Learning Disabilities Flashcards
What is a learning disability?
A significantly reduced ability to understand new or complex information, to learn new skills with;
- a reduced ability to cope independently and
- which started before adulthood with a lasting effect on development
IQ<70
What is a learning diffculty?
An educational term which is used to describe any difficulty that a student has with learning ie: dyslexia
What legalisation is in place for people with learning disabilities?
The equality act (2010)- the public sector equality duty/ equality delivery system
The mental capacity act 2005 (MCA)
Human rights act (1998)
What are the barriers faced by individuals with LD?
Communication Low expectation Physical access Lack of accessible information Fear of health professionals Lack of time Physical environment Poor info from carers Poor support Lack of education Lack of preparation Consent Additional needs Diagnostic overshadowing
What is a borderline intellectual functioning?
Not classified as a learning disability but still vulnerable due to cognitive status
Living independently
Subtle communication difficulties
High school ‘drop out’ or in special education
What are the risk factors for learning disabilities?
Family history Poor nutrition Severe head injuries Child abuse Pregnancy related factors Lead poisoning infections of the CNS Leukaemia can increase the risk
What is a barrier for people with learning disabilities?
Communication problems
Poor skills from healthcare professionals
Negative attitude to people with learning disabilities from healthcare professionals
How do you overcome barriers with learning disabilities?
Communication aids Reasonable adjustment- ie: a person with learning disability may be first on the list to avoid crowds and noise Collateral history Patient centred care Biopsychosocial approach
What other problems might children with learning disabilities have?
About 20% of children with learning disabilities also have attention deficit/hyperactivity disorder ADHD
They may become frustrated/lose interest in school and avoid challenges
They may have low self esteem with emotional problems- withdrawal, anxiety, depression or aggression
Dementia is more common
What is challenging behaviour?
Antisocial behaviour
Frequent
Danger to themselves or others- self harming, aggression,
What professionals support people with leaerning difficulties?
The right support from professionals – such as GPs, paediatricians (doctors who specialise in treating children), speech and language therapists, physiotherapists, educational and clinical psychologists and social care – helps people with a learning disability live as full and independent a life as possible.
What causes learning disabilities?
A learning disability happens when a person’s brain development is affected, either before they’re born, during their birth or in early childhood.
This can be caused by things such as:
the mother becoming ill in pregnancy
problems during the birth that stop enough oxygen getting to the brain
the unborn baby inheriting certain genes from its parents that make having a learning disability more likely – known as inherited learning disability
illness, such as meningitis, or injury in early childhood
Sometimes there’s no known cause for a learning disability.
What conditions are associated with having a learning disability?
Downs syndrome
Cerebral palsy
Autism
Epilepsy
What is a profound and multiple learning disability?
A profound and multiple learning disability (PMLD) is when a person has a severe learning disability and other disabilities that significantly affect their ability to communicate and be independent.
Someone with PMLD may have severe difficulties seeing, hearing, speaking, moving
They may have complex health and social care needs due to these or other conditions
What health problems are people with LD more at risk of?
Hirschsprungs
Duodenal atresia
ASD/VSD
Epilepsy
Constipation (may not be able to express this)
GORD
H pylori
Thyroid
Obesity
Osteoporosis
Osteopenia
More prone to GI cancers
Less likely to develop lung, breast
Aspiration pneumonia
Dysphagia
What is reasonable adjustments for learning disability?
A reasonable adjustment is when somebody changes how they do things to make it better for you.
People with a learning disability have a legal right for reasonable adjustments to be made so they can get the same benefits from healthcare services as everyone else.
Ask your GP if you need any reasonable adjustments, such as:
using pictures, large print or simpler words to say what’s happening
booking longer appointments
putting an appointment at the beginning or end of the day, if you find it hard to be in a busy waiting room
The reasonable adjustments you need should be written down in a health profile or health action plan that the GP or nurse can use.
What is transforming care?
One of the main government policies
Community care rather than secondary care
Good QOL
Review psychosocial meds
What are the 3 key criteria that need to be met for people to be diagnosed with learning disability?
1) low IQ (below 70
2) at least 2 limited areas of adaptive functioning exist concurrently
3) disability occurring before the age of 18 years
For a learning disability to be diagnosed, you must have two limited areas of adaptive skills, what are examples of adaptive skills?
Communication Self care Home living Social skills Community use Self direction Health and safety Functional academics Leisure Work
When will you notice a mild learning disability?
With a mild learning disability the person is relatively independent in self care and daily living skills.
They can hold a conversation and engage in the clinical interview
You may begin to notice a mild learning difficulty when it comes down to abstract concepts ie: asking a timeline of a condition, a person may struggle with
When will you notice a moderate learning disability?
These people will have basic communication skills and will speak in short sentences/phrases, you will have to adapt your communication skills likewise
Do most of their own self care but may need to be prompted
Community access with staff
Many people with Down syndrome
What is severe learning disability?
Limited communication and motor impairment
Patient will need supervision in daily activities and live in a 24 hour staffed home
What is a profound learning disability?
Requires 24 hour supervised care
Living either with family or in a group home/nursing home
Multiple medical problems
Inner world largely unavailable to others because of communication difficulty
Are ADHD and ASD learning disabilities?
No they are actually neuro developmental disorders
Most of them have normal IQs
However they are more common in learning disability
Is an acquired brain injury a learning disability?
No because it develops after the developmental period (after 18)
What is the aetiology of learning disabilities?
Unknown in the majority of cases, especially in those with mild to borderline
Most common inherited cause of LD= fragile X
Most common known genetic cause of LD= down’s syndrome
Most common cause of learning disability world wide= malnutrition
What are examples of chromosomal abnormalities which cause learning disabilities?
Autosomal abnormalities…
Down syndrome = Trisomy 21
Edwards = Trisomy 18
Pataus= Trisomy 13
Sex chromosomal abnormalities…
Fragile X syndrome
Klinefelters syndrome 47 XXY
Turners syndrome 45 XO
What are autosomal dominant disorders which cause learning disabilities?
Tuberous sclerosis
Neurofibromatosis
Sturge- weber syndrome
What are the autosomal recessive disorders which cause learning disabilities?
Disorders of protein megabolism- PKU
Disorders of carb metabolism- galactosaemia
Disorders of fat metabolism (lipidoses)
Cerebromacular degeneration
Niemann pick disease
What are examples of deletions which cause learning disabilities?
Angelmans syndrome
Williams syndrome
What are the perinatal cases of learning disabilities?
Iatrogenic- radiation, chemo, medication
TORCH group- where the mother has an infection during the first trimester T= toxoplasmosis O= others R= rubella C= cytomegalovirus H = herpes
Delivery- anoxic brain injury, prematurity
Foetal alcohol syndrome, hyperbilirubinaemia
What are the postnatal causes of learning disabilities?
Encephalitis Hypoglycaemia Hypothyroidism Thrombo embolism Lead poisoning Head injury Meningioma Low socio economical background, malnutrition, deprivation
What is the behavioural phenotype in down syndrome?
They are: humorous, good natured, sociable, affectionate and stubborn
What does down syndrome effect and what are some of the key features?
It is a multisystem disorder…
- growth failure, mental retardation
- flat back of head
- abnormal ears
- single palmer crease
- intestinal blockage
- umbilical hernia
- big toes widely spaced
- congenital 💕 disease
What are the common co morbidities of down syndrome?
Epilepsy- infantile spasms, tonic clonic seizure
Hypothyroidism
Obesity
Sensory impairements
C spine abnormalities (7-10% have atlanto axial instability)
Reccurent resp tract and ear infection
Obstructive sleep apnoea
What are the psychiatric associations of down syndrome?
Dementia Depression Hyperactivity Conduct disorder Autism
What are the problems with learning disabilities and other health problems?
There is often diagnostic overshadowing
What are the issues in communication in people with learning disability
Understanding and processing…
- can mask comprehension difficulties
- difficulty understanding medical terms
- will say yes to appease
- suggestible
- sensory issues (hearing impairement, visual, other physical)
- cognitive (attention and retention difficulties)
What should you do when communicating with people with learning disabilities?
Environmental alterations
Use simple language, check if they have understood, clarify
Phrase questions carefully in order to avoid interrogative suggestibility
Give enough time for responses
Write things down, draw picture to aid understanding
What can be done for effective consultations?
Minimise waiting time Double consultation time Make them comfortable Explain basics- who, why, how long Go to patient first but get supporting info from carer ie: timeline Can have a break Continuity of care
Why are psychiatric disorders more prevalent in people with LD?
The presentation of symptoms can be different…
- limited communication skills
- difficult to assess thought disorder and hallucinations esp in IQ <50
Increased vulnerability/stressors
- limited coping strategies
- limited choices and opportunities
- limited social networks
- limited or adverse life experiences- discrimination, victimisation, multiple moves
How do people with learning disabilities present with depression?
Change in behaviour- self harm
Loss of skills- incontinence
Withdrawal/isolating self
Not doing things they used to enjoy doing
Biological symptoms- sleep disturbance and weight change
What are the principles of treatment of psychiatric illness in people with learning disability?
Same options as general population, but…
You need to assess the capacity and best interests
You should get extra support from an MDT, community learning disability team involvement
Go low and slow with meds
What is autism?
A lifelong neuro developmental condition, the core features of which are…
1) persistent difficulties in social interaction
2) Persistent difficulties in communication
3) stereotyped behaviours
