Predictors of asphyxiation risk in adults with intellectual disabilities and dysphagia.
Fast eating, cramming, and premature food loss are clear signals that an adult with ID could choke.
01Research in Context
What this study did
Giallo et al. (2006) read old case notes of adults with intellectual disability and dysphagia. They looked for eating behaviors that showed up before choking events.
The team pulled charts from a long-stay hospital. They compared notes on people who had choked with notes on people who had not.
What they found
Three eating patterns raised the risk of asphyxiation: eating too fast, cramming the mouth, and losing food from the mouth before swallowing.
When any of these behaviors were recorded, choking was more likely to follow.
How this fits with other research
Casey et al. (2009) later showed that about 8% of adults with ID living in the community have dysphagia. Giallo et al. (2006) give you the red-flag behaviors to watch for in that group.
Feldman et al. (1999) slowed eating for one teen with stricture by using prompts and praise. Their single-case result supports the 2006 warning that fast eating is dangerous.
Harkins et al. (2023) reviewed chewing interventions for kids. Their paper includes later studies that teach safer chewing, filling the gap Giallo et al. (2006) left on what to do after you spot the risk.
Why it matters
You can add a 30-second mealtime scan to your session. Count bites per minute, look for over-stuffing, and check for food spillage. If you see any of the three flags, move the client to the top of the SLP referral list and start pace-prompting. No extra tools needed—just your eyes and a timer.
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Join Free →Time three bites during breakfast—if any bite takes <3 seconds, slow the client with a 5-second wait prompt.
02At a glance
03Original abstract
BACKGROUND: Adults with learning disabilities referred for assessment of their eating and drinking are frequently reported to cough and choke when eating and drinking. The research literature investigating dysphagia has often overlooked asphyxiation risk, highlighting coughing and choking as indicators of aspiration only. This is a notable oversight due to the prevalence of asphyxia as a cause of mortality in this population. AIM: This study aims to identify the physiological and environmental factors that predict asphyxiation risk in adults with intellectual disabilities and dysphagia. METHOD: Data were collected from dysphagia-trained speech and language therapists (SLTs) working with the participant adults with intellectual disabilities and dysphagia. The SLTs used case notes, clinical assessment and videofluoroscopic assessment reports to gather the data. RESULTS: Speed of eating, cramming food and premature loss of the bolus into the pharynx were identified as significant predictors of asphyxiation risk in this population. CONCLUSIONS: The findings highlight the importance of maladaptive eating strategies in exacerbating the risk of asphyxiation and choking. These factors should be considered in the assessment of asphyxiation and choking risk and management. Finally, the need for joint assessment and management with other members of the multidisciplinary team is advocated.
Journal of intellectual disability research : JIDR, 2006 · doi:10.1111/j.1365-2788.2005.00784.x