Patients with Intellectual/Development Disability (IDD)
Intellectual disability is used to define a developmental disorder characterized by impaired social functioning and limited cognitive ability that have developed before the age of 18 years. Patients with IDD may have difficulties with abstract concepts and the subtleties of interpersonal interactions. The kind of support needed may vary depending on each patient’s cognitive ability and the presence of other associated developmental disabilities such as cerebral palsy, autism or sensory impairments.
- Someone with a mild intellectual disability (IQ 50-70) might be able to read and write. Some may not have learned to read or write, so sensitivity is required when requesting patients to read information or complete written forms.
- Someone with a moderate intellectual disability (IQ 35-50) can learn to recognize some words in context. With adequate vision, these patients will benefit from visual prompts to clarify meaning.
- Someone with a severe (IQ 20-35) or profound (IQ <20) intellectual disability likely has little or no speech. These patients will rely on facial expression, body language, and gestures to express their needs. Using objects can be helpful to facilitate understanding.
Key Recommendations for Communicating with Patients with IDD
Make sure you have the patient’s attention by addressing the patient by name, making an eye contact and/or using touch
Follow your clinic process to lengthen the appointment time
When unsure of the patient’s ability to understand, assume competence not a lack of understanding. Adjust your method of communication based on patients’ response
Use simple, concrete language in short sentences without idioms, irony, or metaphors. Give direct requests
Use an appropriate tone of voice that is consistent with the patient’s age. Treat an adult patient with IDD as an adult
Don’t rush. Allow time for patient to listen and process what you say
Leverage the support person or guardian for behavior management, communication, and patient preferences
Eliminate distractions and minimize background noises if possible by rooming the patient early
Use dimmable light switches to minimize the sensory input for patients with sensory integration issues
Avoid sensory overload by providing information gradually and clearly
Assign an accessible examination room to accommodate wheelchairs and other adaptive equipment
If the patient doesn’t understand:
- Repeat
- Use simpler or different words
- Use pictures
- Demonstrate
If you don’t understand:
- Don’t pretend to understand
- Ask the patient to say it again
- Ask the patient to show instead
- Ask to involve family member/ support worker if appropriate
Additional Accommodations and Resources for Patients with IDD
Exceptions to the COVID-19 Visitor Policy
Please see Michigan Medicine’s Visitor Guidelines During COVID-19, including the Guidelines for Supporting Adult Patients with Disabilities During the COVID-19 Public Health Emergency. Questions regarding policy modifications should be referred to Patient Relations and Clinical Risk at 734-936-4330.
Policy on Service Animals at Michigan Medicine
To learn more about Michigan Medicine’s policy on service animals, please watch this video. It has been designed to provide real life examples on how to handle patients with service animals and describes the rights of patients with service animals. You may also download a FAQ sheet to share with colleagues.
Relaxation/Distraction Techniques
Have toys or distracting objects (e.g., anything with sensory properties) available and/or ask families about topics that are especially engaging to the patient.
Visual Supports
Visual supports can establish predictability, reduce anxiety, and promote more effective coping during a medical visit. A First-Then Board or a visual schedule can be adopted to communicate with the patient better.
- A First-Then Board can motivate patients to engage in medical procedures by clarifying that the preferred items or activities will be available after it is over.
- A Visual Schedule maps out activities that will happen during a visit. When designing the schedule, try to mix in preferred activities with non-preferred ones and finish with a positive activity. When each task is completed, work with the patient to check the schedule before transitioning to the next activity. Provide praise and/or other reinforcement to the patient for following the schedule.
Questions or Concerns
For any questions or concerns around the patient rights, please reach out to the Patient Civil Rights Coordinator at MichMed_patients_rights@med.umich.edu. For additional guidance and support for identifying resources on topics such as accommodations, physical accessibility, service animals and disability inclusion and awareness, you can also reach out to the ADA team at adacoordinator@umich.edu.