Brainscape's Knowledge GenomeTM

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


See full index

YEAR 4 OLDER PEOPLE INTEGRATED CARE > Learning disabilities > Flashcards

Learning disabilities Flashcards

You may prefer our related Brainscape-certified flashcards:
People You Should Know flashcards
1
Q

What are the 3 diagnostic criteria for learning disabilities?

A

Intelligence- significantly reduced (general) ability to understand new or complex information and to learn new skills

Functioning- reduced general ability to cope independently

Onset- either present from birth or emerges through a child;s early developmental years

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

How do we measure intelligence?

A

IQ- measure of intellectual functioning
Estimate
4 areas: verbal comprehension, perceptual reasoning, working memory and processing speed

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

What can affect IQ? (when doing testing)

A

Mood, psychotropic medication and sleep deprivation

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

How does the severity of LD affect what support the pt needs?

A

Mild LD- can often live independently with varying levels of support

Moderate LD- less likely to live independently, will require support which varies from light level to continuous

Severe- will need significant and continuous help with daily living

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

What is the course of LD?

A

Pts have difficulties throughout their life span
They can learn new skills- environments have big impact, skills need to be supported
However, their overall level of functioning and dependency remains fairly constant over time

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

Learning disabilities vs learning difficulty?

A

NOT the same
Learning difficulty is of 2 types (general + specific) and not as severe as learning disabilities

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

What is a general learning difficulty?

A

Likely to have cognitive impairment, just NOT AS SEVERE as in learning disabilites range, but below average

May struggle with range of tasks and need support in education

Can usually live independently

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

What is specific learning difficulty

A

E.g. dyslexia
Learning problems limited to one or more specific areas (e.g. reading and writing)
Not related to overall intelligence

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

What is developmental delay?

A

Only used with children, can be specific or global

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

What is specific developmental delay?

A

Will be behind most of their peers in a particular area (e.g language skills) but in all other regard their development is typical

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

What is global developmental delay?

A

Will have been late in reaching their developmental milestones compared to most of their peers and be behind their peers in a range of areas.

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

How tell the difference between LD and developmental delay?

A

Hard!
Key difference:
Child with developmental delay continues to show evidence of development and continues to acquire personal, social and educational skills and abilities but at a LATER age to their peers

Child with learning disability slows down in development and the gap between themselves and their peers gradually increases over time

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

IQ range for most people?

A

85-115
Normal distribution curve

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

IQ for pts with LD?

A

Usually score below 70

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

Problems with IQ testing?

A

When you score an IQ test, you use confidence intervals and ranges of scores, where there are large differences between composite scores, Full scale IQ cannot be concluded
Lots of factors can contribute/ depress IQ scores- stress, low mood, medication, preganncy

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

What is CTPLD?

A

Community team for people with learning disability

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

Requirements for CTPLD care?

A

Have a learning disability
Be unable to access mainstream services, even with reasonable adjustments
Have a clinical health need that the CTPLD can support

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

How do you assess LD

A

Initial assessment: gathering info from 3 domains (intelligence, functioning and onset), may be clear at this point,
If not: Clinical psychologists review the information and if it still remains unclear then an initial assessment is completed by a clinical psychologist,

this usually involves gathering a developmental history, a good account of functional ability and psychometric assessment to estimate IQ

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

What is a LD?

A

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​

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

What legislation is there to protect pts with LD?

A

The Equality Act 2010 - The Public Sector Equality Duty /Equality Delivery System (EDS)​
The Mental Capacity Act 2005 (MCA) ​
The Human Rights Act (1998)​

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

What are the barriers faced by individuals with LD?

A

Communication
Physical access
Lack of accessible information
Fear of health professionals
Lack of time
Physical enviromnent
Poor info from carers
Poor support
Lack of education
Lack of preparation
Consent
Additional needs
Diagnostic overshadowing
Low expecation
Bias / prejudice from healthcare professionals

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

What are the IQ ranges for different LD?

A

Mild- 50-69 (89% of all pts w LD)
Moderate- 35-49 (6% of all pts with LD)
Severe- 20-34 (3.5% of all pts with LD)

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

General functioning of pts with mild LD

A

Delayed expressive language, but everyday speech is usual
Reasonable comprehension
Usually fully independent in eashing, eating, dressing and normal continence
Possible independent living

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

General functioning of pts with moderate LD?

A

Delayed expressive language, but uses simple phrases only
Comprehension limited to simple phrases/requests
Limited self care, supervision may be required, but mainly continent
Needs some supervision in living

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

General functioning of a pts with severe LD?

A

Severe delay in expressive language, with very few words only, or absent speech
Very limited, if any understanding of speech
Very limited self care and supervision is always required, mainly incontinent
24 hour supervision is necessary

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

Main causes of LD?

A

4 main categories:
1) before birth or pre-natal
2) during birther or peri-natal
3) after birth or post-natal
4) Multiple causes- mix of the above

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

Examples of before birth/pre-natal causes of LD?

A

Down’s syndrome
Fragile X syndrome
Drug or alcohol abuse by the mother

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

Examples of peri-natal causes of LD?

A

Oxygen deprivation during birth–> brain damage
Injury to baby due to birth complications, and difficulties resulting from premature birth

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

Examples of birth/ post-natal causes of LD?

A

Illnesses e.g. meningitis, encephalitis
Brain injury or children being deprived of attention to their basic needs- undernourished, neglected or phsyically abused
Accidental or non accidental injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How are learning disabilities and autism linked?

A

Approximately 1% of the general population has an autism spectrum condition​
​
​
60-70% of people who have an autistic spectrum condition will also have a learning disability​
​
The prevalence of autism increases with greater severity of learning disability or lower verbal IQ. ​
​

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How may pts with LD communicate?

A

Verbal​
Body language​
Signing e.g. Makaton​
Symbols, signs, photos​
Communication books or passports​
Electronic aids​
Using objects of reference​

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What do we need to be aware of when working with a pt with LD?

A

Beware of missing serious illness, considering physical and mental health conditions​

Be more inquisitive, ask more questions​

Find out the best way to communicate with the individual​

Engage and speak to the individual first ​

Listen to parents & carers concerns​

Do not make assumptions about a person’s quality of life​

Be clear on the law about capacity to consent​

Ask for help, guidance or advice from learning disability services​
​

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What physical problems do pts with LD have a higher risk of?

A

Reduced life expectancy​
Respiratory problems​
Heart problems​
Overweight or underweight​
Certain cancers​
Epilepsy​
Mental health needs​
Diagnosis of challenging behaviour​
Physical impairments​
Sensory impairments​ - visual and hearing
Communication difficulties​
Thyroid dysfunction​
Dental problems​
Difficulties eating/drinking​
Dementia​
Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Pts with LD are likely to have worse access to healthcare, what are they less likely to attend to?

A

Annual health checks​
Screening for cancer ​
Sight & hearing tests​
Receive pain relief​
Get health promotion advice​
Be included in consultations ​
Be included patient forums​
Access health services​

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Who’s responsibility is it to provide care/ annual health checks for pts with LD?

A

Primary health services

36
Q

What are the common physical health problems in pts with LD?

A

Constipation
Dental problems
Epilepsy: 20-25%
GORD+/- H.pylori
Infections- Ear/UTI/RTI
Mobility problems
Obesity
Sensory impairmets
Swallowing problems
Injuries
GI cancer
Diabetes/metabolic

37
Q

What conditions are associated with Down’s syndrome?

A

Sensory/hypothyroid/CVS/Resp

38
Q

What is fragile X syndrome

A

Genetic condition causes by CGG trinucleotide repeat in the FMR1 (fragile mental retardation 1) gene on the X chromosome, affecting synaptic development

Most common inherited cause of learning disabilities

39
Q

Presentation of fragile X syndrome?

A

A long face
Large, protruding ears
Intellectual impairment
Macroochidism- post pubertal
Social anxiety
Autism spectrum features

40
Q

What is tuberous sclerosis

A

Autosomal dominant, neurocutaneous syndrome characterised by cellular hyperplasia, tissue dysplasia and hamartomas involving multiple organs

41
Q

Clinical features of tuberous sclerosis?

A

Infantile spasms with hypsarrhythmia seen on electroencephalogram
Skin: Ash leaf macules; Shagreen patches; facial angiofibromas; subungual fibromas
Neurological/Cognitive: Learning disabilities; Sub-ependymal nodes; Seizures/Epilepsy
Renal: Angiomyolipomas
Cardiac: Cardiac rhabdomyomas

42
Q

Aetiology of tuberous sclerosis?

A

2 genetic loci:
TSC1, found on chromosome 9q34 - hamartin;
TSC2, found on chromosome 16p13 - tuberin;
The clinical phenotype can result from a mutation in either of these genes.

43
Q

Management of tuberous sclerosis?

A

Angiofibromas <2mm in diameter will respond to laser therapy
Angiofibromas >2mm in diameter require dermabrasion or surgical resection
Many patients with renal disease will require anti-hypertensive therapy
Tubers should be regularly imaged and may require surgical resection

44
Q

What is autism?

A

Autism is a neurodevelopmental condition characterized by qualitative impairment in social interaction and communication as well as repetitive stereotyped behaviour, interests, and activities.

45
Q

Epidemiology of ASD?

A

Recent estimates suggest a prevalence of 1-2%.
ASD is three to four times more common in boys than girls.
Around 50% of children with ASD have an intellectual disability.

46
Q

Clinical features of ASD?

A

Social communication impairments and repetitive behaviours are present during early childhood (typically evident before 2–3 years of age), or maybe manifested later.
The clinical features can be classified as:
Impaired social communication and interaction:

Repetitive behaviours, interests, and activities:

ASD is often associated with intellectual impairment or language impairment.

Attention deficit hyperactivity disorder (35%) and epilepsy (18%) are also commonly seen in children with ASD.

ASD is also associated with a higher head circumference to the brain volume ratio.

47
Q

Examples of impaired social communication/interaction in ASD?

A

Children frequently play alone and maybe relatively uninterested in being with other children.
They may fail to regulate social interaction with nonverbal cues like eye gaze, facial expression, and gestures.
Fail to form and maintain appropriate relationships and become socially isolated.

48
Q

Examples of repetitive behaviours, interests and activities?

A

Stereotyped and repetitive motor mannerisms, inflexible adherence to nonfunctional routines or rituals are often seen.
Children are noted to have particular ways of going about everyday activities.

49
Q

Goal of autism management?

A

The goal is to increase functional independence and quality of life through learning and development, improved social skills, and improved communication
decreased disability and comorbidity

Aid to families

50
Q

Non-pharma therapy for ASD?

A

Early educational and behavioural interventions:
Applied behavioural analysis (ABA).
ASD preschool program.
Treatment and Education of Autistic and Communication related handicapped CHildren (TEACCH)/Structured Teaching method.
Early Start Denver Model (ESDM).
Joint Attention Symbolic Play Engagement and Regulation (JASPER).
Important to have family support and counselling to encourage pts to accept their child’s behaviours

Biopsychosocial approach-

51
Q

Pharma therapy for ASD?

A

no consistent evidence demonstrating medication-mediated improvements in social communication
SSRIs: helpful to reduce symptoms like repetitive stereotyped behaviour, anxiety, and aggression
Antipsychotic drugs: useful to reduce symptoms like aggression, self-injury.
Methylphenidate: for attention deficit hyperactivity disorder (ADHD).

52
Q

Clinical features of Down’s syndrome?

A

face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
flat occiput
single palmar crease, pronounced ‘sandal gap’ between big and first toe
hypotonia
congenital heart defects (40-50%, see below)
duodenal atresia
Hirschsprung’s disease

53
Q

Cardiac complications of Down’s Syndrome?

A

multiple cardiac problems may be present
endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)

54
Q

Later complications of Down’s syndrome?

A

subfertility: males are almost always infertile due to impaired spermatogenesis. Females are usually subfertile, and have an increased incidence of problems with pregnancy and labour
learning difficulties
short stature
repeated respiratory infections (+hearing impairment from glue ear)
acute lymphoblastic leukaemia
hypothyroidism
Alzheimer’s disease
atlantoaxial instability

55
Q

Test for Down’s syndrome antenatally?

A

the combined test is now standard:
these tests should be done between 11 - 13+6 weeks
nuchal translucency measurement + serum B-HCG + pregnancy-associated plasma protein A (PAPP-A)
Down’s syndrome is suggested by ↑ HCG, ↓ PAPP-A, thickened nuchal translucency
trisomy 18 (Edward syndrome) and 13 (Patau syndrome) give similar results but the hCG tends to lower

quadruple test:
if women book later in pregnancy the quadruple test should be offered between 15 - 20 weeks
quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A

56
Q

What is Risperidone?

A

Anti-psychotic
Used to treat bipolar, schizophrenia and also used to treat behavioural issues in pts with LD- used as a last resort!

57
Q

How do you deal with challenging behaviours in a pt with LD?

A

1) Biopsychosocial approach- find and treat cause
* Biological cause of their behaviour: are they ill? UTI, constipated, dental pain, GI pain?
* Psych cause: do they have ADHD, anxiety,depression?
* Social cause: has something happened recently? change of environment, has their fave carer left?
2) If can’t find the cause do functional analysis and then use Positive behaviour support:
3) If this doesnt work, medication (risperidone or SSRI or mood stabilizer) + PBS

58
Q

What is diagnostic overshadowing?

A

Attributiing all the pts problems to their LD, dangerous! need to get to the root of the problem

59
Q

6 safeguarding principles within the Care Act 2014?

A

1) Empowerment: Person led decisions and informed consent
2) Prevention: take action before harm occurs
3) Proportionality: Least intrusive response- ‘I am sure than the professionals will work for my best interests, as I see them and they will only get involved as much as I require’
4) Protection: Support and representation for those in greatest need
5) Partnership: Solutions can be found through services working with their communities. Communities have a part to play in preventing, detecting and reporting negliect and abuse
6) Accountability: Accountability and transparency in delivering safeguarding

60
Q

Examples of emotional abuse in pts with LD?

A

Enforced social isolation
Preventing expression of choice and opinion
Preventing stimulation/meaningful occupation

61
Q

Examples of neglect in pts with LD?

A

Failure to adminster medication
Ignoring or isolating the person
Preventing person from making own decision
Pt has inconsistent contact with health professionals

62
Q

How to make an adult safeguarding referral?

A

Assess if pt has mental capacity
Incl pt in decisions about reporting safeguarding concern- if pt refuses AND has capacity can still make the referral if in pts best interest
In report describe what has happened with as much detail as you can and consider if anyone else is at risk
Do not need to contact perpetrator

63
Q

What is the 2-Stage test of capacity?

A

1) does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?
2) does the impariment mean the person is unable to make a specific decision when they need to?

MCA says that a person is able to make a decision if they can
* Understand the info relevant to the decision
* Retaint the info
* Use or weigh up that information
* Communicate the decision back to us

64
Q

What are some actions that can be takent to help pt that has been referred to adult safeguarding?

A

Refer to social services
Local authorities can assgin advocate for pt
Nation charities
Needs assessment for extra support or financial benefits
Court- can appoint another legal guardian

65
Q

How to ensure vulnerable adults are safeguarded in the future?

A
  • Ensure safguarding policu- involving pts carers, any staff involved and managers
  • Appoint safe-guarding lead- can oversee companies safeguarding strategies and practice
  • Staff have DBS checks and carry out regular risk assessments
  • Reports- ensure ease of reporting and voicing concerns anonymously
  • Independent Mental capacity advocate, to help vulnerable people who lack capacity and are facing important decisions including serious haelthcare treatment decisions and who have no-on else to speak for them
66
Q

What are adaptive skills that ppl w/ LD may have limits in?

A
  • Communication
  • Self care
  • Home living
  • Social skills
  • Community use
  • Self direction
  • Health and Safety
  • Functional academics
  • Leisure
  • Work

Need to have limits in at least 2 of these as part of APA criteria

66
Q

Main autosomal dominant disorders causing LD?

A

Tuberous sclerosis
Neurofibromatosis
Sturge-Weber syndrome

67
Q

Main autosomal recessive disorders causing LD?

A
  • PKU
  • Galactosaemia
  • Cerebromacular degeneration
  • Niemann-Pick disease
  • Hurlers disease
68
Q

Common primary (associated) physical health problems in people with LD?

A

Hypothyroidism
Epilepsy
Visual/Hearing impairment
Cerebral palsy
Motor problems

69
Q

Most common genetic syndromes seen in LD clinic?

A

Downs
Fragile X syndrome
Prader-Willi syndrome
Angelman syndrome
Cornellia De lange syndrome
Tuberous sclerosis

70
Q

What mental illnesses are common in pts with LD?

A

Adjustment disorders
Anxiety disorders- more common or just as common as general population
Mood disorders: depression( as common in LD), BD (more common in pts w LD)
Pyschotic illnesses: schizophrenia (more common in LD population)
Personality disorder
Eating disorder

71
Q

What is adjustment disorder?

A

Any significant change in pts life e.g. death in family, day centre closes down, moving house cause this. Usually lasts 6mths

Anxiety, low mood, helplessness, feel as though can’t cope, may affect sleep or appetite - not as intense or frequent as to classify seperate disorder

72
Q

Neurodevelopment disorders in LD?

A

ASD
ADHD

73
Q

Associated features of ASD?

A

Sensory problems- hyper or hypo sensitivity to noise, cognitive rigidty, vestibular problems- they like spinning (soothing and comforting for them)

74
Q

Link between Down syndrome and Dementia?

A

A lot more common- develop AD around 50 y/o

More common in LD population

75
Q

What tools do we use for dementia in LD?

A

DLD
(Dementia Questionnaire for People with Learning Disabilities (DLD) aids early detection of dementia in adults with learning disabilities (developmental ages around 2 to 10 years)

DSDS

76
Q

What is challenging behaviour?

A

Puts themselves, others or the environment at risk

Breaking things
self harm
sexully inappropiate behaviour
aggression and physical violence to others

77
Q

prevalance of challenging behaviour in LD population?

A

15-20%

78
Q

Causes of death in pts with LD

A

pneumonia/aspiration pneumonia
CVS complications

79
Q

what is STOMP ?

A

stopping over medication of people with a learning disability, autism or both with psychotropic medicines.

Side effects:
putting on weight
feeling tired or ‘drugged up’
serious problems with physical health.

80
Q

What is transforming care for people with LD?

A

Care in community
Admission as last resort
Care and treatment review- must take place before admitted and early discharge

Challenges: lack of suitable placements- no alternative to hosp admission

81
Q

What are reasonable adjustments for pts with LD in healthcare centre?

A

Visual aids
Longer appointments
Check understanding
reduce distractions

82
Q

What is the impact of anti-psychotics on weight?

A

Increases cholestrol and weight gain.

83
Q

What are main difficulties faced in consultation with pt w/ LD?

A
  • Identification - what is the problem?
  • Communication - addressing and unpacking the issue at hand
  • Understanding - the pt may not be able to understand the medical problem, why they need treatment, what happens if nothing is done etc
  • Transfer - some wards don’t accept LD pts, not enough staffing etc
  • Capacity
84
Q

What are the barriers to communication w/ a pt who has LD?

A
  • Lower IQ
  • Limited language ability
  • Sensory deficit
  • Specific speech deficit
  • Inattention
  • Emotional dysregulation
  • Psuchiatric comorbiditiy
  • Environmental factors
85
Q

How to improve a consultation w/ pt who has LD?

A
  • make reaonable adjustments - e.g. longer appts, at a certain time etc
  • short and to the point - simple language, time between sentences, shorter sentences
  • offer choices - e.g. bath before dinner or after dinner - offer choices for simple questions/problems.
  • individualised communication plan
  • establish a baseline with the patient

YEAR 4 OLDER PEOPLE INTEGRATED CARE (21 decks)

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