history. Sometimes a patient might give their history through actions or behaviors, possibly even self-injurious behavior. A diagnosis might be suggested by a laboratory finding such as WBCs in the urine, but this still may not be the source of the individual’s symptoms. Issues Related to Obtaining an Adequate History Patients and providers alike benefit greatly from families, guardians, and caregivers when facing the challenge of obtaining an adequate history. These valuable historians are aware of the patient’s medical history and can describe baseline behavior. They will facilitate communication and advocate for the patient. Similarly, you, as the patient’s provider, can aid other healthcare professionals if your patient is hospitalized or needs a medical consultation. At our facility, we have standardized the practice of sending a physical copy of a patient’s medical history, medication list, special diet orders, and list of serious diagnoses when sending that patient to the emergency department. As the time for hospital discharge approaches, a caregiver who is familiar with that patient’s baseline behavior should consult with the hospital treatment team to confirm if they have truly returned to baseline. Etiology and Changes in Frequency of Developmental Disabilities The occurrence of developmental disabilities can be grouped into a few main categories. There are genetic disorders such as Down’s syndrome. Others are born with a disorder that is not genetic such as fetal alcohol syndrome. Some are acquired later in life as the result of an illness or injury such as meningitis or traumatic brain injury. There are many medical diagnoses associated with a developmental disability. These are frequently managed by primary care providers with the assistance of a consulting neurologist or psychiatrist. Epilepsy and autism spectrum disorder are included in this category. The population of individuals with developmental disabilities has changed over time. Some older individuals in this population have conditions well known to previous generations of physicians such as congenital rubella or untreated phenylketonuria (PKU). These conditions today are rare amongst younger patients in this population. Autism spectrum disorder is becoming more prominent in this population today. Despite increasing numbers of less-severe cases of developmental disability, it cannot be understated how debilitating this condition can become | 30
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