Skin Consider ordering a pressure-reducing mattress. For patients who pick at skin, evaluate boredom or anxiety and explore possible replacement behaviors. Information from references 15 through Most adults with developmental disabilities have had genetic, diagnostic, cognitive, speech, occupational, physical, educational, vocational, or developmental assessments. If assessments are outdated, referrals may be warranted. Accurate and thorough record keeping is critical because patients and supporters may not be able to provide a detailed medical history.
Some conditions, such as dementia, may be more difficult to diagnose in the future without this baseline information. Systematically comparing current with past function is essential to recognizing treatable medical problems and rehabilitation potential. Each area of function should be assessed independently because deficits in one area can be mistaken for deficits in another. For example, many patients who cannot speak or hear are assumed to have intellectual disabilities.
Patients who routinely use wheelchairs to attend medical appointments may also be able to stand, walk, or crawl up stairs. Strengths in one area can mask challenges in another.
For example, a patient who is fluently conversational may have significant problems with basic activities of daily living because of issues with memory or executive function that are not apparent in an examination room.
In general, guidelines for age-appropriate health maintenance in the general population should be followed for those with developmental disabilities unless the risk outweighs the benefit for an individual patient. In addition, because targeted physical examination and diagnostic testing may be less reliable in persons with communication, sensory, or cognitive challenges, physicians should be proactive at health maintenance visits to identify possible health problems with a complete history, physical examination, screening tests, and functional assessment.
Chronic gastroesophageal reflux causing damage to the enamel Craniofacial anomalies. Medications Additional sugar intake if the medication contains sugar. Information from U. Department of Health and Human Services. National Institute of Dental and Craniofacial Research. Developmental disabilities and oral health. Accessed April 18, Studies of comprehensive yearly health checks in persons with developmental disabilities reveal that unrecognized and undertreated medical problems are common.
Examples of presenting signs and symptoms of commonly unrecognized and undertreated conditions in patients with developmental disabilities are included in Table 3. Ensuring timely care may require more frequent office visits and adjustments to office protocols. Shortness of breath or cough with or after meals, slight elevation of body temperature, tachycardia. Endocrine or metabolic disorders especially hypothyroidism and syndrome of inappropriate antidiuretic hormone.
Irritability; insomnia; decreased participation; change in function; aggression; scratching, banging, or touching the body part that hurts. Persons with developmental disabilities can and do have sex, marry, and have children. Gender dysphoria has been found to be particularly common among persons with autism. Because pain is an internal sensation, communication difficulties can complicate the assessment. Persons with developmental disabilities often have atypical behavior in response to pain.
For example, they may not grimace, cry, or clutch the part of the body that hurts. Supporters often report that patients with developmental disabilities have a high pain threshold. This interpretation may be accurate because of atypical sensory processing, or the patient may feel the pain but does not show recognizable signs of distress. Conversely, some persons with developmental disabilities may be sensitive to normally benign stimuli such as touch, sounds, or abrupt changes in light, which create painful sensations.
Empiric trials of pain medication may be necessary when assessment is uncertain. Persons with developmental disabilities have high rates of psychiatric problems. When assessing maladaptive behaviors, it is important to evaluate and treat the cause rather than merely suppress the behavior. Maladaptive behavior is often a manifestation of a medical or environmental problem, and is an opportunity to improve communication or to provide a better way to make sure the patient's needs are being met.
When interpreting behavior, it is important to consider the patient's ability to respond to potential mis-treatment or abuse. Some persons with developmental disabilities have had extensive educational and therapeutic interventions focused on improving their compliance with the expectations of authority figures such as parents and teachers. Persons with developmental disabilities who have been taught to comply, especially those who need assistance with activities of daily living, may not have been encouraged or taught to set personal boundaries or to recognize or communicate when they are being mistreated or abused.
These patients may be particularly vulnerable. Supported decision-making principles are particularly important when patients are facing a life-threatening illness.
Terminal illness does not have to lead to a loss of autonomy, dignity, relationships, housing, or self-determination. Persons with developmental disabilities typically report higher quality of life than is perceived by others who are not disabled. Family physicians are important advocates for their patients to access a full range of life-sustaining, curative, palliative care, and hospice services.
This article updates a previous article on this topic by Prater and Zylstra. Data Sources: A PubMed search was completed in Clinical Queries using the key terms supported decision making and developmental disability. The search included systematic reviews, randomized controlled trials, and clinical trials. Search date: January 4, Already a member or subscriber?
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Long-term morbidity and management strategies of tracheal aspiration in adults with severe developmental disabilities. Am J Ment Retard. Can you imagine people with developmental disabilities seeing themselves as part of the solution and valued for their contributions? If this were our approach, what kind of impact would that have on the sexual health of people with developmental disabilities?
As a sexuality educator and trainer, I have had the pleasure of partnering with Green Mountain Self Advocates. We created a sexuality education curriculum that is designed to be team taught by people with developmental disabilities and professionals.
That was when I learned two important lessons. One was that people with disabilities could actually be part of the solution, not just the receivers of sexuality education. People with disabilities reviewed the materials, offered feedback, and then helped us field test, working in teaching teams where they were paired with a professional.
I also learned more about self-advocacy and sexual self-advocacy. Many people with disabilities have told me that it is easier to be a self-advocate than a sexual self-advocate. When they ask about getting a job or living on their own, everyone works hard to help them achieve their goals. When they talk about wanting a relationship or starting to date, there is silence. They can feel the discomfort.
This silence and discomfort come from beliefs that many people have about people with developmental disabilities and their sexuality. Self-advocates—people with developmental disabilities who are taking control of their own lives—say they get the same negative messages about sexuality that everyone in our culture gets. But then they get even more.
The messages they get come from many sources. One self-advocate spoke about being in a mainstream health class in high school, studying nutrition and exercise and safety with everyone else—and then being removed from the class during the sexuality unit. Developmental Disabilities. Section Navigation. Facebook Twitter LinkedIn Syndicate. Minus Related Pages. Links with this icon indicate that you are leaving the CDC website.
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