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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