Arrested intellectual development

Question 1

Define learning disability

Answer 1

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

Question 2

What is the criteria for having a learning disability?

Answer 2

IQ<70
Developmental aetiology <18 years
Deficits in adaptive functioning

Question 3

How would you assess someone with a suspected learning disability?

Answer 3

Pyschometric assessment- most commonly Weslers adult intelligence scale

Question 4

How would you diagnose a suspected learning disability?

Answer 4

Diagnosis is clinical.

Question 5

How could you tell if someone has a learning disability?

Answer 5

Could be immediately apparent (e.g. dysmorphic features)
Information from the person themselves or carers
History of special schooling
Behaviour, communication skills.

Question 6

IQ of someone with mild learning disability?

Answer 6

50-69

Question 7

IQ of someone with moderate learning disability?

Answer 7

35-49

Question 8

IQ of someone with severe learning disability?

Answer 8

20-34

Question 9

IQ of someone with profound learning disability?

Answer 9

<20

Question 10

Borderline learning disability IQ

Answer 10

70+

Question 11

Borderline learning disability mental age

Answer 11

12- under 15

Question 12

Mild leanring disability mental age

Answer 12

9-12

Question 13

Moderate learning disability mental age

Answer 13

6- under 9

Question 14

Describe the presentation of mild learning disability

Answer 14

Delayed speech. Full independence.
Difficulty in reading and writing
Able to perform non-skilled and semi-skilled tasks.
Problems with social and emotional maturity.

Question 15

Describe the presentation of moderate learning disability

Answer 15

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

Question 16

Describe the presentation of severe learning disability

Answer 16

Generally more marked impairment than moderate LD. Achievements more restricted
Epilepsy

Question 17

Describe the presentation of profound learning disability?

Answer 17

Severe inability to comply with requests or instructions
Little to no self care
Often severe mobility restriction
Basic or simple tasks may be acquired

Question 18

What mental age is someone with severe learning disability said to have?

Answer 18

3-<6

Question 19

What mental age is someone with profound learning disability likely to have?

Answer 19

<3

Question 20

What chromosomal abnormality occurs in down syndrome?

Answer 20

Trisomy 21

Question 21

Does Down syndrome cause learning disability?

What other disease is down syndrome associated with?

Answer 21

It causes a low IQ of 30-35 so yes.

Alzheimers dementia.

Question 22

What chromosomal abnormality occurs with Patau syndrome?

Answer 22

Trisomy 13

Question 23

What chromosomal abnormality occurs with Edward syndrome?

Answer 23

Trisomy 18.

Question 24

How does Prader Willi syndrome present?

Answer 24

Over-eating
Self-injurious behaviour
Learning disability

Question 25

Do people with velo-cardiofacial syndrome 22Q have a learning disability? What other disease are they at risk of?

Answer 25

50% of them do

Increased risk of schizophrenia.

Question 26

How does angel man 15Q present?

Answer 26

Learning disability
Ataxia
Paroxysms of laughter

Question 27

What abnormalities in sex chromosomes cause learning disabilities?

Answer 27

Turners syndrome- LD is rare
Trisomy X
Klinefelter
XYY male- IQ may be slightly lower 
Fragile X

Question 28

What prenatal factors can cause learning disability?

Answer 28

Maternal infection- rubella, CMV, toxoplasmosis
Exposure to medication/drugs
Alcohol
Poor diet
Substance abuse

Question 29

What perinatal factors can cause learning disability?

Answer 29

Neonatal septicaemia
Pneumonia
Meningitis/encephalitis
Birth injury
Newborn complications (respiratory distress, hyperbilirubinaemia, hypoglycaemia)

Question 30

What postnatal factors can cause learning disability?

Answer 30

CNS infections, vascular accidents, hypoxic brain injury etc etc.
Congenital hypothyroidism

Question 31

What three aspects of learning disability impede these people?

Answer 31

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.

Question 32

Why are psychiatric illnesses more common in those with learning disabilities?

Answer 32

The organic issue itself (e.g. brain damage) makes them vulnerable
Social deprivation/disadvantage
Life events
Psychological reasons e.g. learned helplessness

Question 33

How should you approach a psychiatric assessment in LD?

NOTE.

Answer 33

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

Question 34

NOTE

Answer 34

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.

Question 35

What things can cause behavioural change in someone with a learning disability- outline physical, environmental and mental?

Answer 35

Physical- pain, epilepsy, constipation
Environmental- abuse, deaths/loss, changes
Mental- depression, psychosis.

Question 36

When would you give a patient with a learning disability anti-psychotics?

Answer 36

In psychosis
Behavioural disturbance
Autism
ADHD

Question 37

When would you give a patient with a learning disability anti-depressants?

Answer 37

Depression
Anxiety disorders
Self injury
Autism

Question 38

When would you give a patient with a learning disability anti-convulsants?

Answer 38

Bipolar affective disorder

Episodic dyscontrol

Question 39

Schizophrenia is twice as common in people with learning disability. T or F?

Answer 39

False- its three times more common.

Question 40

The age of onset of schizophrenia in someone with a learning disability is earlier? T or F?

Answer 40

True- generally around 23.

Question 41

What is the main symptom of schizophrenia in someone with a learning disability?

Answer 41

Change in behaviour.

(NOTE- may also have unexplained aggression, bizarre behaviour, social withdrawal, mood lability, increased mannerisms or stereotypy)

Question 42

How would depressive disorder in someone with learning disabilities present?

Answer 42

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

Question 43

Triad of symptoms in autism?

Answer 43

Abnormal social interaction
Communication impairment
Rigid/restricted repetitive behaviour

Question 44

Treatment/support strategies for autism?

Answer 44

Communication aids and speech and language therapy
Educational and vocational interventions
Behavioural interventions- behavioural modification
Family intervention- support