Learning difficulties and psychological development

Question 1

Define “learning disability”

Answer 1

condition of arrested or incomplete development of the mind, characterised by impairment of skills manifested in the developmental period

Question 2

Define “disability”

Answer 2

any restriction or lack of ability to perform an activity in the manner considered normal for a human being

Question 3

What is learning disabilities caused by?

Answer 3

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

Question 4

What are the key features of learning disabilities?

Answer 4

low intellectual performance
onset at birth or early childhood
reduced life skills

Question 5

How is learning disabilities categorised?

Answer 5

MILD - IQ range 50-69
MODERATE- IQ range 35-49
SEVERE- IQ range 20-34
PROFOUND- IQ RANGE <20

Question 6

How are mild or moderate learning disabilities presented?

Answer 6

delay in speech, deficits in language 
problems in academic setting
social immaturity 
capable of simple work 
can live independently or need supported accommodation

Question 7

What are the clinical features of severe learning difficulties?

Answer 7

low levels of achievement in social, language and visuospatial skills
marked motor problems
need supported accommodation
limited skills

Question 8

Which psychiatric disorders are associated with learning difficulties?

Answer 8

behavioural disturbances - aggression, inappropriate sexual behaviour
depression
anxiety
schizophrenia 
mania

Question 9

How are learning disabilities diagnosed?

Answer 9

antenatal genetic counselling and testing gives parents options of terminating pregnancy

early detection of hormonal and metabolic problems

Question 10

How are learning disabilities assessed?

Answer 10

intellectual impairment assessed using wechsler scale

severity assessed using ICD10

assess quality of life and experiences

Question 11

How are learning disabilities managed?

Answer 11

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

Question 12

What is fragile X syndrome?

Answer 12

X linked dominant - large sequence of triple repeats CGG at a fragile site on the X chromosome

common inherited cause of learning disability

Question 13

What are the clinical features of fragile X syndrome?

Answer 13

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

Question 14

What is Downs syndrome caused by?

Answer 14

full trisomy of chromosome 21
most common cause of learning disability
IQ<50

Question 15

What are the clinical features of downs syndrome?

Answer 15

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

Question 16

What is a “conduct disorder”?

Answer 16

repetitive and persistent pattern of anti social, aggressive or defiant behaviours that violate age appropriate norms

Question 17

What are the risk factors for a conduct disorder?

Answer 17

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

Question 18

What does ICD-10 require for a diagnosis of a conduct disorder?

Answer 18

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

Question 19

How are conduct disorders managed?

Answer 19

1. parental training/ education programmes
   8-12 sessions of group/individual therapy, helps parents understand childs behaviour
2. cognitive behavioural therapies
   targets childs aggressive behaviour and poor social interaction

Question 20

What are the clinical features of Attention Deficit Hyperactivity Disorder?

Answer 20

core symptoms present for >6 months:

1. INATTENTION - careless, easily distracted, failure to finish tasks, poor self organisation
2. HYPERACTIVITY - fidgets with hands/feet, can’t play quietly
3. IMPULSIVITY - talks excessively, blurts out answers, cannot await turn

Question 21

How is ADHD diagnosed?

Answer 21

1. interview family and child
2. observe child in >1 setting
3. collateral history from school and other parties
4. screen for comorbidity
5. rating scales include Connors rating scale and “strengths and difficulties questionnaire”

Question 22

how is ADHD managed?

Answer 22

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

Question 23

Define Autism Spectrum Disorder

Answer 23

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

Question 24

What are the clinical features of autism spectrum disorder?

Answer 24

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

Question 25

Which diagnostic tools can be used to assess autism?

Answer 25

Autism Diagnostic Interview Revised
Diagnostic Interview for Social and Communication Disorders
Developmental Dimensional and Diagnostic interview

Question 26

How is autism managed?

Answer 26

Behavioural therapy - specialist, intensive, breakdown skills and teach how to communicate

Family support

Referral for specialist assessment by SALT, educational psychology and occupational therapy

Question 27

Which medication can be used with autism?

Answer 27

risperidone = for aggression short term

Melatonin = help sleep disturbance

Question 28

Define “enuresis”

Answer 28

involuntary urination, especially by children at night

Primary = never been dry
Secondary = previously dry

Question 29

How is enuresis managed?

Answer 29

1. address excessive fluid intake or abnormal toileting
2. reward system to reinforce success
3. enuresis alarms-devices activated by moisture
4. psychoeducation

Question 30

What is Tourettes syndrome?

Answer 30

a developmental neuropsychiatric disorder characterised by multiple motor and >1 vocal tics, present for at least a year causing distress and impaired function

Question 31

What are the clinical features of Tourettes syndrome?

Answer 31

1. MOTOR TICS
facial tics (excessive blinking), vocal tics, simple or complex

2. ASSOCIATED SYMPTOMS
   coprolalia (involuntary swearing), copropraxia (involuntary rude sign), palilalia (repeating oneself), self injury behaviour

Question 32

How is Tourettes syndrome managed?

Answer 32

1. psycho education
2. behavioural therapy
3. relaxation techniques

Question 33

What is separation anxiety disorder?

Answer 33

increased and inappropriate anxiety around separation from attachment figures of home, which is developmentally abnormal and results in impaired functioning