From Guidelines for Managing the Client with Intellectual Disability in the Emergency Room (© 2002)
I Optimize the clinical encounter
- Practical tips
II Rule out non-psychiatric causes for problems of concern
- Medical disorders
- Problems in expectations and supports
- Emotional upsets
III Seek information on usual level of functioning
- Cognitive (e.g., previous psychological testing, verbal and performance IQ)
- Adaptive (e.g., level of independence in daily activities)
- Communication (e.g., receptive and expressive language)
- Social (e.g., presence of autism/PDD)
- Level of supports provided or required in residential and day setting
IV Assess all symptoms and behaviours as to whether they are new onset or chronic
- Determine usual behaviour and usual level of functioning in areas of: self-care, interest/involvement in school or work, play/leisure activity, social involvement, initiative and level of supervision required
- Determine whether there has been an episode (or episodes) of changed behaviour. Identify whether any psychotic symptoms and/or change in behaviour outside the range of normal for the individual meets criteria for a significant episode. Determine whether episode meets criteria for a DSM-IV diagnosis.
- Functional inquiry to determine the presence of comorbid psychiatric conditions (e.g., self-injurious behaviour, stereotypies, obsessive thoughts, compulsive behaviours, fears, phobias, levels of attention, hyperactivity, impulsivity).
V Determine whether referral concerns likely point to a psychiatric disorder and, if so, generate provisional psychiatric diagnosis
VI Determine immediate intervention
- Medical (or dental) consultation
- Inpatient
- Crisis respite
- Home with supports
VII Follow Up
- Medication
- Referral to specialist services
- Plan for next time