9. Learning Disabilities Flashcards
Define intellectual disability.
- 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.
What is adaptive functioning?
A persons ability to manage activities of daily living.
Significant impairment in this area suggests LD pts need considerable support in navigating ADLs.
What is a learning difficulty?
A person who experiences isolated problems with specific skills only (e.g. reading, writing, numeracy).
What is Fragile X syndrome?
A genetic condition that causes a range of developmental problems, including learning disabilities and cognitive impairments.
Why are males more severely affected by Fragile X syndrome, than females?
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.
Give some pre-natal causes of learning disability.
- Down syndrome
- Fragile X syndrome
- Spinal bifda
- malnutrition
- alcohol
What is the most frequently known cause of LD?
Down syndrome
What is the aetiology of Down syndrome?
Trisomy 21 - it is a genetic condition but cases are sporadic, not inherent.
Presentation of Down syndrome.
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
Give some perinatal causes of LD.
- intrauterine infections (e.g. toxoplasmosis)
- asphyxia
- premature birth
Give some postnatal causes of LD.
- epilepsy
- meningitis
- measles
- head injury
- malnutrition
What are the IQ ranges for
a) mild LD
b) moderate LD
c) severe LD
a) IQ ≤70
b) IQ ≤49
c) IQ ≤34
What are the features of borderline LD (IQ ≤85)?
- living independently
- subtle communication difficulties
- high school drop out / in special education
- difficulty keeping a job
- risk of abusive relationships
What are the features of mild LD (IQ ≤70)?
- 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
What are the features of moderate LD (IQ ≤49)
- basic communication skills
- requires supervision with self-care
- living in supported accommodation
- engage in structures day programmes
- community access with staff
What are the features of severe LD (IQ≤34)?
- limited communication
- motor impairment
- needs supervision in ADLs
- living in 24-hour staffed home
What LD is not
- specific learning difficulty (e.g. dyslexia, dyspraxia)
- emotional or behavioural problems
- ADHD or ASD
- acquired brain injury
What are the physical associations of LD?
- epilepsy
- hypothyroidism
- obesity
- sensory impairments
- recurrent respiratory tract and ear infection
What are the psychiatric associations of LD?
- dementia
- depression
- hyperactivity
- OCD
- ASD
Issues with communication in people with LD:
- mask comprehension difficulties
- difficulty understanding medical terms
- will say ‘yes’ to appease
- suggestible
- sensory issues
Issues with expression in people with LD:
- content of conversation can be superficial
- articulation may be difficult
- may speak too slowly or loudly
What are some factors that can affect communication in LD?
Sensory function:
- hearing impairment
- visual impairment
Cognitive function:
- attention difficulties
- retention difficulties
Environment:
- too many people in room
- temperature
- lighting
- sound
What is a communication passport?
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/
Tips for effective consultations for patients with LD.
- minimise waiting time
- double consultation time
- explain basics
- speak to patient before speaking to carer
- offer breaks
What are independent mental capacity advocates?
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.
What is the prevalence of ASD?
1%
What is the triad of impairments in ASD?
- Social spectrum (passive, overformal, sociable with one person)
- Restricted activities / Imagination spectrum (handles objects for sensations, repetitive movement, special skills)
- Communication spectrum
Define challenging behaviour.
Culturally abnormal behaviour of intensity, frequency or duration that the physical safety of the person or others is placed in jeopardy.
What kind of behaviour might be considered challenging?
- aggressive behaviour
- self-injury
- destructive behaviour
- inappropriate sexual behaviour
What is NICE guidance on use of antipsychotics to manage challenging behaviour?
Other interventions should be tried first - only specialists should initiate antipsychotics.
Monitor response and adverse effects.
What are the four key principles of improving the health of people with LD?
- inclusion
- choice
- independence
- rights
What is diagnostic overshadowing?
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.
What are some reasonable adjustments for consultations with LD patients?
- 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.
