Physical Examination

A careful and thorough physical examination is essential because sufficient history is often not available to focus the examination. Often, developmentally disabled individuals will be very agitated or have extreme tactile defensiveness, making a thorough examination and detection of physical signs difficult. Special attention should be given to all body orifices (ears, nares, mouth, anus, vagina, and urethra) because foreign objects are often inserted into these areas without the caretakers' knowledge. A dental examination is also important because a large number of individuals with mental retardation have significant periodontal disease.

Vital signs should be obtained when the patient is calm, if possible. If not medically contraindicated, it may be helpful to offer the patient food or distractions (toys, magazines) so that they feel less threatened. It also is essential to carefully explain what you are doing and periodically check to see if the patient understands. It is usually very helpful to have a familiar person present during the examination and procedures, particularly if the patient is nonverbal. If none of these approaches decreases the patient's anxiety sufficiently to allow an evaluation, assistance is required to briefly hold the patient.

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