Caring for Adults With Significant Levels of Intellectual Disability in Outpatient Settings: Results of a National Survey of Physicians.
Most outpatient doctors talk past adults with significant ID and sometimes sedate for routine care—behavior analysts can fill the communication gap.
01Research in Context
What this study did
Dai et al. (2023) emailed a short survey to 1,200 U.S. outpatient doctors.
They asked how the doctors talk with adult patients who have significant intellectual disability.
Doctors also reported if they ever give sedation for simple clinic jobs like blood draws.
What they found
Three out of four doctors skip the patient and speak only to the caregiver.
One in ten doctors said they had sedated at least one adult with ID just to do a routine test.
The numbers show big gaps in patient-centered care.
How this fits with other research
Geckeler et al. (2000) already found that GPs feel under-prepared for ID care; G et al. now show what that lack looks like in real visits.
Durbin et al. (2018) proved strong primary-care follow-up keeps adults with ID out of the ER; the new data hint why—when doctors avoid talking to patients, small problems snowball.
Perry et al. (2024) scoping review shows low cancer-symptom awareness across doctors, carers, and patients; together the papers trace a straight line—poor communication leads to missed cues, then more sedation and crises.
Why it matters
You can teach doctors quick rapport builders: give wait-time, use photos, model the task.
Pair each clinic visit with a brief behavior plan—visual schedule, first-then board, and a preferred item.
These small moves cut sedation risk and give your client a voice in their own health care.
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02At a glance
03Original abstract
Between 1% and 2% of the U.S. population has an intellectual disability (ID) and often experience disparities in health care. Communication patterns and sedation use for routine medical procedures are important aspects of care for this population. We explored physicians' communication patterns and sedation use in caring for patients with significant levels of ID through a mailed survey of 1,400 physicians among seven specialties in outpatient settings (response rate = 61.0%). Among physicians who saw at least one patient with significant levels of ID in an average month, 74.8% reported usually/always communicating primarily with someone other than the patient. Among specialists, 85.5% (95% CI: 80.5%-90.5%) reported doing so, compared to 69.9% (95% CI: 64.4%-75.4%) for primary care physicians (p < 0.001). Also, 11.4% reported sedating at least one patient with significant levels of ID for a routine procedure. Three quarters of physicians reported communicating primarily with persons other than the patient usually or always-an approach that, in some instances, may not align with best medical practice. The percentage of physicians who report sedating at least one individual is associated with significant ID and the physician's volume of patients with significant ID.
American journal on intellectual and developmental disabilities, 2023 · doi:10.1352/1944-7558-128.1.36