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Paediatrics > Learning Disabilities > Flashcards

Learning Disabilities Flashcards

1
Q

What is a learning disability?

A
  • State of mind or incomplete development of mind
  • Somebody with general learning disability said to have significant impairment of intellectual adaptive and social functioning
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2
Q

Describe 4 types of learning disability

A

Mild (IQ 50-70) - Approx 85% of cases, usually live normal lives

Moderate (IQ 35-49) - Approx 10%, use simple language but understand speech better, may require support within special residential environment

Severe (IQ 20-34) - Approx 3-4%, any can look after themselves with careful supervision

Profound (IQ <20) - Approx 1-2%, development level of one year old baby across a range of parameters and require intensive help

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3
Q

Describe the demographics of learning difficulties

A
  • 3% of UK population
  • Slightly more common in males than females
  • More common in poorer family backgrounds
  • Numbers have increased over last 35 years
  • Improved socio-economic conditions and neonatal care increasing survival
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4
Q

Name 3 genetic disorders which cause learning difficulties

A
  1. Trisomy
  2. Deletion
  3. Sex Chromosome anomaly
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5
Q

Name an example of trisomy

A

Down’s Syndrome

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6
Q

Name an example of chromosome deletion

A

Cri du Chat

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7
Q

Name 3 sex chromosome anomalies

A
  1. Fragile X syndrome (most common cause of learning difficulties)
  2. Klinefelter’s Syndrome (male with extra X chromosome)
  3. Turner’s Syndrome (one X chromosome and partly missing X chromosome)
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8
Q

Describe 3 types of metabolic conditions leading to learning difficulties

A
  1. Amino acids
  2. Carbohydrates
  3. Lipids
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9
Q

Describe a common amino acid related metabolic disturbance which can lead to learning difficulties

A

Phenylketonuria

 - Inherited autosomal recessive version of gene PAH
 - Unable to break down phenylalanine
 - High level of build up in the brain
 - Low protein diet can prevent intellectual disabilities
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10
Q

Describe a common carbohydrate related metabolic disturbance which can lead to learning difficulties

A

Galactosaemia

 - Inability to metabolise sugar galactose properly
 - Causes convulsions, irritability and failure to thrive
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11
Q

Describe 2 common lipid related metabolic disturbances which can lead to learning difficulties

A

Tay-Sachs diseases

 - Lack of vital enzyme needed to break down fatty waste in brain
 - Waste accumulates and causes brain damage

Gaucher’s Disease

 - Fatty substance sphingolipids accumulate in cells and certain organs
 - Organ and neurological damage
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12
Q

Describe 3 cerebral degenerations which lead to learning difficulties

A
  1. Tuberous Sclerosis (benign tumours which grow in brain)
  2. Familial hydrocephalus
  3. Neurofibromatosis (tumours form on nerve tissue)
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13
Q

Name 2 drugs which can cause learning difficulties

A
  1. Phenytoin

2. Alcohol

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14
Q

Name 3 preinatal causes of learning difficulties

A
  1. Pre-eclampsia
  2. Antepartum haemorrhage
  3. Premature labour
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15
Q

Name an intrapartum cause of learning difficulties

A

Asphyxia

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16
Q

Name 2 neonatal causes of learning difficulties

A
  1. Meningitis

2. Severe neonatal jaundice

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17
Q

Name 4 postnatal causes of learning difficulties

A
  1. Injury
  2. Infection encephalitis
  3. Anoxia / Asphyxia / Status epilepticus
  4. Metabolic hypoglycaemia
18
Q

Describe 4 presentations of learning difficulties

A
  1. Developmental delay (eating, speech, intellectual ability, logic)
  2. Regression of development
  3. Behaviour problems
  4. Unusual habits (Hyperkinesis / Pica)
19
Q

Describe the diagnosis of learning disabilities

A
  • Presentation depends on cause
  • Generally poor performance on tasks such as short term memory
  • Associated with syndromes
  • Consideration of family history, birth history and medical difficulties
20
Q

Name 3 major associated problems with learning difficulties

A
  1. Physical
  2. Psychological
  3. Behaviour
21
Q

Name 4 physical difficulties associated with learning disabilities

A
  1. Motor and mobility
  2. Speech, hearing, visual
  3. Epilepsy
  4. Urinary and faecal incontinence
22
Q

Name 5 psychological difficulties associated with learning disabilities

A
  1. Schizophrenia
  2. Anxiety and depression
  3. Early onset dementia
  4. Autism
  5. Hyperactivity and ADHD
23
Q

Name 4 b behavioural difficulties associated with learning disabilities

A
  1. Threatening safety of themselves of others
  2. Seemingly violent but harmless behaviour
  3. Temper tantrums
  4. Criminal activities
24
Q

Describe the important features of communicating with a person who has learning difficulties

A
  • Focus on abilities and not disabilities
  • Always greet patient before addressing accompanying person
  • Check verbal capacity of patient
  • Up to date medical history available
  • Communication aids for non verbal patients
25
Q

Describe the management of patient’s suffering from learning disabilities

A
  • Multidisciplinary support
  • Psychological support have positive effects on behaviour
  • Psychotropic drugs often used but not very significant benefits
  • Assess for physical sources of discomfort if challenging behaviour
26
Q

Describe how a person is determined capable of giving consent

A

They must comprehend and retain information material to the decision especially as to the consequences of having or not having the intervention in the decision making process

27
Q

Name 6 things which may impair capacity

A
  1. Alcohol
  2. Pain
  3. Anxiety
  4. Learning disabilities
  5. Dementia
  6. Medications / Sedation / GA
28
Q

Describe the stages approach to informed consent

A
  • Establish what is understood
  • Explain nature of conditions and outline options
  • Explain risk and benefits of treatments
  • Check what has been said is understood
  • Inviting further questions and confirming patient’s preferred option
  • Giving and obtaining confirmed and informed consent
29
Q

Describe the things to consider when making a best interests decision

A
  • Not limited to medical and should include wishes of person
  • General well being, relationships, spiritual and religious welfare
  • Involve views of close family and health and social care team
  • Decide what is best for person both now and in future
  • If no agreement is there, court may decide the outcome
30
Q

Name 3 common learning disabilities

A
  1. Down’s Syndrome
  2. ADHD (Attention Deficit Hyperactivity Disorder)
  3. ASD (Autistic Spectrum Disorder)
31
Q

Describe the demographics of Down’s Syndrome

A
  • Trisomy 21 in 95% of cases
  • Most frequent genetic cause of learning impairment (1:800)
  • Delay in cognitive ability mental retardation and physical growth
  • Average IQ of aroudn 50
32
Q

Describe the clinical features of Down’s Syndrome

A
  • Short stature
  • Learning disabilities
  • Typical facies with brachycephaly and widely spaced eyes
  • Brushfield spots in iris
  • Hands show clindoactyly
  • Simian palmar creases
33
Q

Give a brief overview of the associated conditions with Down’s Syndrome

A
  • Congenital cardiac disorders of around 50%
  • Diabetes prevalent
  • Dementia may develop
  • Psychiatric problems
  • Multiple immune defects (infections of skin, GI etc)
  • Chronic respiratory infections include TB
34
Q

Give a general overview of the oral considerations of a patient with Down’s Syndrome

A
  • Macroglossia (circumvallate papillae enlarge)
  • Poor anterior and oral seal
  • Maxilla and molars are small and mandible protrusive
  • Hypodontia relatively common
  • Periodontal disease and xerostomia
35
Q

Describe ADHD

A
  • Defined as a psychiatric and neurobehavioural disorder
  • Characterized by either significant difficulties of inattention or hyperactivity and impulsiveness (or combination)
  • Symptoms emerge before seven years of age
36
Q

Describe ASD

A
  • Describes range of conditions characterized by social deficits, communication difficulties and repetitive behaviours
  • Affects approximately 1:100 people
37
Q

Describe the triad of lifelong developmental disorder which characterizes ASD

A

Social Interaction - Difficulty with social relationships
Social Communication - Struggle with verbal and non-verbal
Imagination - Lack of pretend play and limited imagination

38
Q

Describe Asperger’s Sydrome

A
  • Higher IQ
  • Language intact
  • Poor social skills / lack of empathy
  • Indistinguishable from high functioning autism
39
Q

Describe autism

A
  • Complex developmental disability which impairs communication and social behaviour
  • May appear distant, aloof and have obsessive routines
  • Co-existing conditions
  • Poor eye contact
  • Hyper or hyposensitive to sound, touch, pain or taste
40
Q

Describe dental treatment for a person suffering from ASD

A
  • Review medical history before appointment
  • Consult physicians, family and carers
  • Consent central concern due to communication and mental capabilities
  • Often restricted diet
41
Q

Describe how an appointment for a patient with autism can be made easier

A
  • Talk with parent / carer to determine intellectual ability
  • Tell Do Show
  • Desensitization appointment
  • First appointment of session so not waiting in busy waiting area
  • Sensory overload may occur
  • Know when to refer to specialist

Paediatrics (12 decks)

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