Screening Tests for Adults with Intellectual Disabilities

Joanne E. Wilkinson; Larry Culpepper; Mary Cerreto

doi:10.3122/jabfm.2007.04.060210

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Table 1.

Diagnostic Criteria for Intellectual Disability (Formerly Mental Retardation)

Intellectual functioning significantly below the population mean (generally IQ score at least 2 standard deviations below the mean or <75)
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)
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 Criterion	Potential 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”	301	109	173	19	12
“Cholesterol/ lipoproteins, LDL cholesterol/ Lipoproteins, HDL cholesterol”	79	69	6	4	3
“Diabetes Mellitus, Type 1/ Diabetes Mellitus, Type 2”	28	16	11	1	0
“Hypertension”	100	43	48	9	6
“Smoking Cessation [Methods, Psychology, Statistics and Numerical Data]”	3	1	0	2	2
“Colonic Neoplasms” or “Colonoscopy”	20	17	1	2	2
“Breast cancer” or “Mammogram”	17	10	3	4	3
“Pap smear” or “Cervical Cancer”	2	0	0	2	2
“Prostate Cancer”	3	1	0	2	2
“Skin Neoplasms”	33	25	8	0	0
“Osteoporosis”	23	7	6	10	10
“Vision Screening” or “Vision” or “Vision Tests”	57	2	33	14	12
“Hearing Disorders” or “Hearing Tests”	116	23	86	7	5
“Mental Health” or “Depression”	88	9	57	20	11

* 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

Screening	USPSTF Guideline for All Adults in the US	USPTF SOR	Evidence-Based Recommendation for Adults with ID	SORT
Obesity/body mass index	Yearly body mass index measurement and counselling for obese patients	B	At least yearly measurement; individualized counselling	B
Cholesterol/lipid	Yearly screening for men over age 35 and women over age 45 if average risk (earlier if at risk)	A	Be alert to higher incidence of risk factors in this group^*	C
Diabetes	Yearly glucose screening if hypertensive or has hyperlipidemia^*	B	Same as for cholesterol/lipid; note increased prevalence of risk	I
Hypertension	Yearly blood pressure measurement for adults ≥18 years of age	A	Same as for diabetes	C
Tobacco/smoking cessation	Regular counselling for all smokers (at least yearly)	A	Same as diabetes; individualized counselling	I
Colon cancer	Fecal occult blood screening ± scope yearly after age 50	A	Same as diabetes; may combine with other tests while patient is under sedation	B
Breast cancer (women)	Mammogram every 1–2 years after age 39	B	Same	C
Cervical cancer (women)	Pap smear yearly if sexually active	A	Pap individualized to patient's risk factors (generally can be done less often)	B
Prostate cancer	Insufficient evidence to recommend	I	Same as for cervical cancer	I
Skin cancer	Insufficient evidence to recommend	I	Same as for cervical cancer (probably less prevalent)	I
Osteoporosis	Bone densitometry	B	Yearly screening beginning at age 40 for institutionalized patients and age 45 for community-dwelling patients	B
Vision and hearing^†	Yearly in all adults		At least yearly; modified/individualize methods	B
Mental health	Regular screening for depression/mood disorders	B	Yearly with attention to physical symptoms of mood disorders	C

* 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.