Learning disabilities

Question 1

Define what an intellectual disability is

Answer 1

A condition of incomplete or arrested development of the mind, which is especially charaterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence - ie cognition, language, motor and social abilities

ICD-10

Question 2

What are the criteria for diagnosis of an intellectual disability

Answer 2

In order for a diagnosis to be made - patients must have:

1) Impaired intelligence - an IQ < 70
2) Social or adaptive dysfunction
3) Onset in the developmental period - ie under 18 y.o

Question 3

How is intelligence impairment calculated in the diagnosis of intellectual impairment?

Answer 3

IQ tests - Wechsler Adult Intelligence scale

IQ more than 2 S.D below the mean score of 100 - ie <70

Question 4

One of the criteria for a diagnosis of intellectual impairment is social or adaptive dysfunction

What scoring system is used to calculate this?

What results are in keeping with a diagnosis of intellectual impairment?

Answer 4

VABS - Vineland Adaptive Behaviour Scale

Deficits / impairments in 2 or more of the following:

communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure & work

Question 5

What proportion of the population:

a) have an IQ <70
b) have a learning disability

Why are these not equal?

Answer 5

a) 2.2% - because below 2SD off the mean (lecture wrong)
b) 1-2% of population have LD

Not equal because of 2 reasons:

• learning disability associated with higher mortality
• there are people who have IQ <70 who function normally within their environment thus dont have a LD

Question 6

How is the severity of a learning disability classed?

Answer 6

Both intellectual and adaptive functioning are used to grade the severity of a learning disability:

Mild LD = IQ 50-69 / functional age 9-12 years

Moderate LD = IQ 35-49 / functional age 6-9 years

Severe LD = IQ 20-34 / functional age 3-6 years

Profound LD = IQ < 20 / functional age < 3 years

Question 7

Give an overview of the aetiology of learning disabilities (ie the groups of causes)

Answer 7

Can be Inherited, acquired or idiopathic

Inherited:

• Single gene
• Microdeletion / duplication
• Chromosomal abnormality

Acquired:

• Infective
• Toxic
• Traumatic

Question 8

Give examples of inhrited causes of Learning disabilities

Answer 8

Inherited causes of LD…

Single gene:

• Fragile X
• PKU (phenylketonuria)
• Retts syndrome

Microdeletion / duplication:

• DiGeorge syndrome
• Prader-Willi
• Angelman syndrome

Chromosomal abnormality:

• Down Syndrome

Question 9

What are the acquired causes of LD?

Answer 9

Acquired causes of LD

Infective:

• rubella
• zika virus

Toxin:

• foetal alcohol syndrome

Trauma:

• hypoxic injury in birth
• head injury in childhood

Question 10

What health inequalities are faced by those with learning disabilities?

Answer 10

Social exclusion

Socioeconomic deprivation

Inaccessible services

Discrimination

Challenges to communication

Lack of appropriate knowledge and skills of professionals

Minimal evidence base from research

Question 11

What health problems are associated with intellecual disability?

a) neurological, sensory
b) Gastrointestinal
c) Respiratory
d) Orthopaedic
e) Dermatological & dental

Answer 11

a) Neurological, sensory impairments

• epilepsy, hearing/vision impairments, cerebral palsy

b) Gastrointestinal

• obesity, dysphagia, reflux oesophagitis, constipation, H. pylorii infection

c) Respiratory

• pneumonia (especially aspiration pneumonia)

d) Orthopaedic

• joint contractures, osteoporosis

e) Dental

• unhealthy gums (80% of Down syndrome patients)

Question 12

What is the relationship between learning disabilities and mental health problems?

Answer 12

Mental health problems are more common in those with LD

In fact - the more severe the LD - the higher the prevalence of mental health problems

Question 13

How is psychiatric assessment for a mental health disorder different in those with learning disabilities than in other patients?

Answer 13

Patients with LD are less likely to complain of and be able to communicate mood changes

This means there is a greater emphasis on noting behavioural change and negative symptoms

eg a patient with LD who has OCD may be unable to communicate their obsessions but would have marked ritualistic compulsive behaviour

Question 14

Are those with LDs more or less likely to commit a crime?

Answer 14

Just as likely overall as the rest of the population

But people with LD are more likley to commit certain crimes - such as arson and sexual crimes

however these are usually things like exhibitionism - that are carried out more due to a lack of inhibition or understanding rather than genuine sexual intent