Developing Good Practice in the Clinical Assessment of People With Profound Intellectual Disabilities and Multiple Impairment

Abstract

The task of assessing people with profound intellectual disabilities and multiple impairments can be a daunting one, for experienced and newly qualified clinicians and practitioners alike. Difficulties with definitions in the context of challenging, excluding service delivery models can sometimes lead to incoherent and inconsistent approaches. The author examines a number of issues, including the paucity of adequately sensitive, standardized assessment tools, the importance of collaborative working, and the acknowledgment that services can be ill‐equipped to face the challenges presented by people with such complex and chronic support needs. The role of an overly generic service philosophy in potentially limiting the work of clinicians is noted, and the author notes that evaluating development is a crucial factor in any overall assessment. The author concludes with a number of recommendations for developing good practice in this crucial area of the support process, including: agree on terminology and inclusion criteria; take a transdisciplinary approach; use a developmental model; consider the impact of neurological conditions; select measures and informants carefully; and consider the assessment as an intervention.

Behavioural assessment of autism spectrum disorders in people with multiple disabilities

“…The available tools lack norms for people with sensory and/or IDs, and often, items are inappropriate because they require sight or hearing to pass them (Jure et al . ; Carnaby ; Hoevenaars‐van den Boom et al . ; Matson & Shoemaker ).…”

“…Despite the presence of instruments to screen for or diagnose ASD in people with IDs (Matson & Shoemaker 2009;Matson & Williams 2014), there are still no instruments that can validly diagnose ASD in people with multiple disabilities. The available tools lack norms for people with sensory and/or IDs, and often, items are inappropriate because they require sight or hearing to pass them (Jure et al 1991;Carnaby 2007;Hoevenaars-van den Boom et al 2009;Matson & Shoemaker 2009).…”

Visual Habituation Paradigm With Adults With Profound Intellectual and Multiple Disabilities: A New Way for Cognitive Assessment?

“…In , Carnaby stated that assessing an individual's level of developmental functioning is often crucial to the way support staff are going to ‘join’ this individual by proposing activities that are personally meaningful and relevant. Therefore, assessing cognitive abilities is an important issue in providing a support that is adjusted to the person's needs and possibilities.…”

Treatment Models for Treating Patients with Combined Mental Illness and Developmental Disability

“…Communication barriers plus exquisite sensitivity to multiple physiological and environmental stressors confound attempts at diagnosis and long term treatment planning. As a result these individuals need more intensive, specialized, integrated, long-term treatment, and perhaps most critical, consistent high quality behavioral intervention [1,2].…”

“…Impaired social and communication skills create also add to this risk while also creating problems for mental health professionals unfamiliar with autism. In many circumstances, the core features of autism are misattributed to or confused as symptoms of severe primary mental disorders [1]. Teasing out this boundary requires a thorough developmental history that includes gathering information from multiple informants about pregnancy, neonatal, and early developmental and psychosocial history, direct observations by clinicians familiar with autism as well as data gathered from standardized assessment instruments [1].…”