Physical Investigations

People with mild intellectual disability and good communication skills are generally able to inform others if they are in discomfort or pain. However, some people with autism spectrum disrders and some people with an intellectual disability may find it difficult to identify pain and discomfort, and to communicate this effectively to others. Painful medical conditions can present with challenging behaviour as their only apparent manifestation in people with a moderate or severe intellectual disability, and it is essential to seek out a comprehensive physical review ior these people. Establishing regular contact with a general practitioner who has an interest in people with an intellectual disability is helpful in the longer term as well.  Physical examination should include checking, for example, that there is no ear infection, urinary tract infection, chest infection or any obvious dental problems. Routine blood tests can usually indicate if there is a need for further investigation. However there are some disorders that may require specific investigation. These include, for example, performing an ultrasound for gall bladder problems or ovarian cysts or an endoscopy for gastric ulcers. As these investigations can be invasive and difficult to administer without cooperation, they are generally only undertaken if the behaviour is severe and normal strategies are not working.  Physical review should also indicate if a specific genetic syndrome may be contributing to the behaviour, and if further genetic testing is indicated.