Health Care for Individuals with Developmental Disabilities

1
Health Care for Individuals with Developmental
Disabilities

• Charts and lists from Medical Care for Children
  Adults with Developmetnal Disabilities, Rubin and
  Crocker

2
Sleep Disorders among Individuals with Autism

• 56-83 have sleep problems
• Refusing to go to bed
• Getting out of bed
• Tantrums at bedtime
• Early waking
• Frequency of problems increases with severity of
  disability

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Sleep Disorders among Individuals with Autism

• Side effect of medicines
• Other medical causes
• GERD
• Allergies
• asthma
• Sleep apnea
• Snoring, bruxism
• Associated with daytime hyperactivity and
  irritability

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Sleep Disorders among Individuals with Autism

• Pharmacologic interventions
• Melatonin
• Clonidine
• Antihistamines/antidepressants/ hypnotics
• Paradoxical effects, other side effects
• Periodic reassessment and weaning when possible

5
Gastrointestinal Disorders among Individuals with
Autism

• 25 with chronic diarrhea
• 25 with chronic constipation
• Pathologic findings in some studies
• Upper or lower intestinal inflammation
• Abnormal permeability
• GERD

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Dental Conditions among Individuals with Autism

• Oral hygiene can be challenging
• Pain may aggravate underlying behavior problems
• Face slapping as presentation of underlying
  dental problem (Lacamera, 1997)
• May present as decreased appetite or oral self
  stimulation

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Ear, Nose, and Throat Conditions among
Individuals with Autism

• Sensitivity to sound
• Mild to moderate hearing loss in 7.9
• Severe to profound in 3.5
• Otitis media
• As cause of unexplained pain
• Delayed diagnosis due to relative insensitivity
  to pain
• Consider in setting of prolonged colds,
  increased irritability,
• head banging, decreased responsiveness to sound

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Eye Conditions among Individuals with Autism

• Opthalmologic problems more common than in the
  general population
• Cause of unexplained irritability
• Cant communicate symptom of visual disturbance

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Genitourinary Disorders among Individuals with
Autism

• Enuresis (bedwetting)
• Night time dryness before age 7 unusual
• Behavioral interventions
• Medications DDAVP, desmopressin
• Polyuria (frequent urination)
• Urethritis
• May present as masturbation

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Seizures in Autistic Individuals

• 25-35 incidence
• Two peaks
• Early childhood
• Adolescence
• Landau Kleffner syndrome (acquired epileptic
  aphasia)
• Language regression between first and third
  birthday)
• Sleep EEG

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Seizures in Autistic Individuals Subclinical
signs of seizures

• Poor memory
• Staring, spacing or dizzy spells
• Eye blinking
• Repetitive mouth movements
• Speech or memory loss
• Poor response to name
• Unexplained aggression
• Behaviors outside the usual repertoire

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In case things seemed too simple.

• Severe constipation can precipitate a true
  epileptic seizure
• Or a pseudoseizure
• Or self injurious behavior

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Behavior as Symptom History, history, history

• Timing
• Settings- home/ bus/ school
• Time of day- evening vs. morning
• Mealtimes
• Toileting
• Other events of the day
• Frequency
• Duration
• Stressors
• Change in routine, family circumstance, staff

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Potential Side Effects of Medications in
Individuals with Autism

• Medication class
• Decongestants
• Antihistamines
• Anticonvulsants
• Potential side effects
• Agitation
• Sedation, disinhibition
• Irritiability, activation, drowsiness, dizziness,
  personality changes, clumsiness, nystagmus,
  gingival hypertrophy, rash, hirsuitism, alopecia,
  diplopia, confusion, dyspepsia, photophobia,
  hyperphagia

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Potential Side Effects of Medications in
Individuals with Autism

• Medication class
• Stimulants and nonstimulants
• Mood stabilizers, neuroleptics
• Serotonin reuptake inhibitors
• Potential side effects
• Agitation, aggressiveness, stereotypies, tics,
  isolatory behaviors, loss of appetite, nausea,
  lethargy
• Tremor, weakness, posturing, dyskinesias,
  autonomic movements, agitation, weight loss
• Agitation, hyperactivity, sleep disruption,
  constipation, weight gain

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Common Symptoms of Distress In Individuals with
autism

• Self injurious behavior
• Aggressive behavior
• Agitation
• Self stimulatory behavior
• Sleep disruption
• Regression and loss of skills
• Regression in toilet training
• Behavior regression
• Masturbation
• Poor attention and increased hyperactivity and
  distractibility
• Rectal digging and fecal smearing
• Excessive eating
• Weight gain or weight loss
• Increase in toe walking

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Implications of Sensory Issues
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Implications of Sensory Issues
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Implications of Sensory Issues
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The need for an interdisciplinary approach
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Health Care for Individuals with Developmental
DisabilitiesRoles and Challenges for support
staff

• Know individual patterns, history to recognize
  changes.
• Communicate with other staff, supervisors,
  nurses.
• Document observations and responses.

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Health Care for Individuals with Developmental
DisabilitiesRoles and Challenges for support
staff

• Support staff may have
• limited familiarity with history
• Limited time/ exposure
• Patients may
• Limited verbal skills
• Not provide reliable histories
• The advantage of institutional living Longer
  life span
• up to 88 increased mortality rates among adults
  with developmental disabilities living in the
  community compated with those with similar
  medical conditions living in institutions
  (Strauss et al. 1999)

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Health Care for Individuals with Developmental
Disabilities

• Roles and Challenges for support staff
• In the hospital
• Provide continuity and support
• Inform and guide nursing and medical staff
• Advocate
• Wrong medicine?
• Need a bed pan?
• Give clinicians perspective on patients level of
  functioning and quality of life
• In the ER
• Examining physician should speak with PCP
• For historical background
• To interpret individuals behavior
• To suggest best approach for acute presentation

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Health Care for Individuals with Developmental
Disabilities

• Roles and Challenges for support staffMedical
  visits
• Facilitate transitions to help resident feeling
  comfortable and safe.
• Hold hands, verbal praise
• Consider desensitizing to procedure in advance
• Role for pre-medication
• Communicate clearly with physician-
• be prepared with as much detailed history as
  possible. You may be the only one who can help
  the physician connect the dots between symptoms
  and diagnosis.
• Bring data- eg charts of sleep patterns/
  menstrual cycles
• Bring back written and verbal assessments and
  treatment plans to the staff.

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Health Care for Individuals with Developmental
DisabilitiesRoles and Challenges for support
staff

• General considerations
• Dont get in over your head
• Provide data- you do not have burden of making
  diagnosis
• For sharing important news, make sure doctors
  communicate with family
• If you are feeling unsure, call your support for
  help

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Roles and Challenges for support staffPrevention

• Infection control
• Hand washing
• Hygienic food practices
• Basic safety considerations
• Flu shots