Learning Disabilities Flashcards
What is a learning disability?
- State of mind or incomplete development of mind
- Somebody with general learning disability said to have significant impairment of intellectual adaptive and social functioning
Describe 4 types of learning disability
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
Describe the demographics of learning difficulties
- 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
Name 3 genetic disorders which cause learning difficulties
- Trisomy
- Deletion
- Sex Chromosome anomaly
Name an example of trisomy
Down’s Syndrome
Name an example of chromosome deletion
Cri du Chat
Name 3 sex chromosome anomalies
- Fragile X syndrome (most common cause of learning difficulties)
- Klinefelter’s Syndrome (male with extra X chromosome)
- Turner’s Syndrome (one X chromosome and partly missing X chromosome)
Describe 3 types of metabolic conditions leading to learning difficulties
- Amino acids
- Carbohydrates
- Lipids
Describe a common amino acid related metabolic disturbance which can lead to learning difficulties
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
Describe a common carbohydrate related metabolic disturbance which can lead to learning difficulties
Galactosaemia
- Inability to metabolise sugar galactose properly - Causes convulsions, irritability and failure to thrive
Describe 2 common lipid related metabolic disturbances which can lead to learning difficulties
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
Describe 3 cerebral degenerations which lead to learning difficulties
- Tuberous Sclerosis (benign tumours which grow in brain)
- Familial hydrocephalus
- Neurofibromatosis (tumours form on nerve tissue)
Name 2 drugs which can cause learning difficulties
- Phenytoin
2. Alcohol
Name 3 preinatal causes of learning difficulties
- Pre-eclampsia
- Antepartum haemorrhage
- Premature labour
Name an intrapartum cause of learning difficulties
Asphyxia
Name 2 neonatal causes of learning difficulties
- Meningitis
2. Severe neonatal jaundice
Name 4 postnatal causes of learning difficulties
- Injury
- Infection encephalitis
- Anoxia / Asphyxia / Status epilepticus
- Metabolic hypoglycaemia
Describe 4 presentations of learning difficulties
- Developmental delay (eating, speech, intellectual ability, logic)
- Regression of development
- Behaviour problems
- Unusual habits (Hyperkinesis / Pica)
Describe the diagnosis of learning disabilities
- 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
Name 3 major associated problems with learning difficulties
- Physical
- Psychological
- Behaviour
Name 4 physical difficulties associated with learning disabilities
- Motor and mobility
- Speech, hearing, visual
- Epilepsy
- Urinary and faecal incontinence
Name 5 psychological difficulties associated with learning disabilities
- Schizophrenia
- Anxiety and depression
- Early onset dementia
- Autism
- Hyperactivity and ADHD
Name 4 b behavioural difficulties associated with learning disabilities
- Threatening safety of themselves of others
- Seemingly violent but harmless behaviour
- Temper tantrums
- Criminal activities
Describe the important features of communicating with a person who has learning difficulties
- 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
Describe the management of patient’s suffering from learning disabilities
- 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
Describe how a person is determined capable of giving consent
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
Name 6 things which may impair capacity
- Alcohol
- Pain
- Anxiety
- Learning disabilities
- Dementia
- Medications / Sedation / GA
Describe the stages approach to informed consent
- 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
Describe the things to consider when making a best interests decision
- 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
Name 3 common learning disabilities
- Down’s Syndrome
- ADHD (Attention Deficit Hyperactivity Disorder)
- ASD (Autistic Spectrum Disorder)
Describe the demographics of Down’s Syndrome
- 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
Describe the clinical features of Down’s Syndrome
- Short stature
- Learning disabilities
- Typical facies with brachycephaly and widely spaced eyes
- Brushfield spots in iris
- Hands show clindoactyly
- Simian palmar creases
Give a brief overview of the associated conditions with Down’s Syndrome
- 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
Give a general overview of the oral considerations of a patient with Down’s Syndrome
- Macroglossia (circumvallate papillae enlarge)
- Poor anterior and oral seal
- Maxilla and molars are small and mandible protrusive
- Hypodontia relatively common
- Periodontal disease and xerostomia
Describe ADHD
- 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
Describe ASD
- Describes range of conditions characterized by social deficits, communication difficulties and repetitive behaviours
- Affects approximately 1:100 people
Describe the triad of lifelong developmental disorder which characterizes ASD
Social Interaction - Difficulty with social relationships
Social Communication - Struggle with verbal and non-verbal
Imagination - Lack of pretend play and limited imagination
Describe Asperger’s Sydrome
- Higher IQ
- Language intact
- Poor social skills / lack of empathy
- Indistinguishable from high functioning autism
Describe autism
- 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
Describe dental treatment for a person suffering from ASD
- Review medical history before appointment
- Consult physicians, family and carers
- Consent central concern due to communication and mental capabilities
- Often restricted diet
Describe how an appointment for a patient with autism can be made easier
- 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
