking
a single task
Carrying out
simple or complex
and coordinated
activities related
to the mental and
physical
components of a
single task, such
as initiating a
task, organizing
time, space and
materials for a
task, pacing task
performance, and
carrying out,
completing and
sustaining a task.
d230: Carrying out
daily routine
Carrying out
simple or complex
and coordinated
activities in order
to plan, manage
and complete the
requirements of
day-to-day
procedures or
duties, such as
budgeting time
and making plans
for separate
activities
throughout the
day.
d250: Managing
one’s own
behaviour
Carrying out
simple or complex
and coordinated
actions in a
consistent manner
in response to new
situations, persons
or experiences,
such as being
quiet in a library.
d310:
Communicating
with - receiving -
spoken messages
Comprehending
literal and implied
meanings of
messages in
spoken language,
such as
understanding that
a statement asserts
a fact or is an
idiomatic
expression, such
as responding and
comprehending
spoken messages.
d315:
Communicating
with - receiving -
nonverbal
messages
Comprehending
the literal and
implied meanings
of messages
conveyed by
gestures, symbols
and drawings,
such as realizing
that a child is tired
when she rubs her
eyes or that a
warning bell
means that there is
a fire.
d330: Speaking Producing words,
phrases and
longer passages in
spoken simple and
complex messages
with literal and
implied meaning,
such as expressing
a fact or telling a
story in oral
language.
d335: Producing
nonverbal
messages
Using gestures,
symbols and
drawings to
convey messages,
such as shaking
one’s head to
indicate
disagreement or
drawing a picture
or diagram to
convey a fact or
complex idea, this
includes
producing body
gestures, signs,
symbols,
drawings and
photographs.
d350: Conversation
Starting,
sustaining and
ending an
interchange of
thoughts and
ideas, carried out
by means of
spoken, written,
sign or other
forms of
language, with
one or more
persons one
knows or who are
strangers, in
formal or casual
settings.
d410: Changing
basic body position
Getting into and
out of a body
position and
moving from one
location to
another, such as
rolling from one
side to the other,
sitting, standing,
getting up out of a
chair to lie down
on a bed, and
getting into and
out of positions of
kneeling or
squatting
including
changing body
position from
lying down, from
squatting or
kneeling, from
sitting or standing,
bending and
shifting the
body’s centre of
gravity.
d415: Maintaining
a body position
Staying in the
same body
position as
required, such as
remaining seated
or remaining
standing for work
or school
including
maintaining a
lying, squatting,
kneeling, sitting
and standing
position.
d420: Transferring
oneself
Moving from one
surface to another,
such as sliding
along a bench or
moving from a
bed to a chair,
without changing
body position.
d440: Fine hand
use
Performing the
coordinated
actions of
handling objects,
picking up,
manipulating and
releasing them
using one’s hand,
fingers and
thumb, such as
required to lift
coins off a table
or turn a dial or
knob.
d445: Hand and
arm use
Performing the
coordinated
actions required to
move objects or to
manipulate them
by using hands
and arms, such as
pulling or pushing
objects, reaching,
turning or twisting
the hands or arms,
throwing,
catching an
object.
d450: Walking Walking short
distances, at
home, in the yard,
as well as long
distances of more
than 1 kilometre
across a village or
town.
d455: Moving
around
Moving the whole
body from one
place to another
by means other
than walking,
such as climbing
over a rock or
running down a
street, skipping,
jumping, or
running around
obstacles.
d465: Moving
around using
equipment
Moving the whole
body from place
to place, on any
surface or space,
by using specific
devices designed
to facilitate
moving or create
other ways of
moving around.
d470: Using
transportation
Using
transportation to
move around as a
passenger, such as
being driven in a
car, bus, private or
public taxi.
d510: Washing
oneself
Washing and
drying one’s
whole body, or
body parts.
d520: Caring for
body parts
Looking after
those parts of the
body, such as
skin, face, teeth,
scalp, nails.
d530: Toileting Indicating the
need for, planning
and carrying out
the elimination of
human waste
(menstruation,
urination and
defecation), and
cleaning oneself
afterwards.
d540: Dressing Carrying out the
coordinated
actions and tasks
of putting on and
taking off clothes
and footwear in
sequence and in
keeping with
climatic and
social conditions.
d550: Eating Indicating the
need for, and
carrying out the
coordinated tasks
and actions of
eating food that
has been served,
bringing it to the
mouth, cutting or
breaking food into
pieces, using
eating implements
and dining.
d560: Drinking Indicating the
need for, and
taking hold of a
drink, bringing it
to the mouth and
consuming the
drink, opening
bottles, drinking
through a straw or
drinking running
water.
d630: Preparing
meals
Planning,
organizing,
cooking and
serving simple
and complex
meals for oneself
and others, such
as by making a
menu, selecting
edible food and
drink, getting
together
ingredients for
preparing meals,
cooking with heat
and preparing
cold foods and
drinks, and
serving the food.
d640: Doing
housework
Managing a
household by
cleaning the
house, washing
clothes, using
household
appliances,
storing food and
disposing of
garbage, washing
counters, walls
and other
surfaces;
collecting and
disposing of
household
garbage; tidying
rooms, closets and
drawers; cleaning
footwear; using
brooms, brushes
and vacuum
cleaners․
d650: Caring for
household objects
Maintaining
household objects,
including house
and contents,
clothes, vehicles
and assistive
devices, and
caring for plants
and animals,
watering plants.
d660: Assisting
others
Assisting
household
members and
others with their
learning,
communicating,
self-care,
movement, within
the house or
outside; being
concerned about,
or drawing other’s
attention to, the
well-being of
household
members and
others.
d710: Basic
interpersonal
interactions
Interacting with
people in a
contextually and
socially
appropriate
manner, such as
by showing
consideration and
esteem when
appropriate, or
responding to the
feelings of others
as well as
showing respect,
warmth,
appreciation, and
tolerance in
relationships;
responding to
criticism and
social cues in
relationships, and
using appropriate
physical contact
in relationships.
d760: Family
relationships
Creating and
maintaining
kinship
relationships, such
as with members
of the nuclear
family, extended
family.
d810: Informal
education
Learning at home
or in some other
non-institutional
setting, such as
acquiring non-
academic (e.g.
crafts) or
academic (e.g.
home-schooling)
skills from parents
or family member
in home or
community.
d815: Preschool
education
Learning at an
initial level of
organized
instruction in the
home or in the
community
designed
primarily to
introduce a child
to a school-type
environment and
prepare the child
for compulsory
education, such as
by acquiring skills
in a day-care or
similar setting in
preparation for
school.
d820: School
education
Gaining
admission to
school, education;
engaging in all
school-related
responsibilities
and privileges;
learning the
course material,
subjects and other
curriculum
requirements in a
primary or
secondary
education
programme.
d860: Basic
economic
transactions
Engaging in any
form of simple
economic
transaction, such
as using money to
purchase food
with cash or cards
(exchanges),
exchanging goods
or services or
saving money.
d880: Engagement
in play
Purposeful,
sustained
engagement in
activities with
objects, toys,
materials or
games, occupying
oneself or with
others.
d910: Community
life
Engaging in
aspects of
community social
life, such as going
to various events,
concerts,
weddings, parks,
cafes and other
public venues.
d920: Recreation
and leisure
Engaging in any
form of play,
recreational or
leisure activity,
such as informal
or organized play
and sports,
programmes of
physical fitness,
relaxation,
amusement or
diversion, going
to art galleries,
museums,
cinemas or
theatres; engaging
in crafts or
hobbies, reading
for enjoyment,
playing musical
instruments;
sightseeing,
tourism and
travelling for
pleasure,
including games,
sports, arts and
culture, crafts,
hobbies and
socializing.
The questionnaire was completed by (Name, Last Name)
Ergotherapist-------------------------------------------------------------------------------------------(-----------------------
-------)
Logopedist-----------------------------------------------------------------------------------------------(---------------------
---------)
Psychologist --------------------------------------------------------------------------------------------(----------------------
--------)
Social Worker-------------------------------------------------------------------------------------------(---------------------
---------)
_____________________________ 2017
Attachments/ Forms
1. Personal summary evaluation/profile
2. Professional intervention programme
3. Reassessment form
Form 1
Personal summary evaluation/profile Date of completion: 00/00/0000
Name, Last name, Middle name:
___________________________________________
Diagnosis: ____________________________
Age: ______________________________
day, month, year
Photograph
Provided services ● Logopedist
● Ergotherapist
● Social Worker
● Psychologist
Issues raised by the ICF
assessment
(Here are all the issues that
have been identified with
the help of the
questionnaire)
1 2 3 4 Intervention plan Result indicators according to
the ICF assessment results
Form 2
PROFESSIONAL INDIVIDUAL INTERVENTION
PROGRAMME Professional/ first name/ last name
/Fill out the first and last name of the specialist which created the individual intervention plan/
Date of completion: dd/mm/yyyy/ /Fill out the date, month and year of the creation of the individual intervention plan/
First name, last name, middle name: (Fill out the first, last and middle name of the child receiving rehabilitation services).
Birthday, month, year: (Fill out the date of birth by date, month, and year of the child receiving rehabilitation services).
Diagnos(is/es) 1 (Fill out the child’s medical diagnosis, according to the agency of medical and social expertise)
Conclusions made by a specialist based on the ICF assessment 2 (Fill out the specialist’s conclusions of the individual intervention plan)
Participation/activity (d) environmental (e) issues raised (ICF)
● d 000 - denotation
(Fill out the code with the appropriate characters and name)
description of the issue
(Fill out a detailed description of the relevant issue based on the
code)
1 Diagnosis according to the conclusion of the agency of medical and social expertise.
2 By the professional service provider.
Intervention Outcomes
(Fill this field with the long term-objectives for vitality and participation as defined by the specialist)
Short-term intervention
description
(Fill out a detailed description of
the intervention programme as
planned by the specialist)
Applied methods, approaches,
measures and steps
(Fill out all the methods,
approaches and steps that are
applied during the planned
intervention, which the specialist
will use in the course of the
intervention to achieve the goal)
Result indicators of the
professional individual
intervention plan
(Fill out the results of the
intervention completed by the
specialist and the deadlines of the
intervention)
Form 3
REEVALUATION OF THE INDIVIDUAL INTERVENTION
PROGRAMME (After the completion of their intervention, each specialist also conducts a re-evaluation based on the set goals)
Re-evaluation date dd/mm/yyyy/
(Fill out the day, month and year of the re-evaluation)
Short-term goal of the intervention Short-term goal clearly defined by the specialist
Re-evaluating the child’s individual
intervention programme by a
specialist, according to professional
observation (Fill out the results of the intervention completed by the
specialist and the timing of the intervention)
Other notes (If there are any points subject to explanation, please describe them in detail)
DICTIONARY Adaptation
adjustment, alteration, modification
Adequate
suitable, sufficient, equal, fully compliant
Hyperactive
extremely active
Hyperkinetic
Features a consistently good and happy mood. Active, full of energy. They manifest an aspiration of
leadership. They are friendly, are not stable in their interests.
They have difficulty adapting to being alone. They easily adapt to unfamiliar environments, do not like
monotony, discipline, monotonous work and imposed activity. They are optimistic and tend to overestimate
their own capabilities. They react emotionally to events and are excitable.
Facial Expression
Facial muscle movements, the expression of inner experiences playing on the face.
Sensor
a physical organism that causes senses (visual sensor, auditory sensor, etc.)
Perception
a reflection of the full images of objects in the inner world of a person.
Comprehension
Thoughtful, meaningful, understood perception
Gesture
A gesture is an appropriate movement performed by the body or any part of the body to transmit an
expression of something. The hands, fingers and head are often used to make gestures. The most common
gesture in the head is the movement of nodding, which means yes.
If the head shakes from right to left and left to right then it means no. There is also another gesture that
happens when you move the jaw to the right and to the left, thereby expressing disapproval.
Self-service
The ability to serve oneself without the help of any other person.
Language
a system of symbols and rules for connecting them to each other.
Auditory stimulus
that which is perceived by the auditory analyzer
To reflect
to think, contemplate, consider, ponder
Obsessive thoughts
thoughts that an individual has regularly or at constant intervals
Tardiness
being late, prolongation, delay
Memory
The ability to maintain perceptions in the mind (brain) and replicate them, which is also a group of complex
mental processes.
Reflection
one of the methods that activate thinking and imagination
Thinking
a mental cognitive process, most often a problem-solving process, with which we understand hidden aspects
of occurrences and the patterns of existence.
Remembrance
the original process of memory, the process of keeping that which is perceived in mind.
Trifle
1. small items, objects
2. items and accessories of secondary importance
System of symbols
All the signs that are required to communicate in writing, such as letters, punctuation marks and more.
Non-verbal
not with spoken word
Pathological deviation
development does not have a sustainable deviation
Taciturn
untalkative
Symbolic games
Those games when an object refers to something else who does not exist at the given moment. For example,
when a baby takes a piece of wood and riding it like a horse.
Role-playing game
the collection of behaviour experience and general judgement and a means of forming the main components
of the child’s moral and social aspirations. During the game, an emotional atmosphere is formed that
contributes to the child’s character’s empathy, that is, the formation of attitudes, sensitivity, care, readiness
and fairness.
Verbal
the phenomenon of spoken “word,” the term used to indicate the process of words, signs and actions.
Verbal guidance
Direction, help, which occurs in the form of spoken word or speech, for example, “raise your hand” etc.
Visual cards
Cards designed for visual orientation
Visual stimulus
that which is perceived by the visual analyzer
Distractedness
the inability to focus on anything more or less for a long time. it is the opposite of sustainability.
Attention
the direction of a person’s mental activity towards certain objects and phenomena
Concentration of attention
the concentration of mental activity on one or a few objects, thanks to which they are perceived in clear and
precise details.
Stability of attention
the temporal characteristic of attention: the attention of a person, who has been focusing their attention on a
particular object or activity for a long time, is stable
To interact
to mutually influence, to influence each other or impact each other
Helper/assisting device
customized or special-purpose equipment, products and technologies, with the help of which people can
move around, such as walkers, wheelchairs, crutches as well as with the help of which people are able to
transmit and receive information such as special purpose visual aids, electro-optical devices, special purpose
printers, equipment for painting or writing with the hand, signalling systems and special software, hearing
aids, personal hearing aids, audio prostheses, communication panels, glasses and contact lenses.
Physical activity
any movement of the body that is accompanied by energy expenditure, with the help of muscle power.
Physical guidance
immediate physical assistance from any person, for example, guiding a child by hold their hand and taking it
towards the object or task.
Function
In Armenian: an operation, the role that the subject can perform. Simply put, that which can be done with the
help of a given item. For example, a pen is for writing, a key is for opening and closing a lock, a spade for
digging and so on.
References 1. Anne Mclntyre & Anita Atwal (2005); Occupational Therapy and Older People, Brunel University,
London UK.
2. Catherine A. Trombly & Mary Vining Radomski (2002); Occupational therapy for physical dysfunction
fifth edition.
3. Finlay, L. & Nelson Thornes (2004), The practice of Psychosocial Occupational Therapy.
4. World Health Organization, International Classification of Children and Youth Functionality, Disability
and Health, 2007.
5. Classification of functionality, disability and health, 2001.
6. M. Harutyunyan, L. Grigoryan (2016), ԱՀԿ Ֆունկցիայի միջազգային դասակարգման հիման վրա
հաշմանդամության սահմանման համար մշակված գործիքների e կոդերի՝ միջավայրային
գործոնների գնահատման ուղեցույց [Guidelines for the Assessment of e Code, Environmental Factors
Developed to Identify Disability Based on the WTO Functional Classification]
7. M. Harutyunyan, L. Grigoryan, A. Hayrapetyan, L. Yesayan (2016), ԱՀԿ Ֆունկցիայի միջազգային
դասակարգման հիման վրա հաշմանդամության սահմանման համար մշակված գործիքների d
կոդերի՝ անձի գործունեության և մասնակցության գնահատման ուղեցույց [Guidelines for the
Assessment of d Code an Individual’s Activity and Participation Factors Developed to Identify Disability
Based on the WTO Functional Classification]