Nutritional well-being is recognised as an important
factor in maximising growth potential, maintaining health, and improving
quality of life and longevity.
HEALTH GUIDELINES FOR ADULTS WITH AN INTELLECTUAL
DISABILITY
AN IASSID PUBLICATION
While the epidemiology of dental disease in people with an intellectual
disability has not been extensively studied, several studies have
indicated high rates of dental disease in this population. An
Australian study (Scott et al 1998) noted that various types of
dental disease, particularly periodontal disease, oral mucosal
pathology, and moderate to severe malocclusion, were up to seven
times as frequent compared to the general population. In a population
study of adults with an intellectual disability, Beange et al
(1995) found that dental disease was the most frequent health
problem, occurring in 86% of subjects.
Recommendations Education and behavioural interventions, which ensure that
appropriate dietary habits are established and oral hygiene practices
are made a part of the daily life of persons with ID, should be
directed toward individuals with ID, and their caregivers, to
the maximum extent possible.
Schedule dental visits for oral examinations and prophylaxis
at three-month intervals for those with active disease and those
at high risk for oral disease (most ID patients) and every six
months for persons judged to be at low risk by the dental care
team. This should be part of the overall health maintenance
program for persons with ID.
Preventive therapies such as fluoride or anti-microbial agents
should be implemented where indicated.
Multidisciplinary team approaches incorporating input from
medical professionals and mental health providers, as well as
dentists and dental hygienists, need to be adopted in many patients
to ensure optimal oral health. (Santos et al 1999).
Sensory impairments amongst people with an intellectual disability
have health, educational and environmental implications. Individuals
with such impairments may be relatively more handicapped because
of the superposition of age-related losses upon childhood impairments,
and the frequent combination with a motor handicap or a dual sensory
handicap.
2.2.1 Vision High frequencies of ocular disorders have been found in several
surveys (Wilson & Haire 1992; Warburg & Rattleff 1992;
Warburg 1994; Cathels 1993; McCulloch et al 1996). In a large
community survey, Warburg (1994) found that non-correctable visual
impairment was present in 10% of adults, at least 7 times higher
than in the general population. Adults with Down syndrome aged
30 years and over are at risk for premature age-related cataract
(Eissler & Longenecker 1962), increasing refractive errors,
and degenerative corneal changes (Völker-Dieben et al 1993).
Recommendations For adults with an intellectual disability, routine screening
for age-related visual loss at 45 years and every 5 years thereafter
has been recommended (Evenhuis & Nagtzaam 1998). If possible
this should be done by an ophthalmologist. An extra vision check
at age 30 years has been recommended for adults with Down syndrome.
2.2.2 Hearing Deafness is common in this population, often unrecognised,
and if recognised poorly managed (Wilson & Haire 1992; Howells
1986). Hearing loss as a result of impacted earwax is a frequent
problem in adults with an intellectual disability (Crandell &
Roeser 1993). Adults with intellectual disability aged 30 years
and over, especially those with Down syndrome, are at risk for
early age-related hearing loss (Evenhuis et al 1992).
Recommendations Routine screening for age-related hearing loss of all adults
at age 45 years and every 5 years thereafter has been recommended
(Evenhuis & Nagtzaam 1998). If possible this should be done
by anaudiologist. Screening of the hearing function of
adults with Down syndrome is recommended every 3 years throughout
life.
Nutritional well-being is recognised as an important factor
in maximising growth potential, maintaining health, and improving
quality of life and longevity. Nutrition related health problems,
particularly obesity and chronic constipation, are more common
in people with intellectual disabilities than in the general population
(Stewart et al 1994). People with severe disabilities and people
with cerebral palsy have a high prevalence of dysphagia and gastro-oesophageal
reflux disease (Böhmer et al 1996; Waterman et al 1992).
This places them in a high-risk group for severe under-nutrition.
Nutrition risk screening has been recommended and implemented
in programs for the elderly, for hospitalised patients and for
early intervention in children (Campbell & Kelsey 1994). However,
it has not been used widely with adults with intellectual disability.
Recommendations Nutrition risk screening provides a systematic approach to
improving recognition and management of nutrition problems that
should also benefit adults with intellectual disabilities. Screening
for nutrition related problems could be performed by anyone working
with people with disabilities provided a simplified screening
tool is developed. The tool should use indicators of weight and
weight change, eating abilities, general appearance and a simple
assessment of their food and fluid intake. Some basic knowledge
of nutrition and knowledge of and access to a referral system
is also required. The criteria for referral should be clear and
as specific as possible. Simple and safe nutrition interventions
should be applicable with the use of basic nutrition educational
materials (Amundson et al 1994; Foltz et al 1993).
Individuals at high risk should be referred for a more systematic
assessment of nutritional status by an experienced dietitian.
People with persistent underweight or overweight, eating and drinking
problems, chronic constipation or specific medical conditions
requiring more complex nutrition interventions (such as Coeliac
disease) would be amongst those needing systematic assessment.
A dietitian, preferably working with an interdisciplinary health
care team, should review the screening form and conduct assessment
of nutritional status. To be comprehensive, the process involves
using medical, nutritional and medication histories; physical
examination and anthropometric measurements; and biochemical data.
Constipation is significantly correlated with immobility, medication
such as anticonvulsants, benzodiazepines, H2-receptor antagonists
or proton pump inhibitors, food refusal, and IQ<35 (Bohmer,
2001). Jancar described death from complications of constipation,
with symptoms not always recognised.( Jancar, 1994)
Recommendation: There is a need for dietary assessment, as described
under nutrition, and pro-active medical treatments.
People with an intellectual disability have a significantly
increased lifetime risk of developing epilepsy (Corbett 1988).
There is an association with higher prevalence of epilepsy and
increasing disability. Community data suggest prevalence figures
of approximately 22% (Welsh Office 1995). The aetiology of epilepsy
is complex reflecting that of the disability itself, though in
some cases it would appear that the epilepsy itself causes the
intellectual disability (Binnie 1990).
There is good evidence that epilepsy adds both additional morbidity
and mortality (Forgren 1996). The morbidity includes the physical
trauma of the seizures leading to fracture and soft tissue injury,
hospital admission, the impact on learning and development through
seizure activity and the complex social impact of seizures (Baxter
1999). Less well defined is the negative impact of anticonvulsant
medication on learning and attention. It is also apparent that
epilepsy adds to carer strain and burden (Wilson 1998). There
is reduced life expectancy for people with an intellectual disability
who have epilepsy – though this may be correlated with the degree
of disability and thus additional morbidity.
Health guidelines should aim to
Reduce seizure frequency
Reduce epilepsy-related falls and fractures
Reduce epilepsy-related admissions to hospital and emergency
rooms
Reduce atonic seizures
Reduce side effects consequent to treatment (in particular,
cognitive, emotional and behavioural)
Reduce mortality due to seizures or accident in seizures
Reduce epilepsy related morbidity in carers.
Recommendations Ensure all individuals with epilepsy:
have a plan for the acute management of seizures
have a yearly assessment for medication side effects
are assessed for accuracy of epilepsy diagnosis, appropriateness
of current therapy and potential for improvement with further
treatment
are not restricted in terms of social, educational or employment
access as a result of their epilepsy
Provide education on epilepsy to all individuals and their
carers.
Ensure all individuals and their carers have appropriate education
on hazard, especially safe bathing and water hazard.
Ensure respite services are available which can support the
management of seizures, in particular the administration of
rectal diazepam.
Thyroid disease can be difficult to diagnose, particularly so
in patients with developmental disability. Often the only 'symptom'
is reported by the carer, usually mother, who observes that the
patient's behaviour has changed in some non-specific way. (Wilson
& Haire 1992).
Recommendations Thyroid disease should be considered at any new presentation.
Thyroid function tests should be performed on any unusual presentation
and annually in high risk subgroups (patients with Down syndrome
and patients with a previous history of thyroid disease). Thyroid
function tests should be performed every three to five years in
other patients with development disability. The management is
usually straightforward but may involve supervision of medication.
Psychiatric disorders are more prevalent in people with an intellectual
disability compared with the general population (Tonge & Einfeld
2000; Borthwick – Duffy & Eyman 1990; Corbett 1979; Gostason
1985; Reiss 1993; Rutter et al 1976). Specialist psychiatric services
are available in countries such as the UK and the USA, however
the provision of high quality psychiatric services remains a concern
in many countries (Parmenter 1988; Lennox & Chaplin 1995;
Lennox & Chaplin 1996; Molony 1993; White et al 1995; Beange
et al 2000).
Recommendation Health services should implement strategies to maximise the
quality of identification and management of mental disorders.
GERD is a major clinical problem in people with an intellectual
disability, overlooked and underestimated (Böhmer et al 1997a;
ibid 1999; ibid 2000). The prevalence of GERD and reflux esophagitis
(RE) in people living in institutions is very high, especially
in those with specific and well-defined risk factors. In a Dutch
institutionalised population, approximately one third of individuals
with IQ<50 were diagnosed with RE (Böhmer et al 1999).
Possible predisposing factors include scoliosis, cerebral palsy,
use of anticonvulsant drugs or other benzodiazapines, & IQ<35.
Symptoms indicative of reflux are vomiting, haematemesis, rumination
and depressive symptoms. Helicobacter pylori infection is increased
in populations of children and adults with an intellectual disability
(Böhmer et al 1997b). This infection can cause peptic ulcer
and gastric carcinoma (McColl et al 1998).
Recommendations Identify and treat gastro-esophageal reflux disease and illness
from Helicobacter pylori infection. Treatment should be undertaken
with the same indications as for the general population.
Osteoporosis has been shown to occur with high prevalence among
people with developmental disability, including an unselected
population sample (Center et al 1998). Factors associated were
small body size, hypogonadism, and Down syndrome. Sub groups of
people with intellectual disability are at increased risk of fracture
(Tannenbaum et al 1989), and an increased risk of falling has
been documented (Spreat & Baker-Potts 1983). Falls and osteoporosis
should be prevented where possible to decrease the frequency of
fractures, which cause pain and further disability. Special attention
should be given to persons on anticonvulsants, who are at increased
risk of fractures (Tohill 1997).
Recommendations Osteoporosis is common and would be best prevented. This requires
a global approach, with the life long goal of optimising activity
and nutrition, particularly calcium intake. People with an intellectual
disability should be screened by osteodensitometry at least once
in early adulthood; further decisions regarding progress screening
should be based on that result. Individuals who have low sunlight
exposure either due to management practices or to local climatic
conditions, or are receiving anticonvulsant therapy, should have
Vitamin D status assessed, and a Vitamin D supplement if identified
as deficient (Compston 1995). All women should have bone mineral
density assessed at the time of cessation of menstruation regardless
of the reason for menopause, and all hypogonadal men require assessment
(Eastell et al 1998). The local recommendations for treatment
of osteoporosis in the general population should be followed and
any decision to provide a different standard of care from that
of the general population should be explicit.
Polypharmacy (Reiss & Aman 1997) and inadequate medication
review (Beange et al 1995) are acknowledged problems in this population.
However, many individuals need daily medications because of the
high prevalence of epilepsy, psychiatric disorders, and other
serious disease. The nature of intellectual disability is such
that affected individuals have limited ability to consent to medication
or to monitor efficacy and side effects of medication.
Recommendations Medication should be regularly reviewed, ideally every three
months and particularly when polypharmacy exists (Beange et al
1995; Aman 1987; Gowdey et al 1987; Reiss & Aman 1997). Prescribers
need to acknowledge the inherent difficulties with monitoring
(Tu 1979; Reiss & Aman 1997) and ensure that the patient and
carers safely and reliably administer medication, are able to
recognise adverse effects, monitor the efficacy of the medication
and are aware of the review process. Systems for prepackaging
doses for community based patients to maximise compliance and
safety should be considered. Structured mechanisms for monitoring
efficacy are valuable (Einfeld 1990). Consumer and carer education
on the use of medication is important in ensuring compliance,
recognising side effects and maximising efficacy. Continuing reevaluation
should ensure the least effective dose. Side effects should be
monitored and ineffective drugs discontinued.
In a group practice survey, Kerr et al (1996) found that individuals
with an intellectual disability were less likely to have received
regular immunisations when compared with age and sex matched non-disabled
controls.
Recommendations Immunisation schedules for adults with an intellectual disability
should follow national guidelines. At a minimum we should ensure
that immunisation rates for adults with an intellectual disability
are the same as for the general community. Hepatitis A and B immunisations
are indicated for people who live in institutions, and Hepatitis
B is indicated for contacts of persons who are Hepatitis B carriers.
Immunisation against influenza and the pneumococcus is recommended
for the medically vulnerable (US Preventive Services Task Force
1996).
Physical activity and exercise levels amongst adults with an
intellectual disability are generally considered to be low (Beange
et al 1995; Pitetti & Campbell 1991; Rimmer et al 1993). A
lack of opportunity for exercise in spite of increased cardiovascular
risk factors has been documented (Beange et al 1995). Immobility
is a predictor for mortality (Hayden 1998) and life expectancy
is related to activity in those with severe intellectual disability
(Fenhall 1993). Evidence exists that physical activity reduces
mortality and morbidity in coronary heart disease, hypertension,
obesity, osteoporosis and mental health disorders (US Preventive
Services Task Force). All these conditions are increased in intellectual
disability.
Recommendations The American College of Sports Medicine and the Centres for
Disease Control and Prevention recommend 30 minutes or more of
moderate intensity physical activity on most, preferably all,
days of the week for the general population (US Preventive Services
Task Force). It should be possible to ensure this amount of moderate
activity for most disabled people. Two cardiovascular training
programs have been developed for people with intellectual disability
(Pittetti et al 1993). Some active or passive movement should
be provided daily for those with limited mobility due to physical
impairment. Some special services will be necessary for those
who cannot access services for the general population.
Many people with an intellectual disability need support to
maintain a healthy lifestyle and access health services. There
are numerous parallels between the elderly population and people
with an intellectual disability. Both populations are heterogeneous,
and are known to experience unrecognised or poorly managed health
conditions. Periodic comprehensive health assessment has been
demonstrated to be effective in people 75 years and over (Byles
2000). Current research suggests this process will result in improved
health in people with an intellectual disability also (Webb &
Rogers 1999). For a vulnerable population, which has been found
to suffer from multiple undetected and often obvious health problems
(Beange et al 1995; Howells 1986; Wilson & Haire 1992), this
simple measure is likely to be effective.
Recommendation Organise regular comprehensive physical assessment and review
by a medical practitioner.
A genetic aetiology is common in this population. A definitive
diagnosis is important to the patient since it allows a better
estimate of prognosis and the anticipation of complications. It
is important to the family since it enables full discussion and
understanding of the cause of the condition and allows informed
genetic counselling (Curry et al 1997). Estimates of genetic aetiology
vary because of differences in ascertainment and methods of study.
In round figures, it is generally agreed that 40-50% of cases
are genetic, 15-20% due to environmental factors and in 30-45%
the cause is unknown. A significant proportion of the latter is
also suspected to be genetic (Raynham et al 1996; Curry et al
1997; Hou et al 1998; Partington et al 2000).
Recommendations Any patient without an aetiological diagnosis should be referred
to a genetic clinic regardless of age. New genetic knowledge is
constantly becoming available. Diagnostic reassessment at intervals
is worthwhile even into adult life (van Gelderin 1992).
There is general agreement about the benefits of the main preventive
screening services (Sox 1994; US Preventive Services Task Force
1996). Many countries have screening programmes available, and
people with intellectual disability should take part in all these
programmes. Clinical judgment is necessary to tailor the checkups
to the needs of individual patients.
Recommendations Papanicolaou smears are necessary if women have ever been
sexually active. If the examination is distressing or difficult,
the risks of a Papanicolaou smear with / without sedation need
to be balanced against the benefits (Palmer 1999). Mammograms
are recommended according to country policy for the general population.
Aman MG. 1987 Overview of pharmacotherapy: current status
and future directions. Journal ofMental Deficiency
Research, 31, 121-130.
Amundson J, Sherbondy A, VanDyke DC & Randell A. 1994
Early identification and treatment necessary to prevent malnutrition
in children and adolescents with severe disabilities. Journal
of the American Dietetic Association, 94:880-883.
Baxter H. 1999 Personal communication.
Beange H, McElduff A & Baker W. 1995 Medical disorders
of adults with mental retardation: a population study. American
Journal on Mental Retardation, 99, 6, 595-604.
Beange H, Lennox N & Parmenter T. 2000 Health targets
for people with an intellectual disability. Journal of
Intellectual & Developmental Disability, 24, 4, 283-297.
Binnie CD, Channon S & Marston D. 1990 Learning disabilities
in epilepsy: Neurophysiological aspects. Epilepsia,
31, S2-S8.
Böhmer CJM, Niezen-de Boer MC, Klinkenberg-Knol EC,
Tuynman HARE, Voscuil JH, Deville WLJM & Meuwissen SGM.
1997a. Gastro-oesophageal reflux disease in intellectually
disabled individuals: leads for diagnosis and the effects
of omeprazole therapy. American Journal of Gastroenterology,
92, 9, 1475-9.
Böhmer CJM, Klinkenberg-Knol EC, Kuipers EJ, Niezen-de
Boer MC, Schreuder H, Schuckink-Kool F & Meuwissen SGM.
1997b. The prevalence of Helicobacter pylori infection among
inhabitants and healthy employees of institutes for the intellectually
disabled. American Journal of Gastroenterology, 92,
6, 1000-4.
Böhmer CJM, Niezen-de Boer MC, Klinkenberg-Knol EC,
Deville WL, Nadorp JH & Meuwissen SGM. 1999 The prevalence
of gastro-oesophageal reflux disease in institutionalised
intellectually disabled individuals. American Journal of
Gastroenterology, 94, 3, 804-810.
Böhmer CJM, Niezen-de Boer MC, Klinkenberg-Knol EC,
Meuwissen SGM. 2000 Review article. Gastroesophageal reflux
disease in intellectually disabled individuals: how often,
how serious, how manageable? American Journal ofGastroenterology;
July, in press.
Bohmer CJM, Taminiau J, Klinkenberg-Knol E, Meuwissen S.
The prevalence of constipation in institutionalized people
with intellectual disability. Journal of Intellectual Disability
Research 2001;3(45):212-8.
Borthwick-Duffy SA & Eyman RK. 1990Who are the
dually diagnosed? American Journal on Mental Retardation,
94, 586-595.
Byles J. 2000 A thorough going over: evidence for health
assessments for older persons. Australian and New Zealand
Journal of Public Health, 24, 2, 117-23.
Campbell MK & Kelsey KS. 1994 The PEACH survey: a nutrition
screening tool for use in early intervention programs. Journal
of the American Dietetic Association, 94:1156-1158.
Center J, Beange H & McElduff A. 1998 People with developmental
disability have an increased prevalence of osteoporosis: a
population study. American Journal on Mental Retardation,
103, 1, 19-28.
Compston JE. 1995 The role of Vitamin D and calcium supplementation
in the prevention of osteoporotic fracture in elderly. Clinical
Endocrinology, 43, 393-405.
Corbett JA. 1979 Psychiatric morbidity in mental retardation.
In: (Eds)Snaith P & James FE, Psychiatric Illness
& Mental Handicap. London: Gaskell.
Corbett J. 1988 Epilepsy and mental handicap. In: (Eds)
Laidlaw J, Richens A & Oxley J. A Textbook of Epilepsy,
3rd edition. Edinburgh, Churchill Livingstone,
533-538.
Crandell CC & Roeser RJ. 1993 Incidence of excessive
/impacted cerumen in individuals with mental retardation:
a longitudinal investigation. American Journal on Mental
Retardation, 97, 568-574.
Curran J & Hollins S. 1996 In: (Eds) Kendrick T, Tylee
A, Freeling P & Goldberg DPB. The prevention of mental
illness in primary care. Cambridge University Press.113-129.
Curry CJ, Stevenson RE, Aughton D, Byrne J, Carey JC, Cassidy
S, Cunniff C, Graham JM, Jones MC, Kaback MM, Moeschler J,
Schaefer GB, Schwartz S, Tarleton J, & Opitz J. 1997 Evaluation
of mental retardation: recommendations of a consensus conference.
American Journal of Medical Genetics, 72, 468-477.
Eastell R, Boyle IT, Compston J, Cooper C, Fogelman I, Francis
RM, Hosking DJ, Purdie DW, Ralston S, Reeve J, Ried DM, Russell
RGG & Stevenson JC. 1998 Management of male osteoporosis:
report of the UK Consensus Group, QJM, 91, 71-92.
Einfeld SL. 1990 Guidelines for use of psychotropic medication
in individuals with developmental disability. Australia
& New Zealand Journal of Developmental Disability,
16,1.
Eissler R & Longnecker LP. 1962 The common eye findings
in mongolism. American Journal of Ophthalmology, 54,
398-406.
Evenhuis HM, Van Zanten JA, Brocaar MP & Roerdinkholder
WHM. 1992 Hearing loss in middle aged persons with Down syndrome.
American Journal on Mental Retardation, 97, 47-56.
Fernhall B. 1993 Physical fitness and exercise training
of individuals with mental retardation. Medicine and Science
in Sports and Exercise, 25, 442-450.
Foltz MB, Schiller MR & Ryan AS. 1993 Nutrition screening
and assessment: current practices and dietitians’ leadership
roles. Journal of the American Dietetic Association, 93:
1388-95.
Forgren L, Edvinsson SO, Nystrom L, & Blomquist HK.
1996, Influence of epilepsy on mortality in mental retardation:
an epidemiologic study. Epilepsia, 37(10): 956-963.
Gostason R. 1985 Psychiatric illness among the mentally
retarded: a Swedish population study. Acta Psychiatrica
Scandinavica, 71 Suppl. 318, 1-117.
Gowdey WC, Zarfas DE & Phipps S. 1987 Audit of psychoactive
drug prescriptions in group homes. Mental Retardation,
25, 6, 331-334.
Hayden MF. 1998 Mortality among people with mental retardation
living in the United States: research review and policy application.
Mental Retardation, 36, 345-359.
Hou JW, Wang TR & Chuang SM. 1998 An epidemiological
& aetiological study of children with intellectual disability
in Taiwan. Journal of Intellectual Disability Research,
42, 2, 137-143.
Howells G. 1986Are the needs of mentally handicapped
people being met? Journal of the RoyalCollege ofGeneral Practitioners, 36, 449-435.
Jancar J, Speller CJ. 1994 Fatal intestinal obstruction in
the mentally handicapped. Journal of Intellectual Disability
Research, 38, 413-422.
Kerr MP, Richards D, Glover G. Primary care for people with
a learning disability - a Group Practice survey. Journal
of Applied Research in Intellectual Disability 1996;9(4):347-352.
Lennox NG & Chaplin R. 1995 The psychiatric care of
people with intellectual disabilities: the perceptions of
trainee psychiatrists and psychiatric medical officers.
Australian & New Zealand Journal of Psychiatry, 29,
632-7.
Lennox NG & Chaplin R. 1996 The psychiatric care of
people with intellectual disabilities: the perceptions of
consultant psychiatrists. Australian & New Zealand
Journal of Psychiatry, 30, 6, 774-780.
McColl K, Murray L, El-Omar, Dickson A, El-Nujumi A, Wirz
A, Kelman A, Penny C, Knill-Jones & Hilditch T. 1988 Symptomatic
benefit from eradicating Helicobacter pylori infection in
patients with non-ulcer dyspepsia. New England Journal
of Medicine, 339, 1869-74.
McCulloch DL, Sludden PA, McKeon K & Kerr A. 1996 Vision
care requirements among intellectually disabled adults: a
residence based pilot study. Journal of Intellectual DisabilityResearch, 40, 140-150.
Molony H. 1993 Mental health services for people with intellectual
disability: Current developments. Special Issue: Ninth World
Congress on Intellectual Disability. Australia and New
Zealand Journal of Developmental Disabilities, 18, 3,
169-176.
Nunn, Jane. (ed) 2000. Disability and Oral Care,
FDI World Dental Press Ltd.
Palmer D. 1999 Women’s Health Issues. In: (Eds) Lennox NG
& Diggens JD. People with Developmental and Intellectual
Disabilities, Therapeutic Guidelines, Melbourne, 151-164.
Parmenter TR. 1988 An analysis of Australian mental health
services for people with mental retardation. Australia
and New Zealand Journal of Development Disabilities, 14,
9-14.
Partington MW, Mowat D, Einfeld S, Tonge B & Turner
G. 2000 Genes on the X chromosome are important in undiagnosed
mental retardation. American Journal of Medical Genetics,
92, 57-61.
Pitetti KH & Campbell KD. 1991 Mentally retarded individuals
- a population at risk? Medicine andScience in
Sports and Exercise, 23, 5, 586-593.
Pitetti KH, Rimmer JH & Fernhall B. 1993 Physical fitness
and adults with mental retardation. An overview of current
research and future directions. Sports Medicine, 16,
1, 25-56.
Raynham H, Gibbons R, Flint J & Higgs D. 1996 The genetic
basis of mental retardation, QJM: Monthly Journal of the
Association of Physicians, 89, 169-173.
Reiss S & Aman MG. 1997 The international consensus
process on psychopharmacology and intellectual disability.
Journal of Intellectual Disability Research, 41, 6,
448-445.
Reiss S. 1993 Assessment of psychology in persons with mental
retardation. In: (Eds) Matson JL & Barrett RP, Psychopathology
in thementally retarded: 2nd Edition, Allyn &
Bacon, Boston.
Rimmer JH, Braddock D & Fujijura G. 1993 Prevalence
of obesity in adults with mental retardation: Implications
for health promotion and disease prevention. Mental Retardation,
31, 105-110.
Rutter M, Tizard J, Yule W, Graham P & Whitmore K. 1976.
1964-1974 Isle of Wight studies, Psychological Medicine,
6, 313-332.
Santos R, Malmstrom H, Henderson CM, Moss M, Meyerowitz
C, Beange H & Lennox N. 1999 Health targets for people
with intellectual disability: Oral Health. IASSID Roundtable,
Geneva, April 1999.
Scott A, March L & Stokes ML. 1998 A survey of oral
health in a population of adults with developmental disabilities:
Comparison with a national oral health survey of the general
population. Australian Dental Journal, 43, 4, 257-61.
Sox HC. 1994 Preventive health services in adults. The
New England Journal of Medicine, 330, 22, 1589-1595.
Spreat S & Baker-Potts JC. 1983 Patterns of injury in
institutionalised mentally retarded residents. Mental Retardation,
21, 23-29.
Stewart L, Beange H & Mackerras D. 1994 A survey of
dietary problems of adults with learning disabilities in the
community. Mental Handicap Research, 7:41-50.
Tannenbaum TN, Lipworth L & Baker S. 1989 Risk of fractures
in an intermediate care facility for persons with mental retardation.
American Journal of Mental Retardation, 95, 444-451.
Tohill C. 1997 A study into the possible link between anti-epileptic
drugs and the risk of fractures in Muckamore Abbey Hospital.
Journal of Intellectual and Developmental Disability,
22, 4, 281-292.
Tonge B & Einfeld S. 2000 The trajectory of psychiatric
disorders in young people with intellectual disabilities,
Australian and New Zealand Journal of Psychiatry, 34,
80-84.
Tu Jun-Bi. 1979 A survey of psychotropic medication in mental
retardation facilities. Journal of Clinical Psychiatry,
40, 125-128.
US Preventive Services Task Force. 1996 (Eds) DiGuiseppi
C, Atkins D, Woolf SH. Guide to Clinical Preventive Services.
Williams and Wilkins, Baltimore, USA.
Van Gelderen IG. 1992 Benefits of a second look at the causes
of mental handicap in an institution. In: (Ed) Roosendaal
J. Mental Retardation and Medical Care, Uitgeverij
Kerckebosch, Zeist, 120-126.
Volker-Dieben HMJ, Odenthal MTP, d’Amaro J & Kruit J.
1993 Surgical treatment of corneal pathology in patients with
Down Syndrome. Journal of Intellectual Disability Research,
37, 169-75.
Warburg M & Rattleff J. 1992 Treatable visual impairment.
A study of 778 consecutive patients with mental handicap placed
in sheltered workshops. In: (Ed) Roosendahl J. Mental Retardation
& Medical Care, Uitgeverij Kerkebosch, Zeist, 350-356.
Warburg M. 1994 Visual impairment among people with developmental
delay. Journal ofIntellectual Disability Research,
38, 423-432.
Waterman ET, Koltai PJ, Downey JC & Cacace AT. 1992
Swallowing disorders in a population of children with cerebral
palsy. International Journal of Pediatric Otorhinolaryngology,
24, 63-71.
Webb O & Rogers L. 1999 Health screening for people with
intellectual disability: the New Zealand experience. Journal
ofIntellectual Disability Research, 43, 6, 497-503
Welsh Office. Welsh Health Survey 1995. Cardiff.
White MJ, Nichols CN, Cook RS, Spengler PM, Walker BS &
Look KK. 1995 Diagnostic overshadowing and mental retardation:
a meta-analysis. American Journal of Mental Retardation,
100, 3, 293-298.
Wilson R. 1998 Carer burden in learning disability with
coexistent epilepsy. Unpublished MSc thesis. University
of Wales College of Medicine, Cardiff.
Wilson D & Haire A. 1992 Health care screening for people
with mental handicap in the United Kingdom. In (Ed)Roosendaal
J. Mental Retardation and Medical Care. Uitgeverij
Kerckebosch, Zeist, 58-67.
White MJ, Nichols CN, Cook RS, Spengler PM, Walker BS &
Look KK. 1995 Diagnostic overshadowing and mental retardation:
a meta-analysis. American Journal of Mental Retardation,
100, 3, 293-298.
Wilson R. 1998 Carer burden in learning disability with
coexistent epilepsy. Unpublished MSc thesis. University
of Wales College of Medicine, Cardiff.
Wilson D & Haire A. 1992 Health care screening for people
with mental handicap in the United Kingdom. In (Ed)Roosendaal
J. Mental Retardation and Medical Care. Uitgeverij Kerckebosch,
Zeist, 58-67.
This article was first published on the site in 2002.
COMMENTS
If you would like to comment on this article, please send us an e-mail to comments@sgul.ac.uk
(we regret that we are not able to reply to individual queries).
For adults with an intellectual disability, routine
screening for age-related visual loss at 45 years and every 5 years
thereafter has been recommended.
