Learning DIsabilities

Question 1

Describe the American psychiatric association for learning disabilities.

Answer 1

• Sub average intellectual functioning
• At least two limited areas of adaptive functioning exist concurrently
• The disability occurred before the age of 18 years

Question 2

Describe the aspects that need to be addressed in the history of patients presenting with Learning Disability.

Answer 2

• Communication
• Self-care
• Homeliving
• Socialskills
• Communityuse
• Self-direction
• Health and safety
• Functionalacademics
• Leisure
• Work

Question 3

What classification of intellectual function would a patient fall under with an IQ of 100+?

Answer 3

Normal

Question 4

What classification of intellectual function would a patient fall under with an IQ of 70-84?

Answer 4

Borderline IQ

Question 5

What classification of intellectual function would a patient fall under with an IQ of 50-69?

Answer 5

Mild LD

Question 6

What classification of intellectual function would a patient fall under with an IQ of 35-49?

Answer 6

Moderate LD

Question 7

What classification of intellectual function would a patient fall under with an IQ of 20-34?

Answer 7

Severe LD

Question 8

What classification of intellectual function would a patient fall under with an IQ of <20?

Answer 8

Profound LD

Question 9

Describe how a patient with borderline intellectual functioning may present.

Answer 9

• Not classified as LD but still vulnerable due to cognitive status
• Living independently
• Subtle communication difficulties
• High-school ‘drop-out’ or in special education
• Difficulty keeping a job, receiving government assistance

Question 10

Describe how a patient with a moderate learning disability may present.

Answer 10

• Basic communication skills
• Requires supervision with self-care
• Living in supported accommodation
• Can engage in a structured day programme or workshop activities
• Community access with staff

Question 11

Describe how a patient with a mild learning disability may present.

Answer 11

• Relative independence in self-care and daily living skills
• Can hold a conversation and engage in the clinical interview
• Abstract concepts e.g. time are difficult
• Requires varying levels of service support
• May have paid employment

Question 12

Describe how a patient with a severe learning disability may present.

Answer 12

• Limited communication
• Motor impairment
• Needs supervision in daily activities
• Living in 24-hour staffed home
• In alternative day programmes with a combination of skills- based and recreational activities

Question 13

Describe how a patient with a profound learning disability may present.

Answer 13

• Requires 24-hour supervised care
• Living either with family or in group home/nursing home
• Multiple medical problems
• Inner world largely unavailable to others because of communication difficulty

Question 14

True or False: a specific learning difficulty (such as dyslexia, dyspraxia, dyscalculia) is a learning disability.

Answer 14

False

Question 15

True or False: emotional behavioural problems are a learning disability.

Answer 15

False

Question 16

True or False: ADHD or ASD is a learning disability.

Answer 16

False

Question 17

True or False: an acquired brain injury in adult life is a learning disability.

Answer 17

False

Question 18

What is the most common cause of inherited learning disability?

Answer 18

Fragile X Syndrome

Question 19

What is the most common genetic cause of learning disability?

Answer 19

Down’s Syndrome

Question 20

What is the most common cause of learning disability worldwide?

Answer 20

Malnutrition

Question 21

What is meant by cross-boundary in the relation to learning disabilities?

Answer 21

A boundary crossing is a deviation from classical therapeutic activity that is harmless, non-exploitative, and possibly supportive of the therapy itself.

Question 22

How would you perform a mental state examination in a patient presenting with a Learning Disability?

Answer 22

• Appearance
• Behaviour
• Speech
• Mood and affect
• Thought
• Perception
• Cognition
• Insight and judgement

Question 23

What psychotropic medication is used in people with learning disability?

Answer 23

• Antidepressants
• Benzos
• Antipsychotics

Question 24

What is the effect of epilepsy on people with severe learning disability?

Answer 24

• More common than the general population (20-30% in comparison to 1%).
• Multiple types exist in one person at the same time
• More chance of being treatment resistant
• Rate of polypharmacy is higher

Question 25

How do you perform a risk assessment in a patient presenting with a Learning Disability?

Answer 25

Assess recent changes in behaviour using information from family members, carers, staff or others involved in the assessment as well as information from relevant records and previous assessments. Take into account the nature, quality and length of their relationship with the person.

Question 26

How does the mental capacity act relate to patients with a learning disability?

Answer 26

The right of people with a learning disability to make their own decisions has not always been respected. Many people have been viewed as incapable because of their label or diagnosis, or were ‘allowed’ to make decisions by those around
them so long as they were seen by others as making the ‘right’ decision. If someone with a learning disability made a decision that was considered to be unwise by their family or people who support them they were often seen as lacking capacity.

Question 27

Describe the ethical principles that apply when caring for people with Learning Disability.

Answer 27

4 key principles: 
– Inclusion
– Choice
– Independence 
– Rights

Question 28

What sex chromosomal abnormality is present in Turner syndrome?

Answer 28

45 XO

Question 29

Name some autosomal dominant disorders.

Answer 29

– Tuberous sclerosis
– Neurofibromatosis
– Sturge–Weber syndrome

Question 30

Name some autosomal resessive disorders.

Answer 30

• Disorders of protein metabolism (hereditary aminoacidurias)
  – PKU
• Disorders of carbohydrate metabolism – Galactosaemia
• Disorders of fat metabolism (lipidoses) – Cerebromacular degeneration
  – Niemann-Pick disease
• Mucopolysaccharidoses – Hurlers disease

Question 31

Name some autosomal resessive disorders.

Answer 31

• Disorders of protein metabolism (hereditary aminoacidurias)
  – PKU
• Disorders of carbohydrate metabolism
  – Galactosaemia
• Disorders of fat metabolism (lipidoses)
  – Cerebromacular degeneration
  – Niemann-Pick disease
• Mucopolysaccharidoses
  – Hurlers disease

Question 32

Name some autosomal resessive disorders.

Answer 32

• Disorders of protein metabolism (hereditary aminoacidurias)
  – PKU
• Disorders of carbohydrate metabolism
  – Galactosaemia
• Disorders of fat metabolism (lipidoses)
  – Cerebromacular degeneration
  – Niemann-Pick disease
• Mucopolysaccharidoses
  – Hurlers disease

Question 33

Name some perinatal causes of learning disabilities.

Answer 33

• Iatrogenic:
– Radiation, chemotherapy, medication

• Infections
– TORCH group

• Delivery
– Anoxic brain damage
– Prematurity

• Others
– Hyperbilirubinaemia
– Foetal Alcohol Syndrome

Question 34

Name some postnatal causes of learning disabilities.

Answer 34

• Infections
• Metabolic
• Endocrine
• Cerebro-vascular
• Toxins
• Trauma
• Neoplasms
• Psychosocial

Question 35

Name some postnatal causes of learning disabilities.

Answer 35

• Infections
• Metabolic
• Endocrine
• Cerebro-vascular
• Toxins
• Trauma
• Neoplasms
• Psychosocial

Question 36

What physical associations are present in patients with Downs syndrome?

Answer 36

• Epilepsy
– Infantile spasms
– Tonic Clonic Seizure,
in middle age
• Hypothyrodism
• Obesity
• Sensoryimpairments
• C-spineabnormalities 7-40% Atlanto Axial Instability
• Recurrent Respiratory Tract and ear infection
• Obstructive sleep apnoea

Question 37

What psychiatric associations are present in patients with Downs syndrome?

Answer 37

• Dementia
• Depression
• Hyperactivity
• Conduct disorder
• OCD
• Autism

Question 38

Define autism.

Answer 38

Autism is a lifelong neurodevelopmental condition, the core features of which are persistent difficulties in social interaction and communication and the presence of stereotypic (rigid and repetitive) behaviours, resistance to change or restricted interests.