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OtherEvidence-Based Clinical Medicine

Screening Tests for Adults with Intellectual Disabilities

Joanne E. Wilkinson, Larry Culpepper and Mary Cerreto
The Journal of the American Board of Family Medicine July 2007, 20 (4) 399-407; DOI: https://doi.org/10.3122/jabfm.2007.04.060210
Joanne E. Wilkinson
MD, MSc
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Larry Culpepper
MD, MPH
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Mary Cerreto
PhD
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    Table 1.

    Diagnostic Criteria for Intellectual Disability (Formerly Mental Retardation)

    1. Intellectual functioning significantly below the population mean (generally IQ score at least 2 standard deviations below the mean or <75)

    2. Significant limitation in adaptive skill areas (such that the patient cannot function adequately in their environment)–on standardized testing, at least 2 standard deviations below the mean in one of these areas or on a combined score of all three:

      • Conceptual (receptive and expressive language, reading and writing, money concepts, self-direction)

      • Social (interpersonal, responsibility, self-esteem, gullibility, naivete, following rules, obeying laws, avoiding victimization)

      • Practical (eating, bathing, dressing, toileting, meal preparation, telephone use, taking medications, managing money, transportation, occupational skills, maintaining a safe environment)

    3. Above limitations must be present and diagnosed before the age of eighteen

    • From the American Association of Intellectual and Developmental Disabilities (formerly American Association of Mental Retardation).

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    Table 2.

    Screening Criteria Applied to Adults with Intellectual Disabilities

    Screening CriterionPotential Difference in Population of Adults with Intellectual Disabilities
    Disease is serious and has important consequences.Same.
    Disease is progressive and early treatment is more effective than late treatment.Depending on extent of cognitive impairment, treatment of disease might be logistically difficult or ineffective, if identified.
    Disease progresses a preclinical phase easily identified by a screening test.Adults with ID may have a longer detectable preclinical phase since limitations in cognitive functioning may preclude their accurately identifying and reporting symptoms.
    Preclinical phase is of long duration and is prevalent enough in screened population to limit false positives/negatives.Adults with ID may have different prevalence of certain diseases (ex. obesity, sexually transmitted diseases) compared with the general population.
    • Adapted from: Aschengrau and Seage, 2003.4

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    Table 3.

    Search Strategy and Selection of Articles Reviewed

    Search Terms (“Intellectual Disability” OR “Mental Retardation” AND)Articles Identified* (n)Basic Science or Case Reports (n)Other†Final Articles Reviewed (n)Final Articles Used (n)
    “Obesity”3011091731912
    “Cholesterol/ lipoproteins, LDL cholesterol/ Lipoproteins, HDL cholesterol”7969643
    “Diabetes Mellitus, Type 1/ Diabetes Mellitus, Type 2”28161110
    “Hypertension”100434896
    “Smoking Cessation [Methods, Psychology, Statistics and Numerical Data]”31022
    “Colonic Neoplasms” or “Colonoscopy”2017122
    “Breast cancer” or “Mammogram”1710343
    “Pap smear” or “Cervical Cancer”20022
    “Prostate Cancer”31022
    “Skin Neoplasms”3325800
    “Osteoporosis”23761010
    “Vision Screening” or “Vision” or “Vision Tests”572331412
    “Hearing Disorders” or “Hearing Tests”116238675
    “Mental Health” or “Depression”889572011
    • * Via Ovid/Medline search and/or bibliographies of articles reviewed.

    • † Other reasons for elimination: pediatric subjects only, focused on a particular syndrome only (with the exception of Down syndrome), focused on treatment or intervention, not in English (or not translated), subject population included other types of cognitive impairment (such as dementia), or article did not address prevalence or screening.

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    Table 4.

    Screening Recommendations for Adults with ID Based on Current Evidence

    ScreeningUSPSTF Guideline for All Adults in the USUSPTF SOREvidence-Based Recommendation for Adults with IDSORT
    Obesity/body mass indexYearly body mass index measurement and counselling for obese patientsBAt least yearly measurement; individualized counsellingB
    Cholesterol/lipidYearly screening for men over age 35 and women over age 45 if average risk (earlier if at risk)ABe alert to higher incidence of risk factors in this group*C
    DiabetesYearly glucose screening if hypertensive or has hyperlipidemia*BSame as for cholesterol/lipid; note increased prevalence of riskI
    HypertensionYearly blood pressure measurement for adults ≥18 years of ageASame as for diabetesC
    Tobacco/smoking cessationRegular counselling for all smokers (at least yearly)ASame as diabetes; individualized counsellingI
    Colon cancerFecal occult blood screening ± scope yearly after age 50ASame as diabetes; may combine with other tests while patient is under sedationB
    Breast cancer (women)Mammogram every 1–2 years after age 39BSameC
    Cervical cancer (women)Pap smear yearly if sexually activeAPap individualized to patient's risk factors (generally can be done less often)B
    Prostate cancerInsufficient evidence to recommendISame as for cervical cancerI
    Skin cancerInsufficient evidence to recommendISame as for cervical cancer (probably less prevalent)I
    OsteoporosisBone densitometryBYearly screening beginning at age 40 for institutionalized patients and age 45 for community-dwelling patientsB
    Vision and hearing†Yearly in all adultsAt least yearly; modified/individualize methodsB
    Mental healthRegular screening for depression/mood disordersBYearly with attention to physical symptoms of mood disordersC
    • * Risk factors for CAD that would prompt earlier lipid measurement: hypertension, obesity, inactivity, family history of CAD, known diabetes or lipid disorder, cigarette smoking.

    • † Vision and hearing SOR is being updated based on availability of new research (2 to 28 to 07).

    • USPSTF, United States Preventive Services Task Force; SOR, strength of recommendation (as designated by the USPSTF for the general population); ID, intellectual disabilities; SORT = strength of recommendation taxonomy.

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The Journal of the American Board of Family Medicine: 20 (4)
The Journal of the American Board of Family Medicine
Vol. 20, Issue 4
July-August 2007
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Screening Tests for Adults with Intellectual Disabilities
Joanne E. Wilkinson, Larry Culpepper, Mary Cerreto
The Journal of the American Board of Family Medicine Jul 2007, 20 (4) 399-407; DOI: 10.3122/jabfm.2007.04.060210

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Screening Tests for Adults with Intellectual Disabilities
Joanne E. Wilkinson, Larry Culpepper, Mary Cerreto
The Journal of the American Board of Family Medicine Jul 2007, 20 (4) 399-407; DOI: 10.3122/jabfm.2007.04.060210
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