Reflections on the Functional Communication Classification System for children with cerebral palsy.

Development of classification tools for characterizing communication abilities in children with cerebral palsy (CP) has been a longstanding need that has received disproportionately less attention than classification of gross motor function and fine motor function. The lack of information about communication strengths and weaknesses, and how these abilities change with development, represents a significant gap in our knowledge about the functional impacts of CP on a child’s life. The critical need for tools to classify communication has begun to receive attention with the publication of the Communication Function Classification System (CFCS). In spite of enthusiasm and widespread use in the medical community, researchers and clinicians in speech and language pathology have identified several important limitations to the CFCS. One key issue is that of developmental sensitivity. Communication skills emerge over time in children as they acquire and refine speech and language abilities through the school-age years and into adolescence. Advancement in CFCS classification would be expected developmentally in children as they acquire communication skills. Thus is it difficult to know the extent to which CFCS ratings reflect development and the extent to which they reflect functional communication deficits associated with CP. Barty et al. have made a major advancement in overcoming the limitations of the CFCS with their new measure, the Functional Communication Classification System (FCCS) for children with CP. They present a comprehensive overview of the problem of characterizing communication as well as the multifaceted nature of communication. The authors present both theoretical and clinical motivation for the development of the FCCS, with an emphasis on seminal writings in the augmentative communication literature on communicative competence and its constituent components that form a foundation for the development of the FCCS. This grounding in the literature, as well as the way in which the construct of functional communication is operationally defined, add significant validity to the FCCS. An important strength of the FCCS is that it is developed to be age-specific, with data in the present paper focused on children at 4 to 5 years of age. The FCCS and a similar classification paradigm, the Speech Language Profile Group model, are the only existing tools for considering speech, language, and communication in children with CP that integrate consideration of age on development. In summary, the FCCS is an important new tool that is theoretically grounded and developmentally sensitive. It is an important addition to the growing body of tools for classifying communication in children with CP.