Adults with developmental disabilities

Rationale

The need for health care for adults with developmental disabilities is growing because of greater social integration and accessibility and longer life expectancy than in the past. These patients may have complex health issues and poor health status.

Causal Conditions

(list not exhaustive)

1. Unknown etiology
2. Known etiology and associated conditions
   1. Genetic syndromes (e.g., trisomy 21)
   2. Autism spectrum disorder
   3. Fetal alcohol spectrum disorder
   4. Brain injury (e.g., cerebral palsy)
   5. Central nervous system infection
   6. Other

Key Objectives

Given an adult patient with developmental disability, the candidate will identify common physical, mental, and behavioural issues and initiate an appropriate management plan. Particular attention should be paid to the known disparities in health status and health care for this group and to the interdisciplinary coordination of care. It is also important to adapt communication to the patient’s level of intellectual and adaptive functioning.

Enabling Objectives

Given an adult patient with developmental disability, the candidate will

1. list and interpret critical clinical findings, including
   1. assessed level of intellectual and adaptive functioning;
   2. atypical presentations of serious illness and/or pain (e.g., infection, trauma); and
   3. identified risk factors for abuse and neglect;
2. list and interpret critical investigations depending on the disability (e.g., thyrotropin [thyroid-stimulating hormone {TSH}] in trisomy 21, hearing and vision testing); and
3. construct an effective initial management plan, including
   1. assessing the patient’s ability to give voluntary and informed consent;
   2. obtaining input and assistance from caregivers;
   3. initiating interdisciplinary care if necessary;
   4. performing appropriate screening and preventive measures (e.g., for infectious diseases and cancer);
   5. ensuring appropriate use of psychotropic medication (e.g., antipsychotics), including discussion of risks and benefits;
   6. anticipating medium-term and long-term complications (e.g., psychosocial effects, safety); and
   7. obtaining assistance and input from caregivers/support workers.