Intellectual disabilities

Question 1

What is an intellectual disability according to ICD-10?

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 are the criteria for intellectual disability?

Answer 2

IQ <70
Social or adaptive dysfunction
Onset in development period

Question 3

What is mild LD?

Answer 3

IQ 50-69 or functional age 9-12

Question 4

What is moderate LD?

Answer 4

IQ 35-49 or function age 6-9

Question 5

What is severe LD?

Answer 5

IQ 20-34 or functional

age 3-6

Question 6

What is profound LD?

Answer 6

IQ <20 or functional age <3

Question 7

How might LD be inherited?

Answer 7

Fragile X
PKU
Retts syndrome
DiGeorge syndrome
Prader-Willi
Angelman syndrome
Down Syndrome

Question 8

What are some infective causes of LD?

Answer 8

Rubella

Zika virus

Question 9

What are some traumatic causes of LD?

Answer 9

Hypoxic injury during birth
Head injury in childhood
Foetal alcohol syndrome

Question 10

How does epilepsy affect LD?

Answer 10

Increased incidence and complexity with severity of learning disability (10-50%)

Question 11

Are LD more prevalent with sensory impairments?

Answer 11

Yes
Hearing (40%)
Vision 20%

Question 12

What are some GI disorders associated with LD?

Answer 12

Swallowing problems
Reflux oesophagitis
H Pylori
Constipation

Question 13

Are there any resp problems associated with LD?

Answer 13

Chest infections

Aspiration pneumonia

Question 14

Is cerebral palsy associated with LD?

Answer 14

Yes

Question 15

Does LD affect psychiatric disorder incidence?

Answer 15

Higher incidence of psychiatric disorders in those with LD

Presentation of mental illness different especially in moderate-profound LD

Question 16

How does LD affect presentation for psychiatric disorders?

Answer 16

Those with lower IQ/ communication difficulties often present with ‘challenging behaviour’
It’s all about baseline
Where there is less verbal communication, observable signs are relied on more in making the diagnosis

Question 17

What kind of observable signs may be relied on for psych diagnoses in LD patients?

Answer 17

Weight loss
Withdrawal
Agitation
Tearfulness in depression
Behavioural disturbance in psychotic disorder

Question 18

How might presentation of anxiety disorders be different in LD?

Answer 18

Ritualistic behaviour and obsessional themes significantly increased in LD

Question 19

What are some social disorders which are more prevalent in LD?

Answer 19

ADHD

Autism

Question 20

What is diagnostic overshadowing?

Answer 20

Presenting symptoms are put down to their learning disability, rather than seeking another, potentially treatable cause

Question 21

What are some effects of Asperger’s?

Answer 21

Social interaction and communication difficulties but with speech and language unaffected

Question 22

How does autism spectrum disorder present?

Answer 22

Delay in speech and language/social skills
Repetitive/obsessive behaviour
Poor eye contact
Rigidity of thought
Lack of imagination

Question 23

How does ADHD present?

Answer 23

Hyperactivity
Impulsive tendencies
Poor attention span

Question 24

How is ADHD treated?

Answer 24

Methylphenidate (ritalin)

CBT

Question 25

What is the diagnostic triad for autism?

Answer 25

Communication impairment
Impairment of social relationship
Ritualistic behaviour