Learning Disabilities Flashcards
What terms are used to describe learning difficulties
Mental retardation is still used in the ICD10
Mental handicap is used in legal terms
Intellectual or learning difficulty/disability are the most common and preferable terms to use in practice
There is a high level of comorbidity in the learning disabled population - true or false
True
Health need are often unmet and staff have poor understanding
Communication is a big area of difficulty
Does having a learning difficulty affect life expectancy
Yes
Females with a learning disability had an 18-year lower life expectancy and males had a 14 year lower life expectancy than the general population
Those with an intellectual or learning disability are 4x more likely to die of avoidable causes than the general population
What conditions are more common in those with learning difficulty
26x more likely to have epilepsy (increases as severity of LD increases)
8x more to have severe mental illness
5x more to have dementia
3x more likely to have hypothyroidism
2x more likely to have diabetes, heart failure, chronic kidney disease or stroke
Co-morbid physical disabilities and sensory deficits or hypersensitivity are more common
Higher rates of physical and sexual abuse
What learning disability is associated with Alzheimer’s
Down’s Syndrome
What is the definition of a learning disability
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
What are the criteria for learning difficulty
An IQ<70
Not a good measurement in young kids so need to retest
Developmental aetiology - < 18 years
Onset during the developmental period
Deficits in adaptive functioning (how they cope with change) and a functional impairment
How are learning difficulties diagnoses
Based on clinical findings
History
Psychometric assessment - WAIS or Stanford tests
IQ is considered
Also assess function and handicap
Assess for underlying causes - physical exam, bloods, genetics etc.
What is the average IQ of the population
100
Rising over time
How does iodine deficiency affect IQ
It can lead to learning problems
Is dyslexia a learning disability
No
This is an educational difficulty
List the severity classifications of learning disabilities
Borderline LD = IQ 70+ Mild LD = IQ 50-69 Moderate LD = IQ 35-49 Severe LD = IQ 20-34 Profound LD= IQ < 20
How does a borderline LD present
IQ range 70-84
Mental age 12 to under 15
Not a recognised category
How does a mild LD present
IQ range 50-69
Mental age 9 to 12
Most Common
Delayed speech - able to use everyday speech
Full independence – Self care, practical & domestic skills
Difficulties in Reading and Writing
Capable of unskilled or semi-skilled work
Problems if Social or Emotional Immaturity
Rarely organic aetiology
How does a moderate LD present
Mental age 6 to 9 Slow with comprehension and language Limited achievements Delayed self care and motor skills Simple practical tasks - often with supervision Usually fully mobile - physically active Majority Organic Aetiology Epilepsy & Physical Disability common
How does severe LD present
Mental age 3 to under 6
Generally more marked impairment than in moderate LD and achievements more restricted
Epilepsy very common
Will probably be able to pick this up by meeting the patient
How does a profound LD present
Mental age less than 3
Severe limitation in ability to understand or comply with requests or instructions.
Little or no self-care.
Often severe mobility restriction.
Basic or simple tasks may be acquired.
Will probably be able to pick this up by meeting the patient
How can intellectual disabilities be picked up in children
Developmental screening
Those born prematurely should be followed up
Often seen when children fail to reach milestones
Milder cases may present with slow academic progress
What other mental disorders are comorbid with LDs
ADHD
Autism
What can cause LDs
Genetics
Maternal infections
Substance abuse in pregnancy or malnutrition
Extreme prematurity or birth injury
Metabolic dysfunction (PKU), hypoglycaemia or high bilirubin in the post-natal period
Infections or trauma in infancy
What causes Down’s syndrome
Trisomy 21
What is caused by trisomy 13
Patau syndrome
What causes Edward’s syndrome
Trisomy 18
Only 10% survive their first year
List some LDs caused by chromosomal abnormalities
Cri du chat Angelman Prader-WIlli Williams syndrome Velo-cardiofacial syndrome - higher risk of schizophrenia
List syndromes causes by abnormalities of the sex chromosomes
Turner’s - X (LD rare)
Trisomy X
Klinefelter’s - XXY (may have slightly lower IQ)
What is the trend in incidence of LD
It is increasing by 1% per year
Due to increased life expectancy and increased survival of premature babies
What are the 3 aspects of a LD
The impairment itself, e.g. brain injury as result of perinatal trauma
The resulting disability e.g. inability to read
The resulting social handicap
Are psychiatric disorders common in the LD population
Yes - 3x more than rest of the population
They experience the same range of disorders but are often harder to diagnose and treat
Why are psychiatric disorders more common in the LD population
Organic vulnerability – ‘brain damage’
Social deprivation / disadvantage
Life events
Psychological reasons – learned helplessness
What must you consider if someone with a LD has a change in behaviour (becomes challenging)
Physical illness - pain, constipation, epilepsy
Environmental stressors - abuse, loss, changes
Mental disorders - depression or psychosis
How can you manage a LD
Supportive and therapeutic environment - school and home
Behavioral support plans
Psychoeducation
Social support
Commutation aids
Respite care if needed
Pharmacological treatment for comorbid disorders
Behavioural therapy - CBT and sensory therapy
How does schizophrenia present in those with LD
Earlier age of onset
Negative symptoms more common
May present with a behaviour change
3 times more common than the rest of the population
What are the symptoms of ASD
Abnormal social interaction
Communication impairment
Rigid/restricted or repetitive behaviour, interests and activities
ASD is more common in which sex
Males
3:1
What is the definition of intelligence
A person’s capacity to acquire knowledge, apply knowledge (solve problems), and engage in abstract reasoning
How can you measure intelligence
The Intelligence Quotient (IQ)
Which features may increase suspicion of a learning disability
Delayed developmental milestones Lack of educational attainment Lack of employment Inability to manage financial affairs Difficulty with relationships Inability to attend to basic needs such as cooking, shopping Poor personal hygiene
What is the most common identifiable cause for a learning disability
Down’s Syndrome
List genetic causes of arrested intellectual development
Sex chromosomal disorders - Turner’s (45, X0), Trisomy X (47, XXX), Klinefelters (XXY), and XYY males.
Deletions and duplications = Prader-Willi syndrome and Angelman syndrome
Autosomal dominant conditions - Neurofibromatosis and Tuberous sclerosis
Autosomal recessive conditions - phenylketonuria
X-linked recessive conditions -Hunter syndrome
X-linked dominant conditions - Fragile X
Chromosomal - Down’s
List non-genetic causes of arrested intellectual development
Congenital hypothyroidism
Foetal alcohol syndrome
Hypoxic damage
Infective agents (ToRCH syndromes)
CNS and skull development abnormalities (micro and macrocephalies, spina bifida, hydrocephalus)
Disorders of unknown aetiology (e.g. Rett syndrome, disintegrative disorder)
