Intellectual Disability

Question 1

What is the ICD-10 classification for intellectual disability?

Answer 1

A condition of arrested development of the mind characterised by:
-> significant impairment of adaptive skills for understanding/ learning new skills
-> coping independent impairments of skills that occur during the developmental period
-> an onset before 18 years old.

These are classified into mild, moderate and severe.

There is a high rate of co-morbidity with Autism, ADHD, Depression and Schizophrenia compared to the general population.

Question 2

What is used to assess ADL for suspected disability?

Answer 2

ABAS-3 which is used to assess adaptive skills for the diagnosis of disabilities based on 3 domains:

-> Conceptual skills for the application of knowledge: communication, reading, writing, and self-direction

-> Soical skills: leisure and maintaining relationships, obeying laws

Practical skils: Communication, self-care, work and home living, health and safety

Question 3

Which categories are excluded in intellectual disability?

Answer 3

Dyslexia
Adult brain injury
Early onset dementia
Autism
Cognitive and ADL impairment
Below average IQ

Question 4

What is the classification of mild intellectual disability?

Answer 4

IQ of 50-70
->Delay in acquiring speech but eventually gains it
->Generally able to independently self-care
->Difficulties in academic settings
-> Potentially capable of working

Question 5

What is the ICD-10 classification for moderate intellectual disability?

Answer 5

IQ of 35-49
->Delay in acquiring speech
->Few acquire numeracy and literacy
->Occasionally capable ff simple supervised work
->Majority have an organic aetiology

Question 6

What is the ICD-10 classification of severe intellectual disability?

Answer 6

IQ of 20-34
Single words with limited understanding and no literacy and numeracy skills. They require practical support and cannot live independently, associated with physical/neurological issues.
50% of patients with epilepsy

Question 7

What are the common co-morbidities with intellectual disability?

Answer 7

-> Schizophrenia is 3x more common
-> Depression
-> Epilepsy
->Visual impairment
->Hearing impairment
->Epilepsy and sudden death
->Dementia
->Cerebral palsy
->Cancer
->Coronary heart disease
Hypothyroidism

Question 8

What is the ICF definition of disability?

Answer 8

A physical or mental impairment which has an adverse effect on a person’s ability to carry out ADL, typically with an IQ of less than 70. It Interplay of Dysfunction of:
Body functions and structures
Activities
Participation in a situation

It differs from mental illness because it cannot be cured.

Question 9

How do psychiatric problems present in those with learning disabilities?

Answer 9

Dependent on the level of communication skills, which may be different compared to the general population. Symptoms tend to be simpler, with less elaboration and organic symptoms are more prominent.

It is important to gain a collateral history from family members and carers.

Question 10

What is diagnostic overshadowing?

Answer 10

Mistaken attribution of physical symptoms to intellectual disability due to challenging behaviour which may be physical pain, social disruption like bereavement and abuse or psychiatric change like depression/anxiety.

Question 11

How can adjustments be adapted for patients with intellectual disability?

Answer 11

->Longer appointment times
-> Awareness training
->Using simple everyday language, identify patient’s communicative style through aids and clarifying patient’s understanding
->Carrying out the assessment in a quiet area
->Obtaining a collateral history from family/carer
->Maintain continuity of care

Question 12

What is IQ?

Answer 12

A person’s mental age as a proportion of their biological age

Question 13

Which biological factors are involved in mental health for intellectual disability?

Answer 13

Genetic inherited disorders such as Down’s syndrome and neural tube defects
Infection during pregnancy, maternal drug and alcohol and malnutrition
Complications during birth such as respiratory distress and physical distress
Tumour

Question 14

Which social factors are involved in mental health issues of people with intellectual disability?

Answer 14

Limited opportunity for social outings
Reduced employment opportunities
Reduced access to transport
Lack of finance
Potential for financial and sexual abuse
Small circle of friends

Question 15

Which psychological factors are involved in mental health problems for people with intellectual disability?

Answer 15

->Personality style
->Separation
->Recent life events
-> Low Self esteem
-> Lack of assertiveness
-> Feeling hopeless

Question 16

What is the impact on carers for people with complex mental health needs?

Answer 16

Mental strain of managing medications, time off work, cooking and cleaning, providing medical care and attending appointment that leaves them less time to their own needs.

Risk of isolation and loneliness

Greater risk of neglect of the physical self and obesity

Those with complex health needs have greater health demands and support, that puts more strain on carers to seek out resources

Question 17

What are the strategies for behavioural problems in those with intellectual disabilities?

Answer 17

->Educational interventions for the families, carers and patients
->Social interventions to address unmet needs at one and access to facilities to provide opportunities for social interaction
->Facilitating communication needs through use of aids like pictures or speech devices
->Behaviour support plan
->Pharmacotherapy
->Cognitive approaches from counselling to relaxation
->Physical interventions as a last resort

Question 18

What are the legal ethical dilemmas for those with mental health problems?

Question 19

What are the barriers for those with sensory impairments to accessing mental health services?

Answer 19

-> Sensory overload can occur due to hard lighting, loud noises, crowded waiting rooms and strong smells

-> People with sensory impairment are at greater risk of depression and anxiety due to social isolation

->Diagnostic overshadowing

->Specialist mental health centres are essential to provide accurate assessment and treatment with psychotherapeutic interventions