What should be included in an intake form for a psychiatrist to assess an adult child with severe Intellectual Developmental Disorder (IDD), Autism Spectrum Disorder (ASD), and Attention Deficit Hyperactivity Disorder (ADHD)?

Comprehensive Psychiatric Intake Form for Adults with Severe IDD, ASD, and ADHD

A well-designed intake form for parents/caregivers of adults with severe IDD, ASD, and ADHD should comprehensively assess all relevant domains while accommodating the unique presentation of symptoms in this population. The form should gather information across multiple domains to guide psychiatric assessment and treatment planning.

Basic Information Section

• Patient's full name, date of birth, gender
• Primary caregiver's name and relationship to patient
• Current living situation (family home, group home, residential facility)
• Legal guardianship status
• Primary language and communication method
• Insurance information
• Current providers (primary care, specialists, therapists)
• Emergency contact information

Developmental History

• Developmental milestones (when/if achieved)
• Age of diagnosis for IDD, ASD, and ADHD
• Severity level of intellectual disability (IQ testing results if available)
• Adaptive functioning assessment results
• History of early intervention services
• Educational history and current educational/vocational programming
• Previous psychological/neuropsychological evaluations

Medical History

• Current medical conditions
• Seizure history (type, frequency, last occurrence)
• Hearing/vision impairments
• Sleep patterns and disturbances (sleep disturbances are 2.8 times more likely in youth with IDD than typically developing youth) 1
• Gastrointestinal issues (constipation, reflux)
• Menstrual history (for females)
• Dental health
• Recent physical changes or complaints
• Pain assessment (how patient typically expresses pain)
• Recent hospitalizations or emergency room visits

Medication History

• Current medications with dosages and schedules
• Previous psychiatric medications tried (including response and side effects)
• Medication allergies or adverse reactions
• Compliance with medication regimen
• Method of medication administration

Psychiatric Symptoms Assessment

ADHD Symptoms

• Hyperactivity manifestations (specific behaviors)
• Inattention symptoms (note: inattentive symptoms do not typically decrease in teens with IDD as they do in typically developing children) 1, 2
• Impulsivity behaviors (grabbing, pinching, difficulty waiting) 2
• Impact of symptoms on daily functioning
• Environmental triggers that worsen symptoms

ASD Symptoms

• Social communication abilities and challenges
• Repetitive behaviors or restricted interests
• Sensory sensitivities or seeking behaviors
• Response to changes in routine
• Use of visual supports or other accommodations

Other Psychiatric Symptoms

• Mood symptoms (irritability, depression, mania)
• Anxiety symptoms (fears, worries, obsessions)
• Psychotic symptoms (if any)
• Self-injurious behaviors (type, frequency, triggers)
• Aggression (type, frequency, triggers, warning signs)
• Property destruction

Functional Assessment

• Communication abilities (verbal, nonverbal, augmentative)
• Self-care skills (toileting, bathing, dressing, eating)
• Mobility status
• Daily routine
• Preferred activities and interests
• Aversions or triggers for distress
• Coping strategies that work well
• Environmental modifications currently in place

Behavioral Assessment

• Challenging behaviors (detailed description)
• Frequency, intensity, and duration of behaviors
• Antecedents (what happens before the behavior)
• Consequences (what happens after the behavior)
• Perceived function of behaviors (escape, attention, access to items, sensory)
• Current behavior management strategies
• Recent changes in behavior patterns
• Settings where behaviors are better/worse

Psychosocial Assessment

• Family structure and dynamics
• Caregiver stress level and coping resources
• Support systems available
• Major life changes or stressors (moves, deaths, changes in caregivers)
• History of trauma or abuse
• Cultural factors affecting care

Treatment History

• Previous psychiatric treatments and outcomes
• Current and past therapies (ABA, speech, occupational therapy)
• Previous behavioral interventions and their effectiveness
• Response to environmental modifications
• History of psychiatric hospitalizations

Current Concerns and Goals

• Primary concerns prompting psychiatric evaluation
• Duration of current concerns
• Impact on quality of life for patient and family
• Specific goals for psychiatric treatment
• Caregiver's understanding of diagnosis and treatment expectations

Assessment Tools to Include

• Modified rating scales appropriate for individuals with IDD:
  • Aberrant Behavior Checklist (ABC)
  • Nisonger Child Behavior Rating Form
  • Developmental Behavior Checklist for Adults
  • ADHD rating scales adapted for developmental level 2

Special Considerations

Communication Assessment

• Include a detailed communication assessment section since limited ability to communicate can exacerbate psychiatric or behavioral symptoms 1
• Document current communication system and consistency of access across settings
• Note any recent changes in communication abilities

Medication Considerations

• Document sensitivity to medication side effects (particularly sedating or activating medications) 1
• Include specific questions about side effects of current medications that might mimic psychiatric symptoms

Environmental Assessment

• Include questions about demand-ability matching, as inappropriate educational/vocational demands can trigger psychiatric symptoms 1
• Document sensitivity to environmental changes and routine disruptions 2

Implementation Tips

1. Use clear, jargon-free language
2. Include space for open-ended responses
3. Consider digital format with skip logic for sections that don't apply
4. Make the form available prior to the appointment to allow time for completion
5. Include visual supports where helpful
6. Provide options for alternative formats based on caregiver needs

By using this comprehensive intake form, psychiatrists can gather the essential information needed to accurately assess and treat adults with severe IDD, ASD, and ADHD, while avoiding common pitfalls such as diagnostic overshadowing or failing to consider the impact of environmental factors on psychiatric presentation 1, 2.