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OPIC > LD Teaching > Flashcards

LD Teaching Flashcards

1
Q

What is learning disability? (3 criteria)

A
  • Intellectual disability - impairment of intelligence (IQ less than 70)
  • AND impairment of adaptive functioning
  • Must begin within developmental period of life (before 18)
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2
Q

What is adaptive functioning?

A
  • Practical skills - ADLs (eg dressing/bathing)
  • Social skills
  • Conceptual functioning - learning, memory, reading/writing
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3
Q

IQ LD levels

A
  • Mild - 50-69 - MOST
  • Moderate - 35-50 (10%)
  • Severe 20-35 (4%)
  • Profound - under 20 (1%)

More severe = reduced level of functioning

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4
Q

Mild LD

A
  • Relatively independent
  • Struggle under stress, find it difficult to cope
  • May be working in paid job
  • Support with more complex things eg finances
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5
Q

Moderate LD

A
  • More impaired communication than moderate
  • Can usually do ADLs
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6
Q

Severe

A
  • Few words/short sentences
  • Need help with most ADLs
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7
Q

Important genetic syndrome which can cause LD

A
  • Down syndrome - most common, can cause early onset dementia
  • Fragile X - self conscious, self harm sometimes, socially anxious
  • Prader-Willi - deletion Chr15 from father, always hungry, mild-mod LD
  • Angelman syndrome - PW but if deleted from mother, severe LD, problems with speech
  • Cornellia de lange - self harming, autism
  • Tuberous sclerosis - multiple benign tumours in lots of organs
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8
Q

Mental health problems associated with LD

A
  • Mental illness - depression, anxiety, OCD, bipolar, adjustment disorder, psychotic (eg schizophrenia), anorexia nervosa
  • Neuro-developmental disorders - autism spectum disorder, ADHD
  • Neuro-cognitive disorders - dementia
  • Behaviour problems
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9
Q

What is adjustment disorder?

A
  • Emotional/behavioural reaction to stressful event/change in life
  • May cause symptoms of depression/anxiety
  • Finds difficult to cope
  • Last around 6/12
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10
Q

Autistic spectrum disorder features

A
  • Deficits in social interaction, communication and behaviour
  • Restrictive/repetitive behaviours
  • Sensory problems
  • Lack empathy
  • Cognitive rigidity
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11
Q

Features of social problems in autism

A
  • Struggles with social cues
  • Understanding,
  • Empathy
  • Can be non-verbal/limited language
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12
Q

Management of autism

A
  • MDT - SALT, OT, physio
  • Biopsychosocial approach - treat co-morbidities
  • Early intervention important
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13
Q

Dementia in LD

A
  • Common
  • Begins at earlier age
  • Diagnostic challenge - may not present with ‘memory problems’
  • Screen for with DLD (dementia questionaire in LD) and DSDS (dementia screen for down syndrome)
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14
Q

Examples of challenging behaviour seen in LD

A
  • Putting themselves in danger/at risk
  • Putting others in danger/at risk
  • Aggression
  • Self harm
  • Environmental damage - walls/windows
  • Inappropriate sexual behaviour

Can result in banning from school/day centre, 15% of those with LD have

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15
Q

Underlying cause of challenging behaviour

A

Biopsychosocial model

Biological
* Pain - constipation, injury, dental infection

Psychological
* Depression
* Anxiety
* Hypomanic/manic episode
* ADHD

Social
* Environment - new? busy?
* Bullying?

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16
Q

Management of challenging behaviour

A
  • Positive behaviour management
  • Last line - medication
17
Q

Physical health problems in those with LD

A
  • Epilepsy
  • GI - GORD, H-pylori, cancers
  • CVS - congenital heart diseases eg atrial septal defect
  • Endocrine - hypothyroidism, GH
  • MSK - osteoporosis
  • Weight problems - obesity and underweight
  • Visual/hearing impairment
18
Q

Why is there increased mortality in those with LD?

A
  • Attitudes from medical professionals - difficult to communicate, lack knowledge and confidence
  • Prejudice - believe symptoms are due to LD and not invetsigate underlying cause
  • Mental capacity act and best interests decisions
  • Barriers to accessing healthcare
19
Q

What is reasonable adjustment?

A
  • Patients with LD are legally entitled to this
  • E.g providing information in different formats, extended consultation times, timing of appt (end/start of day)
20
Q

What is diagnostic overshadowing?

A
  • Suspect that symptoms are caused by another already known disease (eg LD) and missing a new underlying cause
  • Can lead to premature death
21
Q

What medications are used to manage LD?

A
  • Same medications used in general populations for the underlying diagnoses eg SSRI for depression etc
  • BUT start low and go slow, (titrate carefully)
22
Q

Services for people with LD

A
  • Community LD team
  • GP/primary care
  • Secondary care specialist services
  • Social services
  • Voluntary services
  • Advocacy services
  • Private hospitals
23
Q

Community with LD teams

A
  • LD community nurse
  • Community therapists eg SALT
  • Psychiatrists
24
Q

What is LD liason nurse?

A
25
Q

Intensive support team for those with LD

A
  • Specialist team
  • Work alongside community team
  • Behaviour therapists, psychologists
  • Work 7 days a week - when people become unsettled/challenging
26
Q

Medication management tools for those with LD

A
  • STOMP - stopping overmedication in people with LD - all psychotropic
  • STAMP - Supporting Treatment and Appropriate Medication in Paediatrics
27
Q

Physical health problem management for those with LD

A
  • GP
  • LD register - annual health check, bloods
  • Health screening
28
Q

Mortality in those with LD management

A
  • Investigating premature death - LeDer - mortality reviews
  • Ensure DNACPR is not used inappropriately
29
Q

Preventing admissions to hopsital for those with LD

A
  • Care and treatment review (CTR) - ensure all healthcare professionals agree admission is needed
  • Keep near home if needing admission if possible
30
Q

Assessment of someone with LD presenting with problem

A
  • MSE (mental state exam)
  • Simple cognitive assessment - AMTS-10
  • Basic physical examination - eg A-E
  • Bedside - ECG, observations, urine MSU
  • Bloods - FBC, U&E, LFT, TFTs, CRP, bone profile
  • Imaging - CXR if ?infection, brain imaging if ?infection
  • Special - ABC recording (antecedent behaviour and consequence)
31
Q

Management of someone with LD

A
  • Biopsychosocial management
  • Positive behaviour support

OPIC (30 decks)

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