Screening Tests for Adults with Intellectual Disabilities

Abstract

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. The term "intellectual disabilities" (ID) refers to the condition of people with disabilities characterized by significant limitations both in cognitive functioning and adaptive behavior (conceptual, social, and practical adaptive skills) that originate before age 18 (Table 1). As used here, the term intellectual disabilities is synonymous with the term "mental retardation," a term that many people with ID dislike because it is stigmatizing and is frequently used as a global summary about complex human beings with a wide range of gifts, abilities, and needs. Challenges or limitations may be partially determined by the requirements of the environment in which people with ID live; the degree of disability may vary over time depending on the skills and supports the patient needs to function in his or her current environment. Adults with ID are living longer because of improved medical care, technology, and environmental conditions. They are also more likely to live in community-based settings instead of large institutions.

Primary Care for Women with Intellectual Disabilities

“…As more women grow up and socialize in their communities, their opportunities for consensual sexual activities increase. Based on our review of the literature, we recommend individualizing the interval for screening to each patient's risk, 18 keeping in mind that women with ID may be less able to accurately relate their sexual history. In such cases, details about the patient's environment and known history may be helpful.…”

“…Intellectual disability (ID) refers to a disability that is characterized by significant limitations both in cognitive functioning and in adaptive behavior (conceptual, social, and practical skills) that originate before age 18. 1 This term (intellectual disability) is synonymous with the term "mental retardation" in this article.…”

'It's Easier Said Than Done': Perspectives on Mammography From Women With Intellectual Disabilities

“…6 Researchers have noted health disparities for these women, 7 especially in prevention and screening. 8,9 Although women with intellectual disabilities get breast cancer at the same rate as the general…”

Characteristics Associated With Bone Mineral Density Screening in Adults With Intellectual Disabilities

“…12,17,18 In addition, findings of a 2007 meta-analysis of screening guidelines for adults with intellectual disability suggest that screening should start at age 45 years, based on expert opinion. 19 At this time there are no evidence-based guidelines for screening in adults with intellectual disability. Little is known regarding actual practices of bone density screening in the community for this population, in part because no large studies describing factors associated with bone density screening for people with intellectual disability have been conducted.…”