Intellectual Disability Flashcards
what conditions do PWLD have higher risk of getting
epilepsy mental illness dementia hypothyroidism diabetes heart failure CKD stroke
define learning disability
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 diagnosis of a learning disability
IG < 70
must present <18 (developmental aetiology)
deficits in adaptive functioning
what is used for psychometric assessment
Wechsler Adult Intelligence Scale (WAIS)
In children depending on age (WISC)
WPPSI for primary and preschool children
what percent of population have an IQ < 70
3%
what is the average IQ
100
what is the difference between learning difficulties and disabilities
disability= affects overall IQ, affects all aspects of life ans caring for you self
difficulty= a specific problem e.g. dyslexia, dyscalculia, dyspraxia
what is the flynn effect
each generation smarter than the one before- slowing down in developed countries
what is not a learning disability
dyslexia/ other learning difficulties
not something that happens to an adult (brain injury/ dementia)
cognitive decline due to chronic psychosis
what are the IQ parameters for severities of LD
Mild LD IQ 50-69
Moderate LD IQ 35-49
Severe LD IQ 20-34
Profound LD IQ < 20
Borderline LD IQ 70+
what is the presentation of borderline LDs
IQ range 70-84, mental age 12 to under 15 years.
Not a category in DC-LD, ICD-10 or DSM-IV.
Usually able to read
what is the presentation of mild LDs
IQ range 50-69, mental age 9 to under 12 years.
Most Common
Delayed speech - able to use everyday speech
Full independence – Self care, practical & domestic skills
Difficulties in Reading and Writing
Capable of unskilled or semi-skilled work
Problems if Social or Emotional Immaturity
Rarely organic aetiology
what is the presentation of a moderate LD
I.Q. range 35-49, mental age 6 to under 9 years.
Slow with Comprehension and Language
Limited Achievements
Delayed Self care and Motor Skills
Simple Practical Tasks - Often with Supervision
Usually Fully Mobile - Physically Active
Discrepant profiles
Majority Organic Aetiology
Epilepsy & Physical Disability common
what is the presentation of a severe LD
IQ range 20-34, mental age 3 to under 6 years.
Generally more marked impairment than in moderate LD and achievements more restricted.
Epilepsy
what is the presentation of a profound LD
IQ less than 20 (difficult to measure), mental age less than 3 years.
Severe limitation in ability to understand or comply with requests or instructions.
Little or no self-care.
Often severe mobility restriction.
Basic or simple tasks may be acquired.
give three examples of trisomy conditions that can cause LDs
downs- 21
patau syndrome- 13
edwards syndrome- 18
what are the features of cri du chat 5p
microcephlay severe/profound LD
what are the features of angleman 15Q
(maternally derived) LD, ataxia, paroxysms of laughter
what are the features of prader willi 15Q
(paternally derived) LD, over eating, self injurious behaviour
what are the features of velo-cardiofacial syndrome 22Q
50% have LD, increased risk of schizophrenia
what genetic abnormalities arising from the sex chromosomes can cause LDs
tuners 45, XO trisomy X, 47 XXX klinefelter, XXY XYY male (IQ lower than normal) fragile X, FMR1 gene, trisomy repeat
what defects of protein, carbohydrate, lipid metabolism can cause severe LD
Tuberous Sclerosis
Congenital Hypothyroidism
Lesch Nyhan Syndrome (X Linked)
what are the prenatal causes of a LD
Maternal Infection-Rubella, CMV, Toxoplasmosis
Exposure to medication or drugs
alcohol (Foetal alcohol spectrum disorder – mild LD, association with ADHD )
Poor Diet, Substance abuse
what are the perinatal causes of LDs
Neonatal septicaemia
Pneumonia
Meningitis/encephalitis
Other problems at delivery – birth injury
Other newborn complications (respiratory distress, hyperbilirubinaemia, hypoglycaemia, extreme prematurity)
what are the post natal causes of LDs
CNS infections, vascular accidents, tumours, hypoxic brain injury, head injury, NAI, exposure to toxic agents, psychosocial environment
Congenital hypothyroidism – now screened for neonatally, if untreated leads to mental and growth retardation.
Other disorders of unknown aetiology
Cerebral palsies, epilepsy, autistic spectrum disorders, childhood disintegrative disorders.
what are the infant. childhood causes of LDs
NAI, trauma, infections, toxins
what are the different terms for a learning disability
Mental Retardation - ICD10/DSMIV
Mental Handicap - Legislation
Intellectual Disability
Intellectual Developmental Disorder DSMV/ICD11
what are the obrien principles
Learning disabled people will continue to grow and develop given an appropriate environment
Learning disabled people are worthy of all the dignity and rights of any citizen
Concept of learning through risk taking and the avoidance of over-protection
The availability of everyday, normal conditions of life
The availability of generic environments and services
what are the social impacts of LDs
discrimination family dysfunction sexual abuse different appearance poor employment stigma poor educational provisions autistic spectrum disorder
what are the physical implications of LDs
physical disability
sensory problems
mobility problems
what are the associated health problems with LDs
mental illness
epilepsy
substance misuse
physical illness
what puts someone at risk of a LD
Organic vulnerability – ‘brain damage’
Social deprivation/disadvantage
Life events
Psychological reasons – learned helplessness
why are other conditions underdiagnosed in people with LDs
Intellect
trouble labelling emotions and experiences
Diagnostic overshadowing-
Symptoms attributed to LD
Compliance
“Talked out of” symptoms
Eager to please
how do you assess LDs
Nature and severity of LD Current problem, Hx of Predisposing, precipitating and perpetuating factors Full History – Family Hx Full physical exam Mental state exam Environmental and social factors Support network Reliance on informants
what is the management for LDs
Therapeutic environment General support (eg school), Specific support (eg psychiatric problems) Education Patient, Carers Social Unmet needs, Support network Communication Hearing aids, glasses, Pictorial, Makaton Behavioural Cognitive Pharmacological Physical interventions Headgear Isolation Admission Respite Specialist unit
what are the possible psychological therapies for LDs
behavioural (basic skills, normal patterns, relaxation, assertiveness training) CBT (problem sloving, anxiety, depression, offending behaviour) psychodynamic therapy (relationships, adjustments)
what are the possible pharmalogical treatments for LDs
Antipsychotics Psychosis Behavioural disturbance Autism ADHD
Antidepressants Depression Anxiety disorders Self injury Autism
Anticonvulsants
Bipolar affective disorder
Episodic dyscontrol
how might schizophrenia present in LDs
3 times more common
Age of onset earlier (mean 23)
Negative symptoms more common
Main presenting symptom may be behaviour change
Severe LD
Unexplained aggression, bizarre behaviour, social withdrawal, mood lability, increased mannerisms or stereotypies
Significant proportion undiagnosed
how might depression present in LDs
Three times as common
Somatisation ++
Reduced verbal expression of unhappiness, guilt…
Biological symptoms – sleep, appetite, energy, concentration, anhedonia
what are the cautions of pharmacological treatments in LDs
Comorbid physical disorders Epilepsy Constipation Atypical responses Decreased or increased sensitivity Paradoxical reactions Evidence base often lacking
what is the triad of symptoms of ASD
Abnormal social interaction
Communication impairment
Rigid/restricted or repetitive behaviour, interests and activities
is ASD a learning disability
no develomental disorder
what is the management for ASD
STRUCTURE, ROUTINE, PREDICTABILITY, COMMUNICATION
Communication aids and Speech and Language Therapy Picture boards, Social stories Educational and vocational interventions Mainstream vs specialist Behavioural interventions Behaviour modification, Social skills training Family intervention Education, Support, Advocacy
