Learning Disabilities Flashcards
Definition of Learning Disability (ICD-10)
A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor, and social abilities
Criteria of the diagnosis of Learning Disability
- Intellectual Impairment (IQ<70)
- Social or adaptive dysfunction (Vineland Scale)
- Onset in the developmental period (below the age of 18)
Social or adaptive dysfunction (Vineland Scale)
Deficits/Impairments in 2 or more of following adaptive skills: communication, self-care, home living, social skills, community use, self direction, health and safety, functional academics, leisure & work
Prevalence of a Learning Disability
people with IQ<70 should be 2.5%. But the prevalence of people with LD is 1-2% because of:
Differential mortality (the more severe the degree of learning disability, the higher the mortality c.f. general population)
The role of functioning - those with IQ<70 but no problems functioning within their environment would not be defined as having a learning disability
Mild learning disability
IQ 50-69. Will have the functionality of a young adolescent.
Moderate learning disability
IQ 35-49. Young primary school child. Likely to need help with daily tasks like preparing meals, going shopping. May come across as more verbally able as they are.
Severe learning disability
IQ 20-34. Early pre-school adaptive functioning. Need help with nearly everything.
Profound learning disability
IQ <20. No adaptive functioning. Need help eating, drinking, personal care, going to the toilet. Associated with physical morbidity as well, for example cerebral palsy.
Genetic causes of Learning disability
Single gene: Fragile X, PKU, Retts Syndrome
Microdeletion/duplication: DiGeorge Syndrome, Prader-Willi, Angelman syndrome (microdeletion of chromosome 15, imprinting causing different syndromes)
Chromosomal abnormality: Down Syndrome
Infective causes of Learning Disability
ante-natal e.g. rubella;
post-natal e.g. meningitis, encephalitis
Toxic Causes of Learning Disability
Foetal Alcohol Syndrome
Trauma causes of learning disability
Birth asphyxia or head injury
Common conditions associated with Learning Disability
Epilepsy
Sensory impairment - hearing (40%) and visual (20%)
Obesity
GI swallowing problems, reflux oesophagitis, H.pylori, constipation
Resp problems - chest infections, aspiration pneumonia
Cerebral palsy
Orthopaedic problems
Dermatological and Dental Problems - 33% have unhealthy gums, for Down’s Syndrome 80%
Relation of psychiatric disorders in those with LD
Higher incidence, the more severe, the higher the prevalence.
Presentation of mental illness in patients with Learning Disabilities
Difficulty in communication, there will be less complex delusions. Rely on observations, collateral history.
Schizophrenia and Psychosis in Learning Disability
3% compared with 1% in the normal population. Associated with a change in personality and reduction in functional abilities. There is “self -talk” in LD, particularly Downs Syndrome
Mood disorders in Learning Disability
Increased incidence. Less likely to complain of mood changes and noted by change in behaviour.
OCD in learning disabilities
ritualistic behaviour and obsessional themes significantly increased in learning disability. Obsessions are hard to describe but the compulsions more readily observed.
Autism in LD
2/3 of persons with Autism have a learning disability
Over-activity Syndromes LD
ADHD has a higher incidence in this group of patients. They may be overactive, distractable and impulsive but not to the extent that would indicate diagnosis of ADHD
Challenging Behaviour and Self Injury in LD
Mannerisms, head banging and rocking common with severe LD. The general trend is towards greater prevalence of problem behaviour with increasing severity of LD.
Forensic LD
Mild learning difficulties have similar rates of offending to the general population but different profile of offending. Increased risk of arson and sexual exhibitionism.
