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)
2
Q
What is adaptive functioning?
A
- Practical skills - ADLs (eg dressing/bathing)
- Social skills
- Conceptual functioning - learning, memory, reading/writing
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
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
5
Q
Moderate LD
A
- More impaired communication than moderate
- Can usually do ADLs
6
Q
Severe
A
- Few words/short sentences
- Need help with most ADLs
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
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
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
10
Q
Autistic spectrum disorder features
A
- Deficits in social interaction, communication and behaviour
- Restrictive/repetitive behaviours
- Sensory problems
- Lack empathy
- Cognitive rigidity
11
Q
Features of social problems in autism
A
- Struggles with social cues
- Understanding,
- Empathy
- Can be non-verbal/limited language
12
Q
Management of autism
A
- MDT - SALT, OT, physio
- Biopsychosocial approach - treat co-morbidities
- Early intervention important
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)
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
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?
16
Q
Management of challenging behaviour
A
- Positive behaviour support
- 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
Work with hospitals and GP’s to ensure people with LD can access health services
25
Intensive support team for those with LD
* Specialist team
* Work alongside community team
* Behaviour therapists, psychologists
* Work 7 days a week - when people become unsettled/challenging
26
Medication management tools for those with LD
* STOMP - stopping overmedication in people with LD - all psychotropic
* STAMP - Supporting Treatment and Appropriate Medication in Paediatrics
27
Physical health problem management for those with LD
* GP
* LD register - annual health check, bloods
* Health screening
28
Mortality in those with LD management
* Investigating premature death - LeDer - mortality reviews
* Ensure DNACPR is not used inappropriately
29
Preventing admissions to hopsital for those with LD
* Care and treatment review (CTR) - ensure all healthcare professionals agree admission is needed
* Keep near home if needing admission if possible
30
Assessment of someone with LD presenting with problem
* 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
Management of someone with LD
* Biopsychosocial management
* Positive behaviour support
