Learning Disabilities

Question 1

Definition of Learning Disability (ICD-10)

Answer 1

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

Question 2

Criteria of the diagnosis of Learning Disability

Answer 2

1. Intellectual Impairment (IQ<70)
2. Social or adaptive dysfunction (Vineland Scale)
3. Onset in the developmental period (below the age of 18)

Question 3

Social or adaptive dysfunction (Vineland Scale)

Answer 3

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

Question 4

Prevalence of a Learning Disability

Answer 4

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

Question 5

Mild learning disability

Answer 5

IQ 50-69. Will have the functionality of a young adolescent.

Question 6

Moderate learning disability

Answer 6

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.

Question 7

Severe learning disability

Answer 7

IQ 20-34. Early pre-school adaptive functioning. Need help with nearly everything.

Question 8

Profound learning disability

Answer 8

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.

Question 9

Genetic causes of Learning disability

Answer 9

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

Question 10

Infective causes of Learning Disability

Answer 10

ante-natal e.g. rubella;

post-natal e.g. meningitis, encephalitis

Question 11

Toxic Causes of Learning Disability

Answer 11

Foetal Alcohol Syndrome

Question 12

Trauma causes of learning disability

Answer 12

Birth asphyxia or head injury

Question 13

Common conditions associated with Learning Disability

Answer 13

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%

Question 14

Relation of psychiatric disorders in those with LD

Answer 14

Higher incidence, the more severe, the higher the prevalence.

Question 15

Presentation of mental illness in patients with Learning Disabilities

Answer 15

Difficulty in communication, there will be less complex delusions. Rely on observations, collateral history.

Question 16

Schizophrenia and Psychosis in Learning Disability

Answer 16

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

Question 17

Mood disorders in Learning Disability

Answer 17

Increased incidence. Less likely to complain of mood changes and noted by change in behaviour.

Question 18

OCD in learning disabilities

Answer 18

ritualistic behaviour and obsessional themes significantly increased in learning disability. Obsessions are hard to describe but the compulsions more readily observed.

Question 19

Autism in LD

Answer 19

2/3 of persons with Autism have a learning disability

Question 20

Over-activity Syndromes LD

Answer 20

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

Question 21

Challenging Behaviour and Self Injury in LD

Answer 21

Mannerisms, head banging and rocking common with severe LD. The general trend is towards greater prevalence of problem behaviour with increasing severity of LD.

Question 22

Forensic LD

Answer 22

Mild learning difficulties have similar rates of offending to the general population but different profile of offending. Increased risk of arson and sexual exhibitionism.