Developmentally disabled individuals have a broad range of cognitive abilities. It is essential to approach patients in a manner consistent with their abilities and to be sensitive to and respectful of their thoughts and feelings. About 85 percent of mentally retarded individuals are mildly impaired; they typically function at about a fifth to sixth grade level, although under the stress of illness and the emergency department, this may be reduced. Once their anxiety is alleviated, they can generally provide some relevant history and describe many of their symptoms. They are also likely to understand simple written directions provided jargon is avoided. About 10 percent of mentally retarded adults are moderately affected; they function at the level of a preschool child, are likely to be able to follow commands, and may be able to answer simple questions. The remaining 5 percent are likely to have no expressive language although they sometimes can follow simple commands.
When assessing any verbal developmentally disabled individual, it is important to ask open-ended rather than yes/no questions to verify the patient's understanding of your question. It is also helpful to ask higher functioning individuals to repeat back information to make sure they have sufficient understanding. Many mentally retarded individuals have particular difficulties with time and causality concepts. Nonverbal patients may be able to point in response to simple questions; however, the bulk of information they provide is nonverbal. Painful regions of the body often become targets for self-injurious behaviors. Similarly, the patient may be splinting or mouthing a painful area. Finally, the mentally retarded often have reduced pain sensitivity that may lead to unusual illness presentations.
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