Visual impairments in people with severe and profound multiple disabilities: an inventory of visual functioning

Ophthalmologic diagnoses in youths with autism spectrum disorder: Prevalence and clinical correlates

Autism spectrum disorder (ASD) is associated with a high prevalence of visual dysfunction. This study aimed to investigate the rates of amblyopia, refractive errors, and strabismus, as well as their clinical correlates in ASD. This population-based matched-cohort study used data from the Taiwan National Health Insurance Research Database. A total of 3,551 youths with ASD and 35,510 non-autistic control participants matched by age and sex were included. All the participants were followed-up until they were 18 years old. The prevalence of amblyopia, refractive errors, and strabismus was compared between the ASD and control groups. Effect modifiers, including sex, ASD subgroup, and co-diagnosis of intelligence disability, were examined. Compared to the control group, youths with ASD had a significantly increased risk of amblyopia (adjusted odds ratio [aOR] = 1.75), anisometropia (aOR = 1.66), astigmatism (aOR = 1.51), hypermetropia (aOR = 2.08), exotropia (aOR = 2.86), and esotropia (aOR = 2.63), but a comparable likelihood of myopia according to age. Males with ASD had a significantly lower likelihood of exotropia, but a higher likelihood of myopia than females with ASD. The autism subgroup had a higher OR for hypermetropia, but a lower OR for myopia than the other ASD subgroups. ASD youths with intelligence disabilities demonstrated significantly higher ORs for amblyopia, hypermetropia, and all types of strabismus and lower OR for myopia than those without intelligence disabilities. In conclusion, the rates of amblyopia, refractive errors, and strabismus were higher in youths with ASD. Ocular abnormalities in youths with ASD require a comprehensive assessment and management.

Olfactive short-term habituation in children and young people with profound intellectual and multiple disabilities

BACKGROUND

Despite its importance for learning, the existence of the habituation process and its characteristics in people with profound intellectual and multiple disabilities (PIMD) remains understudied. Habituation is, however, considered the simplest form of learning, and a significant neuroadaptive mechanism. Even though habituation occurs in all sensory modalities, the olfactory system is where it manifests itself very visibly.

AIM

This study explores the olfactory short-term habituation abilities of children and young people with PIMD.

METHOD

Twenty children and young people with PIMD (7-18 years) were presented six times successively with a 30-second habituating olfactory stimulus. The interstimulus interval was 15 s. A new odour was presented on the seventh trial. The scenario was carried out two times with two pairs of stimuli. The participants' head alignment duration on the odour was measured.

RESULTS

Seventeen participants out of 20 manifested a decline in response, which reached about 50 % between the first and sixth presentation of the habituation odour. All habituators also showed a distinctive response when exposed to a novel odour. The participants who did not habituate showed a strong, non-fluctuating response to the stimulus throughout the presentations. Three participants only habituated to one of the two habituation stimuli.

CONCLUSION AND IMPLICATIONS

The results raise theoretical, scientific, and practical issues. They question the factors explaining olfactory habituation mechanisms, namely the stimulus properties and the severity of impairment, reveal the need for points of comparison for interpreting this population's responses, and point to the consequences of stimuli repetition and or variety in therapeutic or educational settings for these individuals' learning and cognitive functioning.

Time Series Analyses of the Responses to Sensory Stimuli of Children with Severe and Multiple Disabilities

Severe and multiple disabilities (SMD) refers to the simultaneous occurrence of intellectual and physical problems. SMD in children is difficult to assess, as they often do not have the proper language or bodily responses to represent their feelings. In this study, we propose a methodology for evaluating reactions of children with SMD to sensory stimuli that does not rely on observations by humans, but rather is based on automatic detection of video-recorded data and quantification by time-series analyses. We present two case studies with typical participants: one with large body movements (P1) and another with subtle body movements (P2). For P1, it was observed that he showed larger bodily movements just before the onset of tactile stimuli, while he became silent for approximately 10 s after the onset, with the stimuli causing him to reduce self-stimulatory behavior and pay attention to his external environment. For P2, two quantitative methodologies – correlation coefficient and Granger causality – were adopted, to compare behavioral difference during the presentation of either sour or sweet taste stimuli. For the sweet conditions, the movement of the mouth was considered to be generated by some internal causes. Through these experiments, we confirmed the authenticity of assessments made by the participants’ caregivers, and also revealed otherwise unseen behavioral patterns and structures.

Considerations for the identification of autism spectrum disorder in children with vision or hearing impairment: A critical review of the literature and recommendations for practice

OBJECTIVE

There is higher risk for autism spectrum disorder (ASD) across many pediatric neurological conditions characterized by vision impairment or hearing loss. Early and accurate identification of ASD is imperative in promoting access to appropriate and early evidenced-based intervention; however, differential diagnosis can be particularly challenging in children with sensory impairment given the heterogeneity of ASD combined with the impact of vision impairment or hearing loss/deafness on development and behavior. A neuropsychologist's unique expertise and appreciation of the interplay between sensory and behavioral manifestations can be valuable for making an early and accurate ASD diagnosis in children who are blind/visually impaired or deaf/hard-of-hearing. This article highlights clinical considerations when identifying ASD within the context of vision impairment or hearing loss/deafness.

METHOD

We discuss clinical considerations for the early identification of ASD in children who are blind/visually impaired and deaf/hard-of-hearing. Information presented in the article is based on a critical review of the literature and the expertise of the author group.

CONCLUSION

Ongoing development of clinical expertise and evidence-based assessment methods are important when informing the early differential diagnosis of ASD in individuals with sensory impairment. Accurate identification is also vital for the development of targeted interventions across the lifespan.

Evaluation of the PlusoptiX photoscreener in the examination of children with intellectual disabilities

PURPOSE:

This study aimed to determine whether the plusoptiX vision screener (PVS) can be used to detect amblyogenic risk factors (ARFs) as defined by the American Association for Paediatric Ophthalmology and Strabismus Vision Screening Committee guidelines (2013) for automated vision screening devices.

METHODS:

In this cross-sectional study, children attending a special needs school underwent screening with the PVS and complete ophthalmologic examinations. Ophthalmologic examinations were used as the gold standard to compute the prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and testability.

RESULTS:

Forty-four children with special needs (mean age, 8.5 years; range, 4–18 years) were included. The PVS recommended referral of 31 cases (referral rate 70%). Thirty-nine of the 44 children (89%) met the referral-positive threshold for strabismus, reduced vision and/or amblyogenic factors on examination. The plusoptiX had a sensitivity of 40% (confidence interval [CI] 7%–83%), specificity of 78% (CI 55%–85%), PPV of 15% (CI 3%–46%), and NPV of 90.3% (CI 73%–97%). The PVS underestimated refractive errors by 0.67 to 0.71 D in the right (P < 0.001) and left eyes (P = 0.002). Testability was relatively low, with the PVS at 75% compared to the gold standard examination at 100%.

CONCLUSION:

We found that although the plusoptiX photoscreener might be a useful tool in pediatric vision screening, it might not perform as well in children with intellectual disabilities. Utilization of the PVS as a single screening device may fail to identify a considerable proportion of young children with ARFs or amblyopia.

Utilising the Orthoptic Skill Set to Improve Access to Eye Care for Adults with Severe/Profound Learning Disabilities-A Service Evaluation

Intro:

There is a wealth of research evidencing the high incidence of visual impairment (VI) and poor uptake of eye care services by adults with learning disabilities (LD). Despite this, very few authorities within England currently provide the additional support required by those with severe/profound LD (S/PLD).

Method:

By means of an initial funded pilot study, an unmet need was evidenced locally and a small service established to improve access to eye care for adults with S/PLD. Operational since 2007, this service has provided evidence to support the campaign for a nationally funded eye care pathway.

This service evaluation outlines the initial service set up, aims and objectives, and provides an analysis of the current service by means of a detailed breakdown of service-user outcomes during a sample 5-year period.

Results:

Orthoptic home visits (OHV) revealed high levels of strabismus (54.4%), refractive error (43.3%), cataracts (23.3%), and many other ophthalmic conditions (29%). Over a quarter of the adults with LD (26.6%) were certified as VI and 61% of people were provided with tailored strategies, the majority of which were for visual processing difficulties.

Conclusion:

The prospect of a nationally funded eye care pathway for adults with LD in England is now a real possibility. This service model has identified a clearly defined unmet need and illustrates the unique skill set orthoptists can offer to address this health inequality. Requiring minimal financial outlay and flexible enough to be integrated into any future national eye care framework, this service has ensured that access to eye care is truly equitable for all people with LD.

Looking back, looking forward: Methodological challenges and future directions in research on persons with profound intellectual and multiple disabilities

BACKGROUND

Within the context of the Special Interest Research Group (SIRG) on Persons with Profound Intellectual and Multiple Disabilities (PIMD), researchers often discuss the methodological problems and challenges they are confronted with. The aim of the current article was to give an overview of these challenges.

METHODS

The challenges are centred on six topics. These reflect the main components of a study's design: (a) participant demarcation, (b) participant recruitment, (c) data collection and instruments, (d) data analysis, (e) ethics/including the "voice" of persons with PIMD and (f) theoretical models.

RESULTS

Next, to describing the specific challenges, possible solutions and pathways to address them are discussed. These are illustrated by recent studies by the authors and other researchers in the field.

CONCLUSIONS

The current contribution wants to stimulate further discussion and exchange of ideas, and the development of creative research techniques.

The Underreporting of Vision Problems in Statutory Documents of Children with Williams Syndrome and Down Syndrome

Vision problems can lead to negative developmental outcomes. Children with Williams syndrome and Down syndrome are at higher risk of vision problems, and these are less likely to be detected due to diagnostic overshadowing and difficulty accessing eye-care. Education, Health and Care (EHC) plans are statutory documents, introduced by the Children and Families Act 2014 in England, with the intention of integrating provision across these domains. Vision issues should be reported in these plans, and recommendations made about appropriate adjustments for them. We analysed the EHC plans from 53 children with Down or Williams syndrome. Our results showed significant underreporting, especially for children with Williams syndrome, and little explanation of what adjustments should be made. We also report pockets of good practice.

Vision in children with autism spectrum disorder: a critical review

Autism spectrum disorder (ASD) is a common neurodevelopmental condition with approximately 1-2 per cent prevalence in the population. The condition has lifelong effects for the individual and family, and early intervention and management helps maximise quality of life and outcomes. Many studies of vision in ASD have attempted to link the behavioural and sensory deficits in ASD with underlying visual processing. From this work, it is clear that individuals with ASD 'see' and process the world differently, but there remain gaps in our understanding. This review will summarise our current knowledge of key aspects of visual functions and the optometric profile of ASD. This includes findings regarding visual acuity and contrast sensitivity, refractive error, eye movements, binocular vision, near visual functions and retinal structure in ASD. From this, a pattern of knowledge emerges for children with ASD: we should expect normal visual acuity; there will likely be atypical eye movements and susceptibility for subtle visuo-motor deficits, there is an increased prevalence of strabismus; an increased likelihood of astigmatism and possibly other refractive errors; attention, crowding and task complexity will likely be problematic; and retinal structure and function may be compromised. Bringing this together, these findings highlight that further work is necessary, not only to understand how higher-level functions link to behaviours, but also to ensure there is a sound understanding of the building-blocks of vision to fully grasp the profile of visual processing as a whole in ASD. This review will give a translational viewpoint for clinicians, and underline the benefits of comprehensive vision care in ASD.

Sensory impairment and intellectual disability

Sensory (visual and hearing) impairment has significant detrimental impact on sociocognitive and language development. Despite this, it is very much underrecognised and underdiagnosed in people with intellectual disability. Raising awareness of sensory impairment among professionals and carers is extremely important for early management to prevent further social handicap in people with intellectual disability. This article reviews sensory impairment in intellectual disability and its association with autism-spectrum disorder and mental illness.

Identifying perception behaviours in people with profound intellectual and multiple disabilities

BACKGROUND

To support people with profound intellectual and multiple disabilities (PIMD), it is essential to understand how they experience their environment. Insight into perception behaviour may provide an entry point for improved understanding.

MATERIALS AND METHODS

A random sample of a 30-min video registration of five participants with PIMD was used to code behaviours per second based on an ethogram containing 157 different perception behaviours in nine categories.

RESULTS

Eighty-nine different perception behaviours were observed, of which movements with eyes, head and arms were most common. The senses used most were seeing, hearing and touching. Finally, the function of five perception patterns was established in relation to their function:awareness, focusing attention and tension regulation.

CONCLUSIONS

Close observation using an observation ethogram provides insight into how people with PIMD perceive their environment.

Physical health issues in adults with severe or profound intellectual and motor disabilities: a systematic review of cross-sectional studies

BACKGROUND

People with severe or profound intellectual and motor disabilities (SPIMD) encounter several risk factors associated with higher mortality rates. They are also likely to experience a cluster of health problems related to the severe brain damage/dysfunction. In order to earlier detect physical health problems in people with SPIMD, first of all, knowledge regarding the prevalence of physical health problems is necessary. The aim of this systematic review was to methodically review cross-sectional studies on the prevalence of various types of physical health problems in adults with SPIMD.

METHOD

MedLine/PubMed, CINAHL, Embase, PsycINFO and Web of Science were searched for studies published between 2004 and 2015. The quality of the incorporated studies was assessed utilising an adjusted 'risk of bias tool' for cross-sectional studies. To estimate the prevalence of the health problems, the proportion and corresponding confidence interval were calculated. A random effect meta-analysis was performed when at least three studies on a specific health problem were available.

RESULTS

In total, 20 studies were included and analysed. In the meta-analysis, a homogeneous prevalence rate of 70% (CI 65-75%) was determined for epilepsy. Heterogeneous results were ascertained in the meta-analysis for pulmonary/respiratory problems, hearing problems, dysphagia, reflux disease and visual problems. For the health problems identified in two studies or in a single study, the degree of evidence was low. As expected, higher prevalence rates were found in the current review compared with people with ID for visual problems, epilepsy and spasticity.

CONCLUSION

This review provides an overview of the current state of the art research on the prevalence of health problems in adults with SPIMD. There is a substantial need for comprehensive epidemiological data in order to find clusters of health problems specific for people with SPIMD. This would provide insight into the excess morbidity associated with SPIMD.

Are all children with visual impairment known to the eye clinic?

INTRODUCTION

There is a growing body of evidence that children with special needs are more likely to have visual problems, be that visual impairment, visual processing problems or refractive error. While there is widespread provision of vision screening in mainstream schools, patchy provision exists in special schools. The aim of the study was to determine the unmet need and undiagnosed visual problems of children attending primary special schools in Bradford, England.

METHODS

Children attending special schools who were not currently under the care of the hospital eye service were identified. Assessments of visual function and refractive error were undertaken on site at the schools by an experienced orthoptist and/or paediatric ophthalmologist.

RESULTS

A total of 157 children were identified as eligible for the study, with a mean age of 7.8 years (range 4-12 years). Of these, 33% of children were found to have visual impairment, as defined by WHO and six children were eligible for severe sight impairment certification.

DISCUSSION

The study demonstrates significant unmet need or undiagnosed visual impairment in a high-risk population. It also highlights the poor uptake of hospital eye care for children identified with significant visual needs and suggests the importance of providing in-school assessment and support, including refractive correction, to fully realise the benefits of a visual assessment programme.

The impact of visual impairment on the ability to perform activities of daily living for persons with severe/profound intellectual disability

BACKGROUND

The ability to perform activities of daily living (ADL) as a component of participation is one of the factors that contribute to quality of life. The ability to perform ADL for persons experiencing severe/profound intellectual disability (ID) may be reduced due to their cognitive and physical capacities. However, until recently, the impact of the significantly prevalent visual impairments on the performance of activities of daily living has not yet been revealed within this group.

AIM

The purpose of this prospective cross-sectional study was to investigate the impact of visual impairment on the performance of activities of daily living for persons with a severe/profound intellectual disability.

METHOD

The Barthel Index (BI) and Comfortable Walking Speed (CWS) were used to measure the ability of performing activities of daily living (ADL) in 240 persons with severe/profound ID and having Gross Motor Functioning Classification System (GMFCS) levels I, II or III; this included 120 persons with visual impairment. The impact of visual impairment on ADL was analyzed with linear regression.

RESULTS

The results of the study demonstrated that visual impairment slightly affects the ability of performing activities of daily living (BI) for persons experiencing a severe/profound intellectual disability. GMFCS Levels II or III, profound ID level, and visual impairment each have the effect of lowering BI scores. GMFCS Levels II or III, and profound ID level each have the effect of increasing CWS scores, which indicates a lower walking speed. A main effect of visual impairment is present on CWS, but our results do show a substantive interaction effect between GMFCS level III and visual impairment on Comfortable Walking Speed in persons with a severe/profound intellectual disability.

CONCLUSIONS

Visual impairment has a slight effect on ability to perform ADL in persons experiencing severe/profound ID.

Ocular disorders in children with learning disabilities in special education schools of Pune, India

AIM

The aim was to study and treat ocular disorders in children with learning disabilities (cLDs) and explore associations with their perinatal history.

MATERIALS AND METHODS

cLDs attending 11 special schools were examined by a team consisting of an ophthalmologist, optometrist, and a social worker in 2007 and followed up in 2008. The students' intelligence quotient (IQ) and their medical histories were noted. Distant visual acuities were measured using Kay pictures or Snellen's tumbling E chart and complete ocular examination was performed. Students were assessed at the pediatric ophthalmology unit and low vision center, if needed. Statistical analysis was done with SPSS and the Chi-square test for ordinal data.

RESULTS

A total of 664 students were examined, 526 of whom were <16 years of age; 323 (61.4%) were male. A total of 326 (60%) had moderate-to-severe learning disabilities (IQs <50), and the mean IQ was 45.4. Two hundred and thirty-eight (45.3%) had ocular disorder; 143 (27.3%) had an uncorrected refractive error, followed by strabismus in 83 (15.8%), nystagmus in 36 (6.8%), optic atrophy in 34 (6.5%), and congenital anomalies in 13 (2.5%), 103 children had more than one abnormality. Only 12 of the 143 students with refractive errors were using spectacles. A total of 132 (48.7%) children with a history of perinatal insult had ocular problems. Ocular disorders were also common in those with a history of epilepsy, Down's syndrome, and cerebral palsy.

CONCLUSION

Nearly half the cLDs in this study had ocular disorders and one-fourth had their vision improved.

Central corneal thickness in children with intellectual disability: a controlled study

PURPOSE

To evaluate the central corneal thickness (CCT) in children with intellectual disability (ID) and to determine the association between ID-related variables and CCT.

METHODS

A total of 77 subjects with ID and 38 healthy controls were included in the study. The subjects with ID were subdivided into mild (IQ 50-69; n = 34), moderate (IQ 35-49; n = 30), and severe (IQ <34; n = 13) groups and syndromic (n = 40) versus nonsyndromic (n = 37) distinctions. All children underwent CCT assessment by ultrasound pachymetry, in addition to complete ophthalmologic examination. Analysis of variance, chi test, and linear regression analysis were used for statistical analysis.

RESULTS

CCT was significantly higher in the ID group (549.7 +/- 21.4 microm) than that the control group (521.6 +/- 16.9 microm; P < 0.0001). Linear regression analysis revealed that presence of syndromic etiology significantly predicted higher CCT among the individuals with ID (P < 0.0001).

CONCLUSIONS

Children with ID have an increased CCT compared with healthy controls. Syndromic etiology is the only variable that predicts higher CCT among the individuals with ID. Although the finding of an increased CCT in children with ID is statistically significant, it is not clinically significant.

Children with cerebral palsy: severity and trends over time

Increasingly, more very-low-birthweight infants in the developed world are now expected to survive the neonatal period than was previously the case. There are concerns that there may be a related increase in the number of infants developing severe sensorimotor impairments. Pooled data from five registers contributing to the UK Network of Cerebral Palsy Registers, Surveys and Databases were used to identify patterns of motor impairment in relation to additional impairments and to birthweight, and to assess whether prevalence of cerebral palsy (CP) by birthweight and by severity of motor impairment had changed over time. Low-birthweight infants are at greater risk of developing CP than larger-birthweight babies. The CP rate amongst children with birthweights <2500 g was significantly higher at 16 per 1000 livebirths [95% confidence interval (CI) 14.9, 16.2] than 1.2 per 1000 livebirths [95% CI 11, 1.2] for normal-birthweight children. Despite being at greater risk of developing CP, smaller-birthweight babies are proportionately less likely to develop the most severe forms of motor impairment. Of those born weighing > or = 2500 g, 23% compared with 15% weighing <1000 g (P < 0.001) were in the most severely motor impaired group. Severe motor impairment is associated with higher levels of additional impairments. CP rates for each motor impairment group in the 1990s were similar to those in the late 1970s. Rates of CP among infants born below normal birthweight are high but have decreased over time. The CP rate for infants weighing 1000-1499 g at birth decreased from around 180 per 1000 livebirths in 1979 to around 50 per 1000 livebirths from the early 1990s onwards.

Failure to detect deaf-blindness in a population of people with intellectual disability

BACKGROUND

Early identification of deaf-blindness is essential to ensure appropriate management. Previous studies indicate that deaf-blindness is often missed. We aim to discover the extent to which deaf-blindness in people with intellectual disability (ID) is undiagnosed.

METHOD

A survey was made of the 253 residents of an institute offering residential and occupational facilities for people with IDs. Data are included for the 224 individuals who were able to complete both auditory and visual assessments. Otoacoustic emissions were used to screen for hearing impairment; those who did not pass were assessed by behavioural audiometry. Visual acuity was assessed with one of the following: EH-Optotypes, LH-Optotypes, Teller Acuity Cards, Cardiff Acuity Cards or the Stycar Ball Vision Test.

RESULTS

Prior to the study hearing impairment had been diagnosed in 12.5% of the 224 subjects, and visual impairment in 17%. Upon completion of the study these figures rose to 46% and 38.4% respectively. Deaf-blindness was diagnosed in 3.6% of the subjects before, and in 21.4% after, the study. Most (87.5%) of the deaf-blind individuals had profound ID.

CONCLUSION

Deaf-blindness is most often not identified either by standard medical screening or by care staff. Individuals with this disability, however, require provision of special kinds of care. Four categories of deaf-blindness are proposed, according to the severity of sensory impairment in each modality. The tests used in this study are non-invasive and are appropriate for individuals with ID and children. Early and periodic screening for visual and hearing impairment in individuals with ID is recommended.

Refractive errors and ocular findings in children with intellectual disability: a controlled study

PURPOSE

To evaluate the ocular findings and refractive errors in children with intellectual disability and in controls of average intellectual development of similar socioeconomic backgrounds.

METHODS

The study was conducted at Diskapi Children's Hospital in Ankara, Turkey: 724 subjects with intellectual disability and 151 control subjects were evaluated. The subjects with intellectual disability were subdivided into mild (IQ 50-69, n = 490), moderate (IQ 35-49, n = 164), and severe (IQ <34, n = 70) groups, and syndromic (n = 138) versus nonsyndromic (n = 586) disability. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by Hirschberg, Krimsky, or prism cover test. The main outcome measure was the prevalence of refractive errors and ocular findings.

RESULTS

Seventy-seven percent of subjects with intellectual disability, and 42.4% of controls, had ocular findings. The children with intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than controls. Children with syndromic intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than subjects with nonsyndromic intellectual disability. Increasing severity of intellectual disability was related to higher prevalence of nystagmus, strabismus, astigmatism, hypermetropia, and anisometropia.

CONCLUSIONS

From a public health perspective, evaluation and treatment of ocular and refractive findings in children with moderate, severe, and syndromic intellectual disability categories is urgently needed and likely to be highly effective in alleviating future health and social care costs, as well as improving the productive lives of individuals with intellectual disability.

Co-morbidity of psychiatric disorder and medical illness in people with intellectual disabilities

PURPOSE OF REVIEW

To examine the most recently published studies on the co-morbidity of medical and mental-health problems in people with intellectual disabilities.

RECENT FINDINGS

Studies that have been published in the review period have advanced our understanding and strengthened the evidence base on how to meet the complex healthcare needs of people with intellectual disabilities more effectively and reduce their health inequalities, as compared with the general population. In particular, there is much emphasis on epidemiology, epilepsy, dementia, use of psychotropic medications and health-screening intervention.

SUMMARY

In view of the common interface of medical and mental-health problems in people with intellectual disabilities, and the disparity in health they often face, initiatives should be taken to enhance their healthcare. Family carers, social-care providers, primary-care practitioners and specialist psychiatric teams can all play an important role in recognizing ill health and navigating access to the appropriate health services that people with intellectual disabilities need.

Screening tests for adults with intellectual disabilities

Adults with intellectual disabilities need thoughtful, well-coordinated primary care from family physicians. However, evidence-based screening recommendations are lacking. We examined screening recommendations for common preventable conditions using the US Preventative Service Task Force guidelines. We also reviewed the literature about the prevalence of these conditions in adults with intellectual disabilities. Obesity, osteoporosis, and smoking are more prevalent in adults with intellectual disabilities, and enhanced screening for these conditions is recommended. Abnormal Papanicolaou smears and cervical cancer are less common in adults with intellectual disabilities and screening recommendations should be individualized. We also discussed strategies to make screening procedures less stressful for these patients.