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Year 4 - OPIC > 9. Learning Disabilities > Flashcards

9. Learning Disabilities Flashcards

1
Q

Define intellectual disability.

A
  • significant impairment of intelligence (IQ ≤ 70)
  • significant impairment of ADLs
  • both impairments evidence before adulthood*

*Note if these impairments develop in adulthood, the correct term is acquired brain injury.

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2
Q

What is adaptive functioning?

A

A persons ability to manage activities of daily living.

Significant impairment in this area suggests LD pts need considerable support in navigating ADLs.

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3
Q

What is a learning difficulty?

A

A person who experiences isolated problems with specific skills only (e.g. reading, writing, numeracy).

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4
Q

What is Fragile X syndrome?

A

A genetic condition that causes a range of developmental problems, including learning disabilities and cognitive impairments.

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5
Q

Why are males more severely affected by Fragile X syndrome, than females?

A

X-linked dominant disease.

Since males only have one X chromosome, it’s phenotypic expression is more apparent than in females with two X chromosomes.

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6
Q

Give some pre-natal causes of learning disability.

A
  • Down syndrome
  • Fragile X syndrome
  • Spinal bifda
  • malnutrition
  • alcohol
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7
Q

What is the most frequently known cause of LD?

A

Down syndrome

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8
Q

What is the aetiology of Down syndrome?

A

Trisomy 21 - it is a genetic condition but cases are sporadic, not inherent.

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9
Q

Presentation of Down syndrome.

A

Physical signs (see image)

Cognitive signs:
- learning disability
- gross and fine motor skills affected
- depression

Behavioural symptoms of Down syndrome:
- stubbornness
- difficulty paying attention
- obsessive or compulsive behaviours

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10
Q

Give some perinatal causes of LD.

A
  • intrauterine infections (e.g. toxoplasmosis)
  • asphyxia
  • premature birth
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11
Q

Give some postnatal causes of LD.

A
  • epilepsy
  • meningitis
  • measles
  • head injury
  • malnutrition
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12
Q

What are the IQ ranges for

a) mild LD

b) moderate LD

c) severe LD

A

a) IQ ≤70

b) IQ ≤49

c) IQ ≤34

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13
Q

What are the features of borderline LD (IQ ≤85)?

A
  • living independently
  • subtle communication difficulties
  • high school drop out / in special education
  • difficulty keeping a job
  • risk of abusive relationships
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14
Q

What are the features of mild LD (IQ ≤70)?

A
  • relative independence in self-care and ADLs
  • can hold conversation and engage in clinical interview
  • abstract concepts (e.g. time) are difficult
  • requires service support
  • may engage in paid employment
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15
Q

What are the features of moderate LD (IQ ≤49)

A
  • basic communication skills
  • requires supervision with self-care
  • living in supported accommodation
  • engage in structures day programmes
  • community access with staff
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16
Q

What are the features of severe LD (IQ≤34)?

A
  • limited communication
  • motor impairment
  • needs supervision in ADLs
  • living in 24-hour staffed home
17
Q

What LD is not

A
  • specific learning difficulty (e.g. dyslexia, dyspraxia)
  • emotional or behavioural problems
  • ADHD or ASD
  • acquired brain injury
18
Q

What are the physical associations of LD?

A
  • epilepsy
  • hypothyroidism
  • obesity
  • sensory impairments
  • recurrent respiratory tract and ear infection
19
Q

What are the psychiatric associations of LD?

A
  • dementia
  • depression
  • hyperactivity
  • OCD
  • ASD
20
Q

Issues with communication in people with LD:

A
  • mask comprehension difficulties
  • difficulty understanding medical terms
  • will say ‘yes’ to appease
  • suggestible
  • sensory issues
21
Q

Issues with expression in people with LD:

A
  • content of conversation can be superficial
  • articulation may be difficult
  • may speak too slowly or loudly
22
Q

What are some factors that can affect communication in LD?

A

Sensory function:
- hearing impairment
- visual impairment

Cognitive function:
- attention difficulties
- retention difficulties

Environment:
- too many people in room
- temperature
- lighting
- sound

23
Q

What is a communication passport?

A

Allows patients with LD and their carers to agree and record all the ways a person communicates, and the best ways you can communicate with the person.

https://www.leicestershospitals.nhs.uk/aboutus/our-hospitals/childrens-hospital/children-and-young-people-with-autism/patientpassport/

24
Q

Tips for effective consultations for patients with LD.

A
  • minimise waiting time
  • double consultation time
  • explain basics
  • speak to patient before speaking to carer
  • offer breaks
25
Q

What are independent mental capacity advocates?

A

Independent persons appointed to represent the interests of people who lack capacity, and have no-one else to speak other than paid carers.

Must be involved for decisions about serious medical treatment.

26
Q

What is the prevalence of ASD?

A

1%

27
Q

What is the triad of impairments in ASD?

A
  1. Social spectrum (passive, overformal, sociable with one person)
  2. Restricted activities / Imagination spectrum (handles objects for sensations, repetitive movement, special skills)
  3. Communication spectrum
28
Q

Define challenging behaviour.

A

Culturally abnormal behaviour of intensity, frequency or duration that the physical safety of the person or others is placed in jeopardy.

29
Q

What kind of behaviour might be considered challenging?

A
  • aggressive behaviour
  • self-injury
  • destructive behaviour
  • inappropriate sexual behaviour
30
Q

What is NICE guidance on use of antipsychotics to manage challenging behaviour?

A

Other interventions should be tried first - only specialists should initiate antipsychotics.

Monitor response and adverse effects.

31
Q

What are the four key principles of improving the health of people with LD?

A
  • inclusion
  • choice
  • independence
  • rights
32
Q

What is diagnostic overshadowing?

A

When a HCP makes assumptions that the behaviour of a person with LDs is part of their disability, without exploring other factors such as biological determinants.

33
Q

What are some reasonable adjustments for consultations with LD patients?

A
  • double consultation time
  • talk to informants
  • reduce stress*

See at home if appropriate; avoid long waits; see at quiet time; seek help for difficult communication.

Year 4 - OPIC (11 decks)

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