Learning difficulties and psychological development Flashcards
Define “learning disability”
condition of arrested or incomplete development of the mind, characterised by impairment of skills manifested in the developmental period
Define “disability”
any restriction or lack of ability to perform an activity in the manner considered normal for a human being
What is learning disabilities caused by?
GENETIC
chromosomal, X linked, autosomal dominant or recessive, mitochondrial disorders
ANTENATAL
infective (rubella), hypoxic, toxins (alcohol,drugs), maternal illness (diabetes, hypothyroidism)
PERINATAL
prematurity, disease(septicaemia, pneumonia), problems at delivery
POSTNATAL
infection, head injury, epilepsy, malnutrition
What are the key features of learning disabilities?
low intellectual performance
onset at birth or early childhood
reduced life skills
How is learning disabilities categorised?
MILD - IQ range 50-69
MODERATE- IQ range 35-49
SEVERE- IQ range 20-34
PROFOUND- IQ RANGE <20
How are mild or moderate learning disabilities presented?
delay in speech, deficits in language problems in academic setting social immaturity capable of simple work can live independently or need supported accommodation
What are the clinical features of severe learning difficulties?
low levels of achievement in social, language and visuospatial skills
marked motor problems
need supported accommodation
limited skills
Which psychiatric disorders are associated with learning difficulties?
behavioural disturbances - aggression, inappropriate sexual behaviour depression anxiety schizophrenia mania
How are learning disabilities diagnosed?
antenatal genetic counselling and testing gives parents options of terminating pregnancy
early detection of hormonal and metabolic problems
How are learning disabilities assessed?
intellectual impairment assessed using wechsler scale
severity assessed using ICD10
assess quality of life and experiences
How are learning disabilities managed?
LIVING CONDITIONS AND SUPPORT
support provided in primary care for families or carers
MDT community team monitor mental health, social skills and problem skills training
admit to specialist environment if severe, physical disability, respite for family
EDUCATIONAL HELP
BEHAVIOURAL TREATMENT
behavioural therapy or CBT
What is fragile X syndrome?
X linked dominant - large sequence of triple repeats CGG at a fragile site on the X chromosome
common inherited cause of learning disability
What are the clinical features of fragile X syndrome?
facial features - large ears and head, long narrow face, macrocephaly
Joints/limbs - hyper extendable fingers, hand flapping, flat feet
Behavioural problems - poor eye contact, ADHD, abnormal speech
What is Downs syndrome caused by?
full trisomy of chromosome 21
most common cause of learning disability
IQ<50
What are the clinical features of downs syndrome?
HEAD/NECK - flat occiput, high arched palate, low set ears, small mouth, protruding tongue
GENERAL PHYSIQUE- short stature, overweight, muscular hypotonia
CARDIAC- atrial/ventricular septal defect, mitral valve disease, patent ductus arteriosus
CNS- alzheimers disease
What is a “conduct disorder”?
repetitive and persistent pattern of anti social, aggressive or defiant behaviours that violate age appropriate norms
What are the risk factors for a conduct disorder?
SOCIAL DISADVANTAGES
poverty, low socio-economic status, overcrowding, homelessness, unemployment
PARENTING PROBLEMS
substance misuse, parenteral psychiatric disorders, teenage pregnancy, violent or harsh parenting
CHILD ISSUES
low IQ, brain damage, epilepsy, attachment issues
What does ICD-10 require for a diagnosis of a conduct disorder?
ICD-10 requires >1 feature for >6 months at a marked level... aggression/ cruelty to others destruction of property theft, crime deceitfulness disobedient behaviour running away from home
How are conduct disorders managed?
- parental training/ education programmes
8-12 sessions of group/individual therapy, helps parents understand childs behaviour - cognitive behavioural therapies
targets childs aggressive behaviour and poor social interaction
What are the clinical features of Attention Deficit Hyperactivity Disorder?
core symptoms present for >6 months:
- INATTENTION - careless, easily distracted, failure to finish tasks, poor self organisation
- HYPERACTIVITY - fidgets with hands/feet, can’t play quietly
- IMPULSIVITY - talks excessively, blurts out answers, cannot await turn
How is ADHD diagnosed?
- interview family and child
- observe child in >1 setting
- collateral history from school and other parties
- screen for comorbidity
- rating scales include Connors rating scale and “strengths and difficulties questionnaire”
how is ADHD managed?
BIO
1st line = methylphenidate e.g. ritalin- immediate release for 4 hours
SE: appetite suppression, psychosis, misuse
2nd line = atomoxetine e.g. stattera
SE: liver dysfunction, abdominal SE, suicidality
PSYCHO
1st line = parent education and educational programmes
Define Autism Spectrum Disorder
group of lifelong developmental disorders characterised by their effect on social and communication skills as well as by a restricted, stereotyped, repetitive repertoire of interests and activities
What are the clinical features of autism spectrum disorder?
difficulties with social relationships - awkward interactions, little concern or awareness of others, lack of empathy
difficulties in communication - monotone voice, language formal/stilted/pedantic, few gestures and lack of eye contact, odd body language
absorbing and narrow interests - obsessive interests, routines/rituals for every day life
