Learning disabilities

Question 1

Define LD

Answer 1

A condition that effects the individual’s ability to learn + function independently

Question 2

What is the DSM IV diagnostic criteria for LD? (3)

Answer 2

1) IQ of 70 or below
2) Deficits in 2 of the following areas - communication, self care, social skills, use of community resources, self direction, health + safety, functional academic skills
3) Onset before the age of 18

Question 3

What is the department of health’s definition of LD?

Answer 3

Significant impairment of intelligence + significant impairment of social functioning that both were acquired before adulthood

Question 4

Give an example of a learning difficulty?

Answer 4

Dyslexia

Question 5

What is ASD?

Answer 5

A neurodevelopmental disorder

Question 6

What are the areas of adaptive functioning? (4)

Answer 6

1) Self care
2) Language + communication
3) Self direction, health + safety
4) Independent living skills + community use

Question 7

Why do LD have to occur before the age of 18?

Answer 7

Because the brain has finished maturing at 18

Question 8

What are the Pre-natal causes of LD?

Answer 8

Genetic - Down’s syndrome, fragile X syndrome
Spina bifida
Cerebral palsy
Environmental - Drugs, alcohol, diseases passed on by mother

Question 9

What are some of the Peri-natal causes of LD?

Answer 9

Biomedical factors - Toxoplasmosis, other infections of the womb
Environmental factors - Asphyxia, Hypoxia, Premature birth, difficulties during labour/birth

Question 10

What are some of the Post-natal causes of LD?

Answer 10

Biomedical factors - Epilepsy, meningitis, measles, other infectious diseases
Environmental factors - Head injury, non accidental injury, lead/mercury poisoning, malnutrition, social deprivation

Question 11

Define mild LD

Answer 11

IQ score of 50 - 70

Question 12

Define moderate LD

Answer 12

IQ score of 35 - 49

Question 13

Define severe/profound LD

Answer 13

IQ score of 0 - 34

Question 14

What are some of the characteristics of a person with mild LD?

Answer 14

Delayed speech, but usual
Reasonable comprehension
Good non verbal communication
Normal continence
Self care - Possible to have independent living
Normal mobility
Capable of doing work + academia

Question 15

What are some of the characteristics of a person with moderate LD?

Answer 15

Delayed speech with simple phrases
Comprehension of single phrase requests only
Limited non verbal communication
Limited with self care - needs supported housing
Delayed mobility
Limited academia, work simple with supervision
Some increase in other disorders eg epilepsy

Question 16

What are some of the characteristics of a person with severe/profound LD?

Answer 16

Severe delay in speech, may not speak at all
Very limited understanding
Rudimentary non verbal communication
Mainly incontinent, help needed with ADL
Not capable of adult work + struggles with academia
Frequently MSK abnormalities
Very limited social development - many have ASD
Frequently have epilepsy, sensory deficits or CNS disorders

Question 17

What is the most common cause of LD?

Answer 17

Down’s syndrome (Trisomy 21)

*25% of LD p’s will develop MH issues)

Question 18

Why do patients with Down’s syndrome develop dementia more?

Answer 18

Coding protein for plaques is on chromosome 21, so extra chromosome causes increased incidence of dementia

Question 19

How can communication be adapted for people with LD?

Answer 19

Use simple language + short sentences
Avoid jargon + negatives
Give concrete examples, don’t use abstract ideas
Be aware of literal meanings - caution with humour
May need to use sign language
Use pictures to express feelings
Check comprehension

Question 20

How can LD appointments be suited to p’s?

Answer 20

Give first appointment of day - delayed waiting times
Double consultation time
Check level of understanding before starting
Explain exactly what is going to happen before starting
Take Hx from patient, collateral from carers
Pt may not have a good understanding of time so think of events eg Christmas
Continuity of care