Intellectual Disability Flashcards
Moderate LD
35-49 10% Language and comprehension limited Autonomy of ADLS's with supervision Simple supervised jobs
Severe LD
20-34 3-4% Marked degree of motor impairment Limited communication Elementary self care Simple tasks under supervision
Profound LD
Epidemiology of LD
Mild LD 1.5-3% Moderate to severe 0.5% Profound 0.05% M:F 3:2 More common in lower social classes
Aetiology of LD
30% have no identifiable cause Polygenic inheritance of low intelligence -> social and educational deprivation Pathological -genetic -pre natal -perinatal -environmental -neuropsychiatric -medical conditions in child hood
Down’s syndrome
Autosomal Trisomy 21 1/660 Risk increases with mothers age Small flattened skull High cheek bones Broad hands with stubby fingers Single transverse palmar arch
Prevention and detection of LD
Universal screening of new borne -phenylketonuria -hypothyroidism -CF Screening of healthy adult population Antenatal screening -Down's syndrome -> 16-18w of pregnancy, a fetoprotien, u conjugated oestriol, hCG Post natal testing of mothers -communicable diseases Compensatory education and early attempts to reduce behaviours
Help for families
Information and advice
Psychological and practical support
Thought life
Education, training and occupation for LD
Encourage mainstream education if possible
-> increase social integration and mutual understanding
May require specialist schools
Offer vocational guidance
Provide a framework for order and structure
Use physical prompts and demonstrations
Be precise and specific
Routines
Housing and social support for LD
Mild may live independent with support
Assess adl’s
Consider residential care-> many different options and levels
Day services-> colleges and leisure, work
Medical care for LD
Maintain access
Recognise communication difficulties
Make certain to understand needs
Specialist nurses
Psychiatric care for LD
3x increased risk of mental illness Poor communication Limited coping Low self esteem Autistic features Loss and grief Symptoms are modified by LD Beware of epilepsy
John bowlbys stages of bereavement
Numbness and protest
Searching for the lost figure
Disorganisation and despair
Reorganisation
Maladaptive responses to LD diagnosis in family
Shopping around for Dr Overprotection/rejection Chronic sorrow Isolation Disharmony Scapegoating Late rejection Infantilisation Over identification
Depression in LD
Is there FH? Observe behaviour-> eg psychomotor retardation Diurnal mood Agitation and anxiety Exaggerated need for sameness Poorly planned suicidal ideas
Mania in LD
Is there FH? Challenging behaviours Over activity and excitement Inappropriate sexual behaviour Lacks infectious quality Less elaborate delusions
Schizophrenia in LD
Difficulty to diagnose if iq
Epilepsy in LD
More likely in severe LD iq
Kanners autism
Most severe type Aloof Repetitive movement Little interaction with mother 49% have no speech No imaginative play Agile but clumsy at copying Temper tantrums 66% have LD
General management of LD
Allow sufficient personal space
Provide a quite location for them to withdraw to
Should not be placed with intrusive people
Separate provisions for challenging behaviours
Plan each day
Planned space for rituals
Provide activities they are capable of
Use physical activities to reduce challenging behaviours
Treat physical problems
Graded change to help decrease obsession
Reward good behaviours
Set limits to interrupt bad behaviours, use positive direction
Prognosis of LD
Life long disorder
Have normal life expectancy
Some improve with age
Better prognosis if good speech and higher iq
Mild LD
IQ 50-69 85% Subtle difficulties, often identified at a later age Academic difficulties May live independently Low skilled job
