Arrested intellectual development Flashcards
Define learning disability
A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills, manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive language, motor and social abilities
What is the criteria for having a learning disability?
IQ<70
Developmental aetiology <18 years
Deficits in adaptive functioning
How would you assess someone with a suspected learning disability?
Pyschometric assessment- most commonly Weslers adult intelligence scale
How would you diagnose a suspected learning disability?
Diagnosis is clinical.
How could you tell if someone has a learning disability?
Could be immediately apparent (e.g. dysmorphic features)
Information from the person themselves or carers
History of special schooling
Behaviour, communication skills.
IQ of someone with mild learning disability?
50-69
IQ of someone with moderate learning disability?
35-49
IQ of someone with severe learning disability?
20-34
IQ of someone with profound learning disability?
<20
Borderline learning disability IQ
70+
Borderline learning disability mental age
12- under 15
Mild leanring disability mental age
9-12
Moderate learning disability mental age
6- under 9
Describe the presentation of mild learning disability
Delayed speech. Full independence.
Difficulty in reading and writing
Able to perform non-skilled and semi-skilled tasks.
Problems with social and emotional maturity.
Describe the presentation of moderate learning disability
Slow with comprehension and language. Limited achievements Delayed self care and motor skills Can perform simple practical tasks- often with supervision Usually fully mobile-physically active
Describe the presentation of severe learning disability
Generally more marked impairment than moderate LD. Achievements more restricted
Epilepsy
Describe the presentation of profound learning disability?
Severe inability to comply with requests or instructions
Little to no self care
Often severe mobility restriction
Basic or simple tasks may be acquired
What mental age is someone with severe learning disability said to have?
3-<6
What mental age is someone with profound learning disability likely to have?
<3
What chromosomal abnormality occurs in down syndrome?
Trisomy 21
Does Down syndrome cause learning disability?
What other disease is down syndrome associated with?
It causes a low IQ of 30-35 so yes.
Alzheimers dementia.
What chromosomal abnormality occurs with Patau syndrome?
Trisomy 13
What chromosomal abnormality occurs with Edward syndrome?
Trisomy 18.
How does Prader Willi syndrome present?
Over-eating
Self-injurious behaviour
Learning disability
Do people with velo-cardiofacial syndrome 22Q have a learning disability? What other disease are they at risk of?
50% of them do
Increased risk of schizophrenia.
How does angel man 15Q present?
Learning disability
Ataxia
Paroxysms of laughter
What abnormalities in sex chromosomes cause learning disabilities?
Turners syndrome- LD is rare Trisomy X Klinefelter XYY male- IQ may be slightly lower Fragile X
What prenatal factors can cause learning disability?
Maternal infection- rubella, CMV, toxoplasmosis Exposure to medication/drugs Alcohol Poor diet Substance abuse
What perinatal factors can cause learning disability?
Neonatal septicaemia Pneumonia Meningitis/encephalitis Birth injury Newborn complications (respiratory distress, hyperbilirubinaemia, hypoglycaemia)
What postnatal factors can cause learning disability?
CNS infections, vascular accidents, hypoxic brain injury etc etc.
Congenital hypothyroidism
What three aspects of learning disability impede these people?
The injury itself- e.g. hypoxic brain damage
The difficulty the injury causes e.g. difficulty speaking
The implication this has on the patient e.g. difficulty with employment due to lack of communication.
Why are psychiatric illnesses more common in those with learning disabilities?
The organic issue itself (e.g. brain damage) makes them vulnerable
Social deprivation/disadvantage
Life events
Psychological reasons e.g. learned helplessness
How should you approach a psychiatric assessment in LD?
NOTE.
Use open questions
Check accuracy
However level of detail may be restricted due to reduced comprehension, reduced verbal skills- this makes observing their behaviour more important
NOTE
psychotic symptoms may reflect developmental level e.g. lack in detail
Paranoid ideas may be based on reality
Some unusual behaviour may be developmentally appropriate.
What things can cause behavioural change in someone with a learning disability- outline physical, environmental and mental?
Physical- pain, epilepsy, constipation
Environmental- abuse, deaths/loss, changes
Mental- depression, psychosis.
When would you give a patient with a learning disability anti-psychotics?
In psychosis
Behavioural disturbance
Autism
ADHD
When would you give a patient with a learning disability anti-depressants?
Depression
Anxiety disorders
Self injury
Autism
When would you give a patient with a learning disability anti-convulsants?
Bipolar affective disorder
Episodic dyscontrol
Schizophrenia is twice as common in people with learning disability. T or F?
False- its three times more common.
The age of onset of schizophrenia in someone with a learning disability is earlier? T or F?
True- generally around 23.
What is the main symptom of schizophrenia in someone with a learning disability?
Change in behaviour.
(NOTE- may also have unexplained aggression, bizarre behaviour, social withdrawal, mood lability, increased mannerisms or stereotypy)
How would depressive disorder in someone with learning disabilities present?
Somatotisation- the manifesting of psychological distress by the presentation of bodily symptoms.
Reduced verbal expression of unhappiness- guilt
Biological symptoms- sleep, appetite, energy, concentration, anhedonia
Triad of symptoms in autism?
Abnormal social interaction
Communication impairment
Rigid/restricted repetitive behaviour
Treatment/support strategies for autism?
Communication aids and speech and language therapy
Educational and vocational interventions
Behavioural interventions- behavioural modification
Family intervention- support
