Medical Care of Adults with Intellectual and Developmental Disabilities

The prevalence of Intellectual Disability/Developmental Disability (ID/DD) comprises about 1% of the population. Persons with ID/DD often have undiagnosed or poorly treated medical disorders; have shorter life expectancy and depending on the underlying causation of their disability, are at risk for developing certain disorders. 

Screening of athletes participating in Special Olympics has documented "widespread health problems" and lack of training of health professionals to provide care to this population. An overwhelming majority of persons with ID/DD live in the community and are expected to receive primary medical care at community-based facilities. However, their access to care has been a problem, especially for adults, less so for children, since most pediatricians receive at least some training in ID/DD and many are trained in Developmental-Behavioral Pediatrics.  These disparities in health and access to health care were identified in the Surgeon General Report of 2002, which also described existing creative programs aiming to eliminate these gaps in care. None of these programs were in Massachusetts with the exception of Tufts Dental Facilities for people with ID/DD.

This access problem to health care is not limited to the United States. Studies list the following factors underlying this health disparity: poor communication between the health care providers and patients (who often have deficient language skills); lack of training of health professionals; "diagnostic overshadowing," which is the tendency to assume that the patient's complaints are due to the intellectual disability; not obtaining detailed past history (due to poor communication and lack of sufficient time).  Negative attitudes to patients with ID are also a problem and physicians tend to see them as difficult to care for. Most, if not all, primary care physicians have the medical knowledge and competence needed to provide medical care to persons with ID/DD. However, additional training and practice modification are needed to achieve among others, the following:

  • To increase knowledge of associated syndromes /disorders

  • To increase collaboration with other health-related professionals who provide services to this population of patients within the same community 

Learning Objectives

  • Make reasonable office and staff accommodations in ascertaining sensitivity to procedures.
  • Document a comprehensive health history, preferably in advance, and utilizing multiple informants if possible.
  • Develop skills of developmentally appropriate and respectful communication with the patient (rather than with the caregivers only).
  • Define relevant legalities such as guardianship and its limitations concerning medical care; end-of-life decisions, major procedures, abortion, sterilization, etc.
  • Recognize medical co-morbidities common in certain ID/DD associated syndromes. 

Additional Information

Partner: 
Massachusetts Medical Society (MMS)
State Approved: 
Massachusetts
Course summary
Available credit: 
  • 1.00 MOC II
  • 1.00 AMA PRA Category 1 Credit™
Course opens: 
04/06/2018
Course expires: 
04/06/2021
Nonmember cost:
$30.00
Member cost:
$15.00
Student or Resident cost:
$7.50
Other Health Care Professionals cost:
$12.00
Cost:
$30.00
Rating: 
0

Leslie Rubin, M.D .
Morehouse School of Medicine
Developmental Pediatric Specialists  
Innovative Solutions for Disadvantage and Disability
Southeast Pediatric Environmental Health Specialty Unit at Emory University

The Massachusetts Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. 

AMA Credit Designation Statement
The Massachusetts Medical Society designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.  

This activity meets the criteria for the Massachusetts Board of Registration in Medicine for risk management study.

MOC Approval Statement 
Through the American Board of Medical Specialties ("ABMS") ongoing commitment to increase access to practice relevant Maintenance of Certification ("MOC") Activities through the ABMS Continuing Certification Directory , this activity has met the requirements as an MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

Allergy and Immunology
Anesthesiology
Colon and Rectal Surgery
Family Medicine
Nuclear Medicine
Physical Medicine and Rehabilitation
Plastic Surgery
Preventive Medicine
Psychiatry and Neurology
Radiology
Thoracic Surgery
Urology

National Commission on Certification of Physicians Assistant (NCCPA).
Physician Assistants may claim a maximum of 1.00 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit ™ from organizations accredited by ACCME or a recognized state medical society.

A score of 70% or higher is required to receive AMA PRA Category 1 Credit ™.

Available Credit

  • 1.00 MOC II
  • 1.00 AMA PRA Category 1 Credit™

Price

Nonmember cost:
$30.00
Member cost:
$15.00
Student or Resident cost:
$7.50
Other Health Care Professionals cost:
$12.00
Cost:
$30.00
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Topics

Risk Management