Learning Disabilities Flashcards
What is a learning disability?
Impairment in CNS developing in the early period, presenting in childhood with reduced intellectual preformance and ability to acquire life skills.
What are the levels of intellectual disability?
o ICD 10 used to classify levels of learning disability: IQ score
o Mild: 50-70
o Moderate – 35-50
o Severe – 20-35
o Profound<20
What is the aetiology of mild disorder?
Mild à Low range of low IQ, Associated with lower SE, Strong correlation with sibling IQ and 1st degree relative à Gene environment interaction
What is the aetiology of moderate disorder?
Severe à No correlation with SES or sibling IQ , Due to brain issue . Often associated with ASD – social, communication and repetitive rhythms. High % of epilepsy, sensory or motor deficits coexisting
What are the genetic causes of learning disabilites?
Chromosomal (Downs), Mendelian AD (NF, TS) or AR (PKU) , Sex linked (fragX), other PWS, velocardiofacial syndrome
What are the structural development causes of learning disabilities?
Hydrocephalus
What are the brain damage causes of learning disabilities?
o Antenatal: infection, toxic, hypoxic, maternal disease
o Natal: birth asphyxia, intracranial bleed
o Postnatal: Infection, injury, eplepsy, hypothyroid.
What conditions are co-morbid for learning disabilities?
Common comorbid conditions: autism, epilepsy, cerebral palsy, hearing impairment, visual impairment, psychiatric disorder, physical disability.
What is the epidemiology of LD?
2% population - Mild 80%, moderate 12%, severe 8%.
What is in the History and exam of LD?
PC:
· Delat in usual developmental milestones
· Difficulty managing school work as well as other children
· Behavioral problems
· Adolescent: difficulties with peers, inappropriate sex behavior, difficulty transitioning to adulthood.
· Adult: every day functioning difficulties, require extra support, problem with social development.
Assessment: obtainc ollateral hx from parent on milestones, enquire abput pregnancy and birth problems (full paeds hx), FHx of LD, assess functional life skill and neuropsychological functioning. Screen for comorbid psychiatric or medical disease.
What investigations do you do for LD?
FBC, UE, TFT, LFT, Glucose, infecton, serology. EEG ? Neuroimaging?Keryotype
What is the management of LD?
MDT approach: psych, OT, PT, SALT, nurse, educational support.
Treat comorbidities as separate medical and psychiatric problems to improve overall functioning and learning. Give information on support groupsBehavrioral treatments to teach certain skills. Medication not certified to be efficacious (low dose antipsychotics)
What are the complications and prognosis of LD?
Higher prevalence of psychiatric comorbidities, Difficulty to diagnose due to language difficulties and atypical presentation
What is Downs?
· Features: small head, round face, single palmar crease, hypotonia, cardiac and GI issues, deafness, AD, leukemia risk, low set ears, upslantic eyes
· Genetics: 1/600 births, commonest single cause mental retardation (33%)
· IQ 30-70
What is fragile X?
· Physical features: prominent ears, facial hypoplasia and progmathism, macroorchidism in adolescence, CT issues (Joint lax/flat feet/MV prolapse)
· Epilepsy in 23% in adolescence
· Genetics: 1/4000 males, partial (200- rpt) 1/8000 females. Deficiency in FMR1
· Expansion of CGG trinucleotide repeats on X ch. Normal 5-20, FX has 200+.
· Learning difficulties
o IQ boys
