智力与发展性残疾儿童言语和语言功能特点及教育课程和康复方案：基于ICF的研究

doi:10.3969/j.issn.1006-9771.2025.08.009

Abstract

Abstract:

Objective To systematically explore the characteristics of speech, language functioning and adaptation in children with intellectual and developmental disabilities (IDD) based on framework of International Classification of Functioning, Disability and Health (ICF), to construct an integrated system that merges curricula and rehabilitation based on an analysis of the content and functional goals within language-related curriculum standards for Peizhi (special education for children with IDD) schools.

Methods Using the bio-psycho-social model of the ICF, the characteristics of speech and communication disorders in children with IDD were systematically analyzed across the three dimensions of body functions and structures, activities and participation, and environmental factors. A content analysis was conducted on the three core curriculum standards for Peizhi schools issued by the Ministry of Education of China, extracting and summarizing the goals and core content related to linguistic ability development, which were then mapped and coded using the ICF classification system. Guided by the ICF's functioning-oriented principles, these curriculum goals were integrated with evidence-based rehabilitation strategies to construct a comprehensive curriculum and rehabilitation interventions that included assessment, goal setting, curriculum module design and intervention strategies.

Results For the speech and language functioning in children with IDD, at the body functions level, impairments were identified in areas such as mental functions of language (b167) and articulation (b320); at the activities and participation level, limitations manifested as significant difficulties in communication (d3) and interpersonal interactions (d7); and environmental factors (e.g., family support, e310; educational services, e585) impacted on functional performance and adaptation. Main curriculum standards of China related to language functioning for Peizhi schools addressed three domains respectively: body functions (Rehabilitation Training Curriculum Standard), communication skills [Living Language (Chinese) Curriculum Standard], and social participation and environment (the Life Adaptation Curriculum Standard). Together, they constructed a standardized system for educational curricula and rehabilitation interventions for children's speech and language functioning.

Conclusion The speech therapy, the courses of Chinese language and adaptation are the complex and multidimensional processes. Based on the theoretical framework of the ICF's bio-psycho-social model, this study systematically integrates China's Living Language (Chinese), Rehabilitation Training, and Life Adaptation curriculum standards to construct a speech rehabilitation program and a language ability curriculum oriented by the children's speech, language functioning and adaptation, which emphasizes a process beginning with functional assessment, grounded in real-life contexts, and actualized through interdisciplinary collaboration, to provide individualized, multimodal and evidence-based education, rehabilitation interventions and support for every child with special needs. By implementing the integrated rehabilitation interventions and language-related curriculum system, it enhances children's speech, language functioning and adaptation, promotes their functional communication, empowers their communication activities and social participation, and improves their social adaptation and overall development.

Key words: intellectual and developmental disabilities, language ability, International Classification of Functioning, Disability and Health, living Chinese language, speech therapy

CLC Number:

R749.93

LI Sha, QIU Zhuoying. Characteristics of speech and language functioning in children with intellectual and developmental disabilities and their educational curricula and rehabilitation interventions: an ICF-based study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 930-938.

Figures/Tables 3

Table 1

Analysis of speech and language functioning characteristics of children with IDD based on ICF"

ICF维度	ICF编码	ICF类别	IDD儿童的常见特征描述
身体功能与结构	b167	语言精神功能	语言习得延迟，词汇量不足，词语使用不当语法规则掌握困难，难以理解和产出复杂句接受性和表达性语言发展不均衡
	b320	构音功能	发音不清，存在音素的替代、省略或歪曲，导致言语清晰度低
	b330	言语的流畅和节律功能	可能伴有口吃、语速异常或不流畅等问题
	b140	注意力功能	共同注意、持续注意困难，影响语言信息的输入和学习
	s320-s340	参与发声和言语的结构	部分儿童可能伴有唇腭裂等物理结构异常，直接影响言语产生
活动和参与	d310	交流-接收-口头讯息	难以理解他人的口头指令，特别是长指令或复杂指令对语境线索理解不足
	d330	说	表达性词汇量有限，句子简短，语法结构单一难以清晰表达自己的需求、想法和情感
	d350	交谈	难以发起和维持对话，轮流转换困难话题局限，常偏离主题语用技能不足，如不理解幽默或间接请求
	d710	基本的人际交往	难以建立和维持友谊。难以理解社会交往中的非语言线索(如面部表情、身体语言)
	d166/d170	阅读/书写	入学后常伴有读写障碍，学习困难
	d820/d920	学校教育/娱乐和休闲	因沟通障碍导致课堂参与困难，难以融入同伴游戏和集体活动
环境因素	e125	用于沟通的产品和技术	缺乏或无法有效使用AAC设备可能成为沟通的障碍，合适的AAC设备是重要的促进因素
	e310/e320	直系亲属家庭/朋友	家庭成员的积极支持、鼓励和有效的沟通互动是关键的促进因素同伴的接纳与互动提供了宝贵的练习机会
	e355/e360	卫生专业人员/其他专业人员(教师)	早期、持续的专业服务(言语治疗、特殊教育)是重要的促进因素服务可及性不足则构成障碍
	e410/e460	直系亲属家庭成员的个人态度/社会态度	对残疾的负面态度和污名化是儿童社会融合和沟通意愿的巨大障碍包容和支持的态度则是重要的促进因素
	e580/e585	卫生服务、体制和政策/教育和培训服务、体制和政策	完善的早期筛查、诊断、康复救助和融合教育政策体系是根本性的促进因素

Table 1

Table 2

Table 3

Integrated framework of speech therapy and key courses in Chinese language and adaptation based on ICF"

阶段	核心任务	具体操作方法与工具	课程标准融合点
第一阶段：功能性评估与目标设定	构建ICF功能画像	资料分析：查阅医学诊断和教育档案标准化评估：使用汉语图片词汇测验等工具评估b167，结果映射到ICF限定词生态化观察：在课堂(生活语文)、游戏(生活适应)中观察d3、d7的表现能力评估：在结构化情境中评估d3、d7的能力环境评估：使用访谈和清单评估e类因素的促进或阻碍作用	评估内容参考康复训练的功能点评估情境源于生活适应和生活语文
第二阶段：IEP制定与课程模块设计	设计功能导向的IEP	长期目标：设定与“参与”相关的目标(如能独立在社区商店购物) 短期目标：分解为具体的“活动”技能目标(如能阅读购物清单，能向店员问路) 支持性目标：明确需要改善的“身体功能”(如清晰说出“谢谢”) 支持策略：列出所需的环境支持(使用图片沟通板)	长期目标来自生活适应短期目标来自生活语文支持性目标来自康复训练
第三阶段：整合性干预实施	在生活主题中融合教康	示例模块：“超市购物” 课前准备(生活语文)：制作图文购物清单，学习商品名称课堂模拟(生活语文+康复)：角色扮演购物对话。个别化支持：构音不清者练习商品发音(b320)；无口语者练习使用AAC (e125)指认辅助器具社区实践(生活适应)：组织学生到真实超市购物，教师和治疗师现场提供支持课后分享(生活语文)：学生分享购物经历，练习叙事能力(d330)	主题源于生活适应技能教学来自生活语文个别化支持来自康复训练
第四阶段：持续性评估与调整	监测进展与调整方案	数据记录：持续记录儿童在自然情境中的沟通行为(如主动发起沟通的频率) 定期评估：定期(如每学期)重新进行ICF功能画像，对比前后变化动态调整：根据评估结果，动态调整IEP目标和干预策略	评估标准应体现语言能力发展与就业成绩

Table 3

References 25

[1]	易玲, 周静, 陈雪芬, 等. 基于ICF的智力残疾儿童言语功能障碍和沟通活动受限特征与康复干预[J]. 中国康复理论与实践, 2025, 31(4): 398-405. doi: 10.3969/j.issn.1006-9771.2025.04.004
	YI L, ZHOU J, CHEN X F, et al. Characteristics and intervention of speech function impairments and communication limitation in children with intellectual disabilities based on ICF[J]. Chin J Rehabil Theory Pract, 2025, 31(4): 398-405.
[2]	邱卓英, 李欣, 刘冯铂, 等. 基于ICF的智力残疾模式、测量方法及社会支持系统研究[J]. 中国康复理论与实践, 2016, 22(4): 373-377.
	QIU Z Y, LI X, LIU F B, et al. Framework, measurement, and social support of intellectual disability based on ICF[J]. Chin J Rehabil Theory Pract, 2016, 22(4): 373-377.
[3]	TASSÉ M, SCHALOCK R, LUCKASSON R. Intellectual disability: Definition, diagnosis, classification, and systems of supports[M]. 12th ed. Washington, D. C.: American Association on Intellectual and Developmental Disabilities, 2021.
[4]	杨亚茹, 郝传萍. 基于ICF构建智力残疾儿童适应性体育课程体系[J]. 中国康复理论与实践, 2022, 28(6): 659-669. doi: 10.3969/j.issn.1006-9771.2022.06.006
	YANG Y R, HAO C P. Construction of adapted physical education curriculum for children with intellectual disabilities using ICF[J]. Chin J Rehabil Theory Pract, 2022, 28(6): 659-669.
[5]	Centers for Disease Control and Prevention (CDC). Developmental disability basics[EB/OL]. (2025-06-02)[2025-06-22]. https://www.cdc.gov/child-development/about/developmental-disability-basics.html.
[6]	World Health Organization. International Statistical Classification of Diseases and Related Health Problems (ICD)[EB/OL]. (2025-02-14)[2025-04-20]. https://www.who.int/standards/classifications/classification-of-diseases.
[7]	周静, 张晓晓, 丁忠冰, 等. 智力与发展性残疾儿童言语与语言障碍康复的系统综述[J]. 中国康复理论与实践, 2024, 30(8): 894-902. doi: 10.3969/j.issn.1006-9771.2024.08.004
	ZHOU J, ZHANG X X, DING Z B, et al. Effect of speech and language rehabilitation on children with intellectual and developmental disabilities: a systematic review[J]. Chin J Rehabil Theory Pract, 2024, 30(8): 894-902.
[8]	中华人民共和国教育部. 培智学校义务教育生活语文课程标准[S/OL]. (2016-12-02)[2025-03-10]. https://www.ictr.edu.cn/Uploads/File/2022/05/23/33_%E5%9F%B9%E6%99%BA%E5%AD%A6%E6%A0%A1%E4%B9%89%E5%8A%A1% E6%95%99%E8%82%B2%E7%94%9F%E6%B4%BB%E8% AF%AD%E6%96%87%E8%AF%BE%E7%A8%8B%E6% A0%87%E5%87%86%EF%BC%882016%E5%B9%B4%E7%89%88%EF%BC%89.20220523162050.pdf.
[9]	中华人民共和国教育部. 培智学校义务教育康复训练课程标准[S/OL]. (2016-12-02)[2025-05-11]. https://www.ictr.edu.cn/Uploads/File/2022/05/23/36_%E5%9F%B9%E6%99%BA%E5%AD%A6%E6%A0%A1%E4%B9%89%E5%8A%A1% E6%95%99%E8%82%B2%E5%BA%B7%E5%A4%8D%E8% AE%AD%E7%BB%83%E8%AF%BE%E7%A8%8B%E6% A0%87%E5%87%86%EF%BC%882016%E5%B9%B4%E7%89%88%EF%BC%89.20220523162202.pdf.
[10]	中华人民共和国教育部. 培智学校义务教育生活适应课程标准[S/OL]. (2016-12-02)[2025-05-10]. https://www.ictr.edu.cn/Uploads/File/2022/05/23/41_%E5%9F%B9%E6%99%BA%E5%AD%A6%E6%A0%A1%E4%B9%89%E5%8A%A1% E6%95%99%E8%82%B2%E7%94%9F%E6%B4%BB%E9% 80%82%E5%BA%94%E8%AF%BE%E7%A8%8B%E6% A0%87%E5%87%86%EF%BC%882016%E5%B9%B4%E7%89%88%EF%BC%89.20220523162356.pdf.
[11]	世界卫生组织. 国际功能、残疾和健康分类(国际中文增补版)[M]. 邱卓英,译. 日内瓦: 世界卫生组织, 2015.
	World Health Organization. International Classification of Functioning, Disability and Health-(International Chinese Supplement)[M]. QIU Z Y, trans trans. Geneva: World Health Organization, 2015.
[12]	MCCARTY T V, LIGHT J C. Supporting peer interactions for students with complex communication needs in inclusive settings: paraeducator roles[J]. Perspect ASHA Spec Interest Groups, 2022, 7(1): 229-244.
[13]	ODOM S L, HALL L J, SUHRHEINRICH J. Implementation science, behavior analysis, and supporting evidence-based practices for individuals with autism[J]. Eur J Behav Anal, 2020, 21(1): 55-73. doi: 10.1080/15021149.2019.1641952 pmid: 32982588
[14]	WOOD J J, MCLEOD B D, KLEBANOFF S, et al. Toward the implementation of evidence-based interventions for youth with autism spectrum disorders in schools and community agencies[J]. Behav Ther, 2015, 46(1): 83-95. doi: 10.1016/j.beth.2014.07.003 pmid: 25526837
[15]	HYMAN S L, LEVY S E, MYERS S M. Identification, evaluation, and management of children with autism spectrum disorder[J]. Pediatrics, 2020, 145(1): e20193447.
[16]	THIEMANN-BOURQUE K, FELDMILLER S, HOFFMAN L, et al. Incorporating a peer-mediated approach into speech-generating device intervention: effects on communication of preschoolers with autism spectrum disorder[J]. J Speech Lang Hear Res, 2018, 61(8): 2045-2061.
[17]	邱卓英, 李沁燚, 陈迪, 等. ICF-CY理论架构、方法、分类体系及其应用[J]. 中国康复理论与实践, 2014, 20(1): 1-5.
	QIU Z Y, LI Q Y, CHEN D, et al. ICF-CY: Framework, approach, classification and implementation[J]. Chin J Rehabil Theory Pract, 2014, 20(1): 1-5.
[18]	SIMEONSSON R J, LEONARDI M, LOLLAR D, et al. Applying the International Classification of Functioning, Disability and Health (ICF) to measure childhood disability[J]. Disabil Rehabil, 2003, 25(11-12): 602-610. doi: 10.1080/0963828031000137117 pmid: 12959334
[19]	LIGHT J, MCNAUGHTON D. Designing AAC research and intervention to improve outcomes for individuals with complex communication needs[J]. Augment Altern Commun, 2015, 31(2): 85-96. doi: 10.3109/07434618.2015.1036458 pmid: 25904008
[20]	KASARI C, SHIRE S, SHIH W, et al. Spoken language outcomes in limited language preschoolers with autism and global developmental delay: RCT of early intervention approaches[J]. Autism Res, 2023, 16(6): 1236-1246. doi: 10.1002/aur.2932 pmid: 37070270
[21]	BROWDER D M. Teaching students with moderate and severe disabilities[M]. 2nd ed. New York: The Guilford Press, 2020.
[22]	BROCK M, BIGGS E, CARTER E, et al. Implementation and generalization of peer support arrangements for students with severe disabilities in inclusive classrooms[J]. J Special Educ, 2015, 49(4): 23-45.
[23]	GULBOY E, YUCESOY-OZKAN S, RAKAP S. Embedded instruction for young children with disabilities: a systematic review and meta-analysis of single-case experimental research studies[J]. Early Child Res Q, 2023, 63(2): 181-193.
[24]	MCNEILLY L G. Using the International Classification of Functioning, Disability and Health framework to achieve interprofessional functional outcomes for young children: a speech-language pathology perspective[J]. Pediatr Clin North Am, 2018, 65(1): 125-134.
[25]	PARSONS L, CORDIER R, MUNRO N, et al. A randomized controlled trial of a play-based, peer-mediated pragmatic language intervention for children with autism[J]. Front Psychol, 2019, 10(3): 1960.

课程标准	核心课程模块目标与内容	言语与语言功能目标对应的ICF类目和编码
康复训练课程标准	沟通与交往训练模块	身体功能
	言语准备：呼吸、发声、构音训练	b3 发声和言语功能
	前沟通技能：沟通动机、共同注意	b130 能量和驱力功能, b140 注意力功能
	口语沟通：理解词句、运用词组和句子表达	b167 语言精神功能
生活语文课程标准	倾听与说话	活动
	低年级：听懂常用语，表达基本需求	d310 交流—接收—口头讯息，d330 说
	中年级：简单讲述生活事情，参与讨论	d330 说，d350 交谈
	高年级：转述主要内容，表达观点	d330 说，d350 交谈
	识字与写字/阅读/写话与习作	活动
	认读和书写生活常用汉字(姓名、站牌等)	d166 阅读，d170 书写
	阅读简单应用文(购物清单、说明书)	d166 阅读
	填写简单表格，书写简单的应用文(贺卡、短信)	d170 写作
生活适应课程标准	个人生活	参与
	会表达自己的身体感受和情绪情感	d330 说，d5 自理
	家庭生活
	与亲友沟通交流，承担家庭责任	d350 交谈，d6 家庭生活，d760 家庭关系
	学校生活
	与师生友好合作，具有团队意识	d710/d720 基本/复杂人际交往，d8 主要生活领域
	社区生活
	愿意参与社区活动，主动寻求帮助	d730 与陌生人交往，d9 社区、社会与公民生活

Characteristics of speech and language functioning in children with intellectual and developmental disabilities and their educational curricula and rehabilitation interventions: an ICF-based study

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 25

Related Articles 15

Metrics

Comments

Recommended 0

[1]	ZHOU Jing, ZHANG Xiaoxiao, DING Zhongbing, CHEN Jianchao, WEI Xingxing, LIN Shuqi. Effect of speech and language rehabilitation on children with intellectual and developmental disabilities: a systematic review [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 894-902.
[2]	YANG Jiakun, ZHANG Xiaoxia. Effect of adapted physical activity on functioning, activity and participation in children with intellectual and developmental disabilities: a systematic review [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 768-777.
[3]	WEI Xiaowei. Effect of digital empowerment techniques on physical activity and health for children with intellectual and developmental disabilities: a systematic review [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 497-504.
[4]	WU Jiaming, ZHANG Qing, WU Aihong. Functioning, health and developmental benefits of music interventions for children and adolescents with intellectual and developmental disabilities: a systematic review of systematic reviews [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 543-553.
[5]	ZHANG Qing, SUN Jiangang, YANG Hongrong, GAO Shaoyu, WU Aihong, WANG Yongli. Research on content and psychometric properties of evaluations of functioning and adaptive behaviors in children with intellectual and developmental disabilities in educational settings using ICF [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 249-256.
[6]	ZHANG Bianjiang, YANG Jian. Effect of physical activity on motor skills and balance function in children and adolescents with intellectual and developmental disabilities: a systematic review of systematic reviews [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1117-1124.
[7]	WANG Shaopu, YANG Yaru, QIU Zhuoying, YANG Jian, YAO Meilin, SUN Hongwei, ZOU Min. Mental health services for children with intellectual and developmental disabilities: a WHO-FICs-based study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 993-1003.
[8]	WEI Xiaowei, YANG Jian, WEI Chunyan, HE Qiling. Adapted physical education programs for psychomotor development in school settings for children with intellectual and developmental disabilities: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 910-918.
[9]	WANG Jia-yu,CHEN Zhuo-ming,XU Jing,CHENG Wen-wen. Application of Embodied Cognition in Speech Therapy (review) [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(3): 350-354.
[10]	WU Xiao-li,ZHANG Xiao-ying,ZHANG Qing-su,YANG Ling-yu,LI Han-zhi,GAO Fei,YANG Yu-qi,HU Xue-yan,CHEN Yu-dong,YE Chang-qing,ZHANG Yu-ge,SHAN Lei,LIU Li-xu. Effect of Melodic Intonation Therapy on Nonfluent Aphasia after Stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1327-1332.
[11]	LI Ming-di, GU Qin, WEI Lai, XU Huan-lan, ZHANG Ai-xia. Effects of Speech Therapy in Group on Children with Autism Spectrum Disorders [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(3): 333-337.
[12]	ZHAO Ya-jun;CHEN Chang-xiang;PANG Hong-wen;et al.. Effect of Constraint-induced Language Therapy on Aphasia in Patients with Sub-acute Stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2014, 20(7): 656-658.
[13]	XIE Ying;LIU Hui-lin;WU Chun-wei;LI Xin- yu;ZHENG Ping;CHEN Chen;LI Xin. Effect of Constraint-induced Aphasia Therapy on Chronic Aphasia after Stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2014, 20(11): 1011-113.
[14]	JIA Ge-hong;LI Ai-xia.. Effect of Speech Therapy on Children with Down Syndrome: 30 Cases Report [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2013, 19(3): 288-289.
[15]	ZHOU Liang;YE Xiang-ming;LI Jue-bao;et al.. Study on Event-related Potential N400 before and after Speech Therapy in Chinese Aphasia Patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2013, 19(12): 1152-1154.