Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 OPIC > Learning Disabilities > Flashcards

Learning Disabilities Flashcards

1
Q

What is a learning disability?

A

Learning disability is a general umbrella term encompassing a range of different conditions that affect the ability of the child to develop new skills.

Learning disabilities are heterogeneous conditions but are defined by 3 core criteria:
lower intellectual ability (usually defined as an IQ of less than 70)
significant impairment of social or adaptive functioning a
onset in childhood

Significant impairment in IQ and adaptive living with onset in childhood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the types of learning difficulty - which may co-exist with learning disability?

A

Dyslexia refers to a specific difficulty in reading, writing and spelling.

Dysgraphia refers to a specific difficulty in writing.

Dyspraxia, also known as developmental co-ordination disorder, refers to a specific type of difficulty in physical co-ordination. It is more common in boys. It presents with delayed gross and fine motor skills and a child that appears clumsy.

Auditory processing disorder refers to a specific difficulty in processing auditory information.

Non-verbal learning disability refers to a specific difficulty in processing non-verbal information, such as body language and facial expressions.

Profound and multiple learning disability refers to severe difficulties across multiple areas, often requiring help with all aspects of daily life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Within what IQ is a learning disability classified as mild?

A

50-69

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Within what IQ is a learning disability classified as moderate?

A

35 – 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Within what IQ is a learning disability classified as severe?

A

20 – 34

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Within what IQ is a learning disability classified as profound?

A

Under 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Conditions that have a strong association with learning disability?

A

Genetic disorders such as Downs syndrome

Antenatal problems, such as fetal alcohol syndrome and maternal chickenpox

Problems at birth, such as prematurity and hypoxic ischaemic encephalopathy

Problems in early childhood, such as meningitis

Autism

Epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does MDT management of learning disability involve?

A

Health visitors
Social workers
Schools (children)
Educational psychologists
Paediatricians, GPs and nurses
Occupational therapists
Speech and language therapists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What must a patient be able to demonstrate the ability to do to be considered to have capacity?

A

Understand the decision that needs to be made
Retain the information long enough to make the decision
Weight up the options and the implications of choosing each option
Communicate their decision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What factors may increase the risk of learning disability?

A

A family history of learning disability increases the risk.

Environmental factors such as abuse, neglect, psychological trauma and toxins can all increase the risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is diagnostic overshadowing?

A

Presenting complaint attributed to existing diagnosis rather than considering an additional underlying differential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is autism

A

Autism is a lifelong neurodevelopmental
condition, the core features of which are
persistent difficulties in social interaction
and communication and the presence of
stereotypic (rigid and repetitive)
behaviours, resistance to change or
restricted interests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What genetic factors make someone more prone to both learning disability and autism

A

Tuberous sclerosis
Fragile X syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is wing and Gould’s Triad

A

The Triad is made up of three areas of difficulty in autism

SOCIAL COMMUNICATION

not appreciate the social uses or pleasure of communication.
talk at people rather than to them.
expression of own emotions/feelings.
understanding the emotions/beliefs of others.
reading the meaning of gestures, facial expressions or tone of voice.

SOCIAL INTERACTION

inappropriate touching
difficulty understanding / using non verbal body language
personal space issues
unaware of different social relationships / hierarchy
struggle to initiate and maintain relationships
not understanding / reading social cues / rules

SOCIAL IMAGINATION

doesn’t understand others views / feelings/ lack of empathy
difficulties with Theory Of Mind
agitated by changes in routine
unable to generalise information
special interests / obsessive behaviour
literality
rigid thought patterns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What problems are patients with learning disabilities more likely to have?

A

Language difficulties
Sensory impairment
Epilepsy
Mobility problems
Physical ill health
Limited coping strategies
Limited social networks
Limited choices and opportunities
Limited or adverse life experiences (repeated broken relationships, hospital care, multiple moves between foster homes, bullying and harassment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Examples of reasonable adaptations for a person with learning disability?

A

Allocate more time - for communication and understanding
Talk to informants
Reduce stress - see at home if appropriate, avoid long waits
Help with communication difficulties (SLT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is challenging behaviour and how can the concept have problems?

A

Culturally abnormal behaviour of such an intensity, frequency and duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour that is likely to seriously limit the use of or result in the person being denied access to ordinary community facilities

Vague, numerous meanings, used as a diagnosis so risk of diagnostic overshadowing, encourages consideration of causes rather than reasons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What kind of behaviour migh be considered challenging behaviour?

A

Aggressive behaviour
Self injury
Stereotypic behaviour
Destructive or dangerous behaviour
Loud behaviour that makes others frightened
“Absconding” or behaviour making the individual vulnerable
Inappropriate sexual behaviour
Spitting, smearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Understanding the physical environment for a person with autism

A

Difficulties in relation to: central coherence, sensory overload (hypo or hyposentivitiy to sensory stimulants such as sound, vision, touch smell, may demonstrated sensory blocking (tune outs, humming)
Making sense of physical space
Understanding structure and routine
Understanding transitions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Examination and investigations in challenging behaviours

A

MSE
physical examination: investigating as appropriate, hearing or eye checks
Observe: environment and interaction with carers, functional analysis (ABC charts etc)
SALT, psychology, OT assesments

Consider capacity and consent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes and reasons for challenging behaviour

A

Physical illness
Pain
Mental DISORDERS (mental illness, OD, dementia, autism)
Communication of need or distress
Learnt behaviour
Sensory impairment
Communication difficulties
Behaviour phenotypes
Medications or substances
Developmentally normal
Environment
Abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

NICE recommendations of use of antipsychotics in patients with learning disabilities

A

Other interventions should be tried first
Only intimidated by specialists
Monitor response and use lowest dose possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

MILD LEARNING DISABILITY FEATURES

A

expressive language is delayed but everyday speech is normal
Able to hold conversation
Comprehension is reasonable, abstract concepts e.g. time are difficult
Good non verbal communication
Full independence in wash and dressing, eating, toileting (normal continence)
Independent living possible
Academic work includes difficulties but able to read, write and do simple maths
Adult work - capable of work demanding practice rather than academic skills
Normal mobility
Social immaturity but otherwise normal social develops
Associated difficulties are as for the non LD population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MODERATE LEARNING DISABILITY FEATURES

A

Expressive language is delayed but simple phrases used
Comprehension is limited to simple phrases and requests
Basic communication skills
Non verbal communication is limited
Self care is limited supervision often required
Often continent
Lives under supervision often with family or supported accommodation
Academic work - limited achievements but may develop some reading, writing and maths skills
Can do simple practical adult work with usoerbision
Delayed mobility but usually fully mobile
Social development is limited but interaction usual
Associated defects: increased risk of neurological disorders, particularly epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

SEVERE/PROFOUND LEARNING DISABILITIES

A

Severe delay in expressive language, with only a few words or absent speech
Comprehension very limited
Non verbal communication is rudimentary
Self care is very limited supervision is always required, mainly in ongoing
Live with 24 hour supervision - family, group/nursing home
Some simple visousoatial skills
Mostly not capable of adult work
Frequent MSK abnormalities
Social development may be very limited, autism common
Associated deficits include neurological disorders and sensory deficits are prevalent
Multiple medical problems
Inner world largely unavailable to others
because of communication difficulty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Common physical health problems in people with intellectual disability?

A

Constipation
Dental problems
Epilepsy
GORD
H pylori
Infections: ear UTI RTI
Mobility problems
Obesity
Sensory impairments - visual/hearing impairment
Cerebral palsy
Fracture
Incontinence
Caries
Edentulus
Swallowing soreness
Injuries - self inflicted, abuse, accidental
Syndrome specific associations - Down’s syndrome: sensory, hypothyroid, CVS, respiratory
Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Key issues in treating with Physical Health needs in people with intellectual disability

A

Understanding / communicating symtpoms
- changing in behaviour
- visual aids/scales

Capacity to consent
- easy read information / visits
- best interest process
- IMCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

LD history

A

Demographics details
History of presenting complaint
** Psychiatry history **
PMH
FHx
Medication history and allergies
** Developmental history **
Forensic history
Personal history
Current social circumstances - functioning, package of care
** Risk assessment **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is learning disability assessed?

A

Functional history (ALDs)
Developmental history (was the onset in the developmental period)
Functioning tests (ABAS - adaptive behaviour assessment)
IQ testing for the minority (many pts already had it and more suitable for milder learning disabilities)

30
Q

Learning difficulty vs disability

A

Difficulty

Isolated problems with specific skills (reading, writing, numeracy)
Emotional/behavioural problems that may have disrupted schooling
Neurodevelopmental disorders such as ASD or ADHD
Head injury or cognitive decline in adult life

Diasbility
Significant impairment in IQ and adaptive living with onset in childhood

31
Q

What all doctors can do to help patients with LD

A

Treat underlying health conditions
- physical or psychiatric disorders
- sensory impairments
- consider medication side effects
Consider social and physical environment
- are carers trained, well and supervised
- avoiding reinforcing behaviour
- any need to adjust environment

LD services: referral or call for advice
- SLT
- psychotherapies, behavioural support etc
- assesment and treatment of mental health conditions

32
Q

What 3 criteria define learning disabilities?

A
  • lower intellectual ability (usually defined as an IQ of less than 70)
  • significant impairment of social or adaptive functioning a
  • onset in childhood
33
Q

What might be considered adaptive skills?

A
  • Communication
  • Self-care
  • Home living
  • Social skills
  • Community use
  • Self-direction
  • Health and safety
  • Functional academics
  • Leisure
  • Work
34
Q

What IQ is considered borderline for learning disability?

A

70 - 84

35
Q

Limitations in the use of IQ in determining the classification of learning disability?

A

These categories have been criticized on the grounds that they omit any measure of social or adaptive functioning.

In addition, it has been argued that in practice IQ scores are often uncertain in people with more severe learning disabilities.

It is also widely recognised that IQ scores are not fixed throughout life, so provide only an approximate guide to intellectual ability.

Accordingly, many health and social care professionals
object to subdividing learning disabilities because such subdivisons create labels that are then used to describe people, often inaccurately.

Whatever subdivisions are used, a person with a milder degree oflearning disability may need support in only some areas (for example, budgeting, planning and time management).

The more severe a person’s learning disability, the more likely the person is to have very limited communication skills and a very significantly reduced ability to learn new skills. Likewise, the more severe the learning disability, the more likely the person is to need support with daily activities such as dressing, washing, eating, and mobility.

It is widely agreed that it is important to treat each person as an individual, with their own specific needs, and it is recognised that a broad and detailed assessment of needs is essential.

36
Q

Borderline Intellectual Functioning

A
  • Not classified as LD but still vulnerable due to
    cognitive status
  • Living independently
  • Subtle communication difficulties
  • High-school ‘drop-out’ or in special education
  • Difficulty keeping a job, receiving government
    assistance
  • At risk of abusive relationships, challenges rearing
    children
37
Q

What sub-classification of learning disability is most common (75% of LD population, 2% general population)

A

Mild (IQ of 50-69)

38
Q

Most common inherited cause of LD

A

Fragile X syndrome

39
Q

Most common known genetic cause of LD

A

Down’s syndrome

40
Q

Most common cause of LD wordwide?

A

Malnutrition

41
Q

Chromosomal Aberrations - Autosomal abnormalities

A

Downs syndrome - Trisomy 21
Edwards syndrome - Trisomy 18
Pataus syndrome - Trisomy 13

42
Q

Chromosomal Aberrations - sex chromosomal abnormalities

A

Fragile X syndrome X q 27-28
Klinefelters syndrome 47 XXY
Turners syndrome 45 XO

43
Q

Autosomal dominant conditions associated with LD?

A

– Tuberous sclerosis
– Neurofibromatosis
– Sturge–Weber syndrome

44
Q

Autosomal recessive conditions associated with LD?

A
  • Disorders of protein metabolism (hereditary
    aminoacidurias)
    – PKU
  • Disorders of carbohydrate metabolism
    – Galactosaemia
  • Disorders of fat metabolism (lipidoses)
    – Cerebromacular degeneration
    – Niemann-Pick disease
  • Mucopolysaccharidoses
    – Hurlers disease
45
Q

Challenging behaviors?

A

Some people with learning disabilities display behaviour that challenges. ‘Behaviour that challenges’ describes actions that often result from the interaction between individual and environmental factors.

It includes aggression toward others, self-injury, stereotypic behaviour (such as rocking or hand flapping), disruptive or destructive behaviour and withdrawn behaviour.

It can also include violence, arson or sexual abuse, thereby bringing the person into contact with the criminal justice system.

The most widely used definition of such behaviour is ‘culturally abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the
person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use, or result in the person being denied access to, ordinary community facilities

.Such behaviours increase the likelihood that restrictive and aversive management strategies will be used and can result in people being excluded from services and from ordinary community life.

46
Q

Deletion syndromes associated with LD?

A

Velo-cardio-facial (Di George) syndrome
- Micro deletion of 22

Smith Magenis
- Deletion of 17

Prader-Willi syndrome
- Micro deletion of paternal 15q

Angelmans syndrome
- Micro deletion of maternal 15q

Williams syndrome
- Micro deletion of 7

Cri du chat syndrome
- Partial deletion of 5

47
Q

X-linked disorders?

A
  • Fragile X syndrome
  • Lesch-Nyhan syndrome
  • Haemoglobin (HbH) disease with mental
    retardation
  • ATR-X syndrome
    (α–thalassaemia/mental
    retardation syndrome)
48
Q

Perinatal causes of learning disability?

A
  • Iatrogenic:
    – Radiation, chemotherapy, medication
  • Infections
    – TORCH group
  • Delivery
    – Anoxic brain damage
    – Prematurity
  • Others
    – Hyperbilirubinaemia
    – Foetal Alcohol Syndrome
49
Q

What maternal infections during the perinatal period may cause LD? (TORCH group)

A

Toxoplasmosis
Other (HIV, syphilis, VZ, Zika, fifth disease)
Rubella
CMV
HSV

50
Q

Post natal causes of LD?

A
  • Infections - Encephalitis
  • Metabolic - Hypoglycaemia
  • Endocrine - Hypothyroidism (cretinism)
  • Cerebro-vascular - Thrombo-embolism
  • Toxins - Lead poisoning
  • Trauma - Head injury
  • Neoplasms - Meningioma
  • Psychosocial - Low socio-economical background, malnutrition, deprivation
51
Q

Multisystem disorder features of Down Syndrome?

A

Hypotonia (reduced muscle tone)

Brachycephaly (small head with a flat back)

Short neck

Short stature

Flattened face and nose

Prominent epicanthic folds ( folds of skin covering the medial portion of the eye and eyelid)

Upward sloping palpebral fissures (gaps between lower and upper eyelid)
Single palmar crease

52
Q

Potential complications/physical associations with Downs Syndrome?

A

Learning disability

Recurrent otitis media

Recurrent respiratory tract infection

Obesity

Obstructive sleep apnoea

Deafness. Eustachian tube abnormalities lead to glue ear and conductive hearing loss.

Visual problems such myopia, strabismus and cataracts

Hypothyroidism (occurs in 10 – 20%)

Cardiac defects (affect 1 in 3) particularly ASD, VSD, patent ductus arteriosus and tetralogy of Fallot

C spine abnormalities - Atlantoaxial instability

Leukaemia is more common in children with Down’s

Dementia is more common in adults with Down’s

53
Q

What does the management of Downs Syndrome involve?

A

Management involves supportive care from the multidisciplinary team to help them meet their needs:

Occupational therapy
Speech and language therapy
Physiotherapy
Dietician
Paediatrician
GP
Health visitors
Cardiologist for congenital heart disease
ENT specialist for ear problems
Audiologist for hearing aids
Optician for glasses
Social services for social care and benefits
Additional support with educational needs
Charities such as the Down’s Syndrome Association

Routine follow up investigations (thyroid, echo, audometry, eye checks)

54
Q

What routine follow up investigations are important for children with Down’s syndrome?

A

Regular thyroid checks (2 yearly)
Echocardiogram to diagnose cardiac defects
Regular audiometry for hearing impairment
Regular eye checks

55
Q

Psychiatric co-morbidities in LD?

A
  • Depression
  • Hyperactivity
  • Conduct disorder
  • OCD
  • Autism
  • Dementia, with unusually early onset
56
Q

Issues in communication faced by patients with LD

A
  • Understanding and processing:
    – Can mask comprehension difficulties
    – Difficulty understanding medical terms
    – Will say ‘yes’ to appease
    – Suggestible
    – Sensory issues
  • Expression:
    -Content of conversation can be superficial
    -Likely to contain ‘fillers’ such as ‘as you know’.
    -Articulation may be difficult
    -May speak too slowly or loudly, find it difficult to use conventional syntax or grammar
  • Pragmatics:
  • Problems understanding and applying social conventions in conversations
  • Difficulty waiting their turn
  • Communication style may seem self-centered
  • Sensitive to criticism or negative approach
    in conversation
  • Sensory function:
  • Hearing impairment
  • Visual impairment
  • Other physical disabilities
  • Cognitive function:
  • Attention difficulties
  • Retention difficulties
  • Environment
  • Too many people in room
  • Temperature
  • Lighting
  • Sound
  • Other environmental trigger
57
Q

How might a clincian improve communication with a patient with an LD?

A

Look at the Communication Passport

Environmental alterations

Use simple language, check if they have
understood, clarify, avoid yes or no questions

Phrase questions carefully in order to avoid interrogative suggestibility

Give enough time for responses

Write things down / draw pictures to aid understanding

If the patient uses sign language (BSL, Signalong and Makaton)

Minimise wait times and increase consultation time

Explain the basics
– Who you are, why you are seeing them, how long it will take

Speak to patient before speaking to carer
* Get supporting information from carer

If anxious consider a short break, eat/drink, favourite
book/object, offer reassurance, one person takes lead

Continuity of care particularly important

58
Q

Why might psychiatric illness present differently in a patient with a LD?

A
  • Limited communication skills
  • Difficult to assess thought disorder & hallucinations esp. in IQ<50
  • Diagnostic overshadowing ( automatically attributed the symptoms or disturbance to LD)
59
Q

Why might a patient with LD be more susceptible to psychiatric illness?

A
  • Limited coping strategies
  • Limited choices and opportunities
  • Limited social networks
  • Limited or adverse life experiences including discrimination, victimisation, multiple moves
60
Q

How might a patient with LD present with psychiatric problems (ie. more atypically)?

A
  • Change in behaviour e.g. self harm
  • Loss of skills e.g. incontinence
  • Withdrawal/isolating self
  • Not doing things they used to enjoy doing
  • Biological symptoms:
    – Sleep disturbance
    – Weight changes
61
Q

Principles of treatment of psychiatric
illness in people with Learning Disability

A
  • Same options as general population, but:
  • Capacity/best interests
  • Extra support
    – Accessible information
    – Psychotherapies may need adapting
    – Community learning disability team
    involvement
  • Go ‘low and slow’ with medication
62
Q

Autism - sensory sensitivities

A

*Hyper / hypo sensitivity to sensory stimuli
– Hyposensitivity more common in LD
* Sound most common sense affected
* Also vision, touch, smell and taste
* Propensity to sensory overload
* Sensory blocking or ‘tune outs’ e.g. humming

63
Q

Primary (associated) physical health problems in people with LD?

A

Hypothyroidism
Epilepsy
Visual/hearing impairment
Cerebral palsy
Motor problems

64
Q

Secondary physical health problems in people with LD?

A

Fracture
Obesity
GORD
Caries
Edentulus
Incontinence
Infection
Constipation

65
Q

Epilepsy in people with learning disability?

A
  • More common than the general population
    (20-30% in comparison to 1%).
  • Multiple types exist in one person at the
    same time
  • More chance of being treatment resistant
  • Rate of polypharmacy is higher
  • Mortality rate is high especially because of
    SUDEP
66
Q

4 key principles of improving health in patients with LD

A

4 key principles:
Inclusion
Choice
Independence
Rights

67
Q

What can help to reduce morbidity and mortality in LD?

A
  • Acute liaison nurses-based in hospitals, facilitating
    reasonable adjustments
  • Primary care liaison nurse-based at GP surgeries
  • Annual Health Check up and Health Action
    (management) Plan:
    – Preventative: cancer screening, immunizations
    – Healthy life style
    – Active case finding and screening
    – Regular monitoring (annual health monitoring)
68
Q

Why do people with learning diasbilities have worse health than people without learning disabilities?

A

Diagnostic overshadowing ( automatically attributed the symptoms or disturbance to LD)

Limited social networks

Vulnerable to abuse

Limited of adverse life expereicnes

Institutionalizations

Predisposition to both primary and secondary co morbidities

69
Q

Somatic phenotypes of Downs syndrome?

A

AD
CVD
Respiratory disease
Sensory defects
Hypothyroidism

70
Q

Behavioural phenotypes of Prader Willi Syndrome?

A

Food seeking
Poor impulse control
Psychiatric illness
Self injury (skin picking)
Sleep abnormalities

71
Q

Hx in LD?

A

P/C - verbatim and further detail
Collateral hx
History of childhood illness, birth history, developmental history, significant adverse events
Motor, communication, and social milestones
Current functional ability
Schooling history
Occupation
Current medications
PMH
Past psychiatric hx
Forensic hx
Specific behavioral history
Premorbid personality

72
Q

Mental state examination in LD

A

Appearance and behavior (level of cooporation, manner, dress/self care, posture/movements, facial expression etc, rapport/appropriateness, gesture/non verbal communication

Mood (objective/subjective, biological features, cognitive inc. suicide)

Though content (concerns/preoccupations, obsessions/complucions)

Abnormal perception

Abnormal perception

Talk/communication (nature/speed, structure/complexity, repetition, vocabulary, disorders of speech)

Cognition [adapted to ability]: orientation, concentraion (serial 7s, months of year fwd/rev, days of week fwd/rev, memory (immediated recall/STM)

General knowledge/intelligence (receptive/expressive ability, constructional dyspraxia, execution of sequential task, literacy, numeracy)

Insight (Ill? Need rx? Attitude to rx?)

Year 4 OPIC (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions