Intellectual disability

All doctors should expect to have some patients with intellectual disability. People with intellectual disability have high rates of physical and mental ill-health problems, and co-morbidity is typical. Frequently associated conditions such as epilepsy, aspiration and choking can cause avoidable death, and problems such as gastro-oesophageal reflux disorder, sensory impairments and injuries can cause recurrent symptoms, persistent disability and distressed behaviour. Other developmental conditions, psychosis and behavioural problems are common. Be aware of readily treatable associated physical conditions such as hypothyroidism in Down syndrome. Problem behaviour can be a sign of distress, which can be the result of physical ill-health, mental ill-health, environmental factors or a combination of these. Medical assessment requires well-developed communication skills and access to multiple sources of information, which must involve relatives and paid carers as well as the person with intellectual disability, so sufficient time should be allocated. Use a biopsychosocial–developmental framework. Avoid attributing symptoms of medical conditions to the person's developmental disabilities (‘diagnostic overshadowing’), which results in illness going untreated. People with intellectual disability face many barriers in accessing healthcare, and proactive approaches are required. Specialist intellectual disability teams, where available, are excellent resources for specialist multidisciplinary assessment and advice.