Person with intellectual disability in consultation

What is it about ?

An intellectual disability or deficit is characterized by an interruption in development or by an incomplete development of intellectual capacities. This deficit is seen over the years of a person’s development and is often accompanied by other diseases or problems:

• attention disorders;
• memory and perception problems;
• motor problems, such as difficulty walking;
• cerebral palsy associated with disturbances in body movements or posture;
• epilepsy;
• mental health problems (psychological problems);
• behavioral disturbances;
• autism;
• speech and language disorders;
• hearing and sight problems.

An intellectual deficit often complicates medical support:

• Communication can be difficult and is not always reliable.
• The person with an intellectual disability may be resistant or anxious to the clinical or technical examination.
• The doctor must make sure that the person understands the explanations and that the treatment is being followed correctly.

Approaching a person with an intellectual disability

The doctor must allow enough time to gain the person’s confidence. Ideally, the person will be accompanied by a parent or a support person during the consultation. The doctor asks short, clear questions. If necessary, he uses illustrated aids, such as pictures or photos. The person’s answers are not always reliable, and he takes that into account.

The doctor also performs a physical examination, as the symptoms can be misleading. Before starting the examination, he explains in detail what he is going to do and, if possible, he will follow the same fixed pattern during the control visits. Exceptionally, the doctor may administer a sedative to the person to make them feel comfortable.

Some specific problems

• Epilepsy
  Sometimes more difficult to master, it must be followed closely. If the seizures are well controlled and drug therapy is stable, routine blood tests are not necessary.

• Hearing and sight problems
  Hearing and vision tests should always be performed, as a decrease in visual or hearing acuity often goes unnoticed and can influence treatment and rehabilitation.

• Behavioral problems, psychological problems and autism
  These elements have an influence on the feeling of the disease and on the treatment.

• Pain
  The person with an intellectual disability often expresses their pain, whatever the cause, in a non-specific way. Sometimes she is just irritable and / or restless, without really complaining that she is in pain. Sometimes she cannot reliably locate the pain. The doctor should therefore systematically carry out a thorough check-up, paying particular attention to traumatic injuries (bruises, fractures, etc.), dental problems, complications of other diseases (such as sinusitis in the context of a cold) , …

• Medications
  Often people with an intellectual disability take different medications. They will usually not spontaneously complain about possible side effects. The vigilance of relatives is therefore essential. Giving the right dose at the right time can also cause problems. It is very important to have a regular doctor who has a good overview of the medications taken and who limits them as much as possible.

• Oral hygiene
  Some medicines, eg used to treat mental health problems, can dry out the mouth and increase the risk of inflammation of the gums (gingivitis). Daily tooth care can also be a problem.

• Gastrointestinal problems and diet
  People with intellectual disabilities are often less mobile. They therefore more often suffer from reflux, constipation and overweight. It is difficult for them to know when to eat, and how much. Advice from a dietitian can be helpful.

• Contraception
  Access to intimate relationships is a fundamental human right, even if the subject often remains taboo. Parents and the person with an intellectual disability themselves often lack information about the need for contraception and its proper use. The subject must be made accessible and the person’s ability to manage their contraceptive method on their own must be evaluated in consultation.

Intellectual deficit is not an indication in favor of sterilization. Sometimes menstrual hygiene is a problem. In such a case, drug therapy may be prescribed to control both menstruation and contraception.

Assessment of the overall situation

It is important to get a complete picture of the possibilities and challenges of the person with an intellectual disability. This table contributes to a better estimate of the functioning, of the follow-up and of the revalidation, as well as to a correct definition of the professional assistance to be requested.

• Are the concomitant diseases – such as epilepsy, diabetes, … – under control? Who is responsible for administering the drugs?
• Are there any orthopedic problems? Is the level of mobility and activity sufficient? Is the help of a physiotherapist necessary?
• Does the person live at home, alone, with or without support?
• What is his daily routine?
• What are their communication skills? Can the help of a speech therapist be useful?
• What does his social life consist of (friends, meetings, hobbies, …)?
• What is its status in terms of employment, education, continuing education, etc.?
• What is the contribution of social services? Does she receive the allowances to which she is entitled?

Help from specialists

Specialist help can be helpful in the following situations:

• the first examination after birth, diagnosis of the deficit, the first supportive measures;
• the start of revalidation;
• the choice of type of education, compliance with compulsory education, planning for further studies;
• the choice of the type of residence, employment or day activity;
• support when leaving the parental home;
• monitoring of psychological or behavioral disorders;
• deterioration of the patient’s condition.

Sources

www.ebpnet.be