Assessment of Individuals with Developmental Disabilities

An estimated 1 to 2% of people living in the United States have a developmental disability (DD),[1] which may include mental retardation (MR). These individuals constitute only one segment of the changing fabric of America's communities. Faced with diversity of languages, backgrounds, and behaviors, audiologists, along with other healthcare professionals, must provide quality care while respecting the rights of each individual. We may feel ill prepared at times to meet this challenge-an attitude that is usually fostered by a sense of uncertainty about the unfamiliar or the unknown. This issue of Seminars in Hearing is intended to heighten audiologists' awareness and understanding of the nature of individuals with DD/ MR and to provide specific ways to approach the process of assessment and follow-up.

Several landmark events during the last 20 years have increased the probability that an audiologist will evaluate an individual with DD/ MR. First is the current emphasis on early identification and intervention. A host of potential problems are being identified in infants and children at earlier ages, thus requiring intervention by specialists soon after diagnosis. Allan Diefendorf covers several of the implications of these interventions in his article on audiological evaluation of youngsters with DD/MR. Second, Federal legislation in the 1950s through the 1970s and court rulings in the late 1960s challenged the widespread institutionalization of individuals with MR and called for changes in service provisions.[2] This prompted the discharge of MR individuals living as residents in large isolated institutional environments into community home arrangements. The implications of this change are discussed by Stephanie MacFarland in her comprehensive and sensitive overview of MR. In recognition that professionals require guidelines for working with individuals with DD, the American Speech Language Hearing Association has prepared several publications, including Position Statements and Technical Reports.[2] [3] [4] [5] These are cited for reference at the end of this introduction.

The process of audiological assessment has many facets. Five articles in this volume are devoted to behavioral and physiological issues. Topics such as behavioral diversity and its management and the influence of medications are included. The need for an individualized and humanistic approach is a common theme in these contributions, which are all written by individuals who have had years of experience in the field.

Knowledge of genetic and syndromic factors is especially important when working with individuals who have DD/MR. Glenn Green provides an overview of common neurologic syndromes with MR and auditory sequelae. Because space limitations prevent comprehensive coverage of this topic, Dr. Green also has included a resource list for readers to access additional information. Down syndrome is among the most common of syndromes that may be seen by the audiologist. Several unique features of individuals with Down syndrome may affect audiological management; therefore, we have included a comprehensive overview of these issues by Dr. Marilyn Dille.

The audiologist's role does not end when the client and/or caregiver leave the test environment. No matter the outcome of the evaluation, some form of follow-up is required. As part of a team approach, the audiologist should make specific recommendations concerning communication. In some cases, this may mean a referral to the speech-language pathologist. For this reason, we have included an article by Cass Faux and Anthony DeFeo, who review common speech and language difficulties that might be encountered in this group. The article also provides information on augmentative and alternative forms of communication.

Collectively and individually, the viewpoint of the authors in this issue is one of working with each individual's strengths rather than working against his or her weaknesses. These authors, who took time away from hectic schedules to write their contributions, represent years of cumulative experience in working with clients who have MR/DD and with their often extensive support network of families, caregivers, and employers. I do not think we realized just how much we would learn in the process of assimilating this information. We hope that readers will take away at least one important message from this volume: The uniqueness of individuals with MR/DD is their strength, and when strengths are respected and appreciated, a mutually successful outcome is likely.

REFERENCES

• 1 Administration on developmental disabilities. www.acf.hhs.gov/news/facts/addfs.htm. Accessed May 30, 2003
• 2 American Speech-Language-Hearing Association. Deinstitutionalization: its effect on the delivery of speech-language-hearing services for persons with mental retardation and developmental disabilities.  ASHA . 1989;  31 84-87
• 3 American Speech-Language-Hearing Association. The role of speech-language pathologists and audiologists in service delivery for persons with mental retardation and developmental disabilities in community settings.  ASHA . 1990;  32(Suppl 2) 5-6
• 4 American Speech-Language-Hearing Association. Serving the communicatively handicapped mentally retarded individual.  ASHA . 1982;  24 547-553
• 5 Gravel J S, Marttila J, Nerbonne M A. et al . Report on audiologic screening.  Am J Audiol . 1995;  4 24-40