The Mentally Retarded Adult

Linmarie Sikich L. Jarrett Barnhill

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Evaluating a developmentally disabled adult in the ED poses a number of challenges, including accurately assessing the ability of the individual to communicate his or her complaints, the ability to make an accurate diagnosis in the absence of sufficient historical information, and the recognition of unusual presentations of common disorders. In addition, 25 percent of individuals with developmental disabilities appear to have significantly increased pain thresholds that result in reduced responses to illnesses and to physical examinations.1 Such pain insensitivity may limit recognition of medical problems (e.g., intestinal obstruction) until late in the disease process with potentially catastrophic consequences.2 Treatment of developmentally disabled individuals is also complicated by questions about guardianship, decreased ability of the patient to understand the treatment recommendations and, often, inadequate preventative and routine medical care. However, it is essential that health care providers overcome these obstacles to provide care to this special population that has difficulty advocating for itself. This has become a growing issue over the past 20 years as large numbers of developmentally disabled adults have moved from specialized institutional settings where a small number of physicians were familiar with their special needs to individual and group homes in the community.

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