Clinical assessment

A general practitioner’s (GP’s) assessment of dysphagia in a person with developmental disability should include:

  • differential diagnosis (eg of neuromuscular conditions)
  • medication review—see Drug-related dysphagia
  • history of mealtime behaviours (eg food preferences, slow versus rapid eating)
  • consideration of
    • conditions related to the person’s dysphagia (eg respiratory compromise, gastro-oesophageal reflux disease [GORD], malnutrition, oral and dental health problems)
    • social dynamics affecting oral intake (eg availability of assistance, access to food, mealtime environment)
    • the person’s quality of life or wellbeing in relation to dysphagia or dysphagia interventions (eg texture-modified foods).

Refer people with developmental disability with suspected swallowing difficulty to a speech pathologist for clinical assessment, and involve the person with developmental disability in decision making about their mealtime management (see Person-centred framework for assessing and managing dysphagia). Speech pathologists will assess the process of swallowing, symptoms of dysphagia and, if required, recommend additional investigations. A speech pathologist may also identify whether the person needs any communication supports, and assist the person with communication about swallowing and mealtimes (eg symptoms, choices of food); see also Establishing successful communication with people with developmental disability).

As well as a speech pathologist, further assessment by a range of allied health professionals and medical specialists may be required. Consider referral to a:

  • dietitian (eg for malnourishment, cachexia)—see also Underweight people with developmental disability
  • occupational therapist (eg for mealtime independence and equipment supports, seating and positioning)
  • physiotherapist (eg for respiratory health, seating and positioning)
  • pharmacist (eg if the person is on multiple drugs that may cause or exacerbate dysphagia, requires alternative formulation of regular medications)
  • dentist and dental hygienist (eg if oral hygiene is poor it may contribute to recurrent respiratory infection)
  • medical specialist (eg if there are chronic infective episodes or complex comorbidities)—respiratory physician, gastroenterologist, general or rehabilitation physician.