Use of directed history and behavioral indicators in the assessment of the child with a developmental disability

It can be very difficult to get a complete history and review of systems for children with developmental disabilities and poor communication skills. In addition, many children with developmental disabilities may engage in self-injurious or aggressive behavior. Although the causes of inappropriate behavior are frequently environmental, physiologic components may exist as well, particularly pain or discomfort. History taking must be focused and specific and may need to focus on the child's behavioral patterns, because the child may not have sufficient communication skills to describe his or her problem and parents or guardians may not realize the relevance of certain behaviors. Gastrointestinal problems in particular may be a source of discomfort and should be reviewed with particular care. Referral to a psychologist who is able to perform a functional analysis of behavior may be necessary to treat problem behavior, especially if medical causes have been ruled out.