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For more information about the SORT evidence rating system, see page 2105 or = consistent, good quality patient-oriented evidence; B = inconsistent or limited quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.For more information about the SORT evidence rating system, see page 2105 or chronic mental or physical disabilities that manifest before a person reaches 22 years of age, are likely to continue indefinitely, and result in substantial functional limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency3Identifies a subset of persons who have developmental disabilities with below-average general intellectual functioning (below 65 to 75) as measured through standardized general aptitude evaluation tools, such as the Wechsler Intelligence Scales or Stanford-Binet Intelligence Scales (mild, 50 to 69; moderate, 35 to 49; severe, 20 to 34; profound, less than 20)Accompanies two or more deficits in adaptive behavior used for everyday living (e.g., communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, work) as determined by a structured evaluation tool such as the Vineland Adaptive Behavior Scales.4Severe chronic mental or physical disabilities that manifest before a person reaches 22 years of age, are likely to continue indefinitely, and result in substantial functional limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency3Identifies a subset of persons who have developmental disabilities with below-average general intellectual functioning (below 65 to 75) as measured through standardized general aptitude evaluation tools, such as the Wechsler Intelligence Scales or Stanford-Binet Intelligence Scales (mild, 50 to 69; moderate, 35 to 49; severe, 20 to 34; profound, less than 20)Accompanies two or more deficits in adaptive behavior used for everyday living (e.g., communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, work) as determined by a structured evaluation tool such as the Vineland Adaptive Behavior Scales.4For physician office visits, patients with mental retardation should be accompanied by a person who is familiar with them and the purpose of the visit.Providing caregivers in advance with a referral sheet documenting the information expected for each office visit can be helpful .For patients with destructive or challenging behaviors, physical and emotional trauma can be minimized and the effectiveness of the evaluation enhanced by providing mild sedation (e.g., lorazepam [Ativan], 1 to 8 mg).Persons with tracheotomy and percutaneous endoscopic gastrostomy (PEG) sites may have chronic colonization with bacteria such as methicillin-resistant.23 Communicable disease guidelines for this population address treatment concerns and encourage integration into community or residential programs (Persons with mental retardation, particularly those with Down syndrome, often have obstructive sleep apnea.24 However, many are unable to tolerate continuous positive airway pressure.Persons with mental retardation are living longer and integrating into their communities.Primary medical care of persons with mental retardation should involve continuity of care, maintenance of comprehensive treatment documentation, routine periodic health screening, and an understanding of the unique medical and behavioral disorders common to this population.

Physical activity, often lacking in this population,6 can improve quality of life for many.7 Participation in Special Olympics also should be encouraged, with appropriate screening for event-specific limitations (e.g., atlantoaxial instability in persons with Down syndrome).

Health issues in these patients include respiratory problems, gastrointestinal disorders, challenging behaviors, and neurologic conditions.

Some commonly overlooked health concerns are sexuality, sexually transmitted diseases, and end-of-life decisions.

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