Learning Disabilities Flashcards
Intellectual Disability:
what is the ICD 10 Definition?
‘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’
what is the criteria that has to be met in order for some to have an intellectual disability?
- Intellectual impairment (IQ < 70) (e.g., Wechsler Adult Intelligence Scale)
- Social or adaptive dysfunction (Vineland Adaptive Behaviour 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 - Onset in the developmental period (before age 18):
To have an intellectual disability, the onset must be in the developmental period and we count that as being before the age of 18
how od you gather information about someone when assessiong if they have an intellectual disability?
Most of these tests are done by asking someone who knows the individual well, a series of quite detailed questions
what is the prevelence of intellectual disabilities?
•Statistically the prevalence of people with IQ<70 should be 2.5% (2SD from mean) but in practice is 1-2%, because of:
- Differential mortality (the more severe the degree of intellectual 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
As well as diagnosing we also characterize the severity of intellectual disability
Both Intellectual and Adaptive functioning is used to classify severity of LD:
what is mild LD?
IQ: 50 - 69 or functional age 9-12yrs
But in terms of the the functional and adaptive behaviours that you would expect to see in some with a mild learning disability, they tend to be similar to people around nine to twelve years old
Both Intellectual and Adaptive functioning is used to classify severity of LD:
what is moderate LD?
IQ: 35 - 49 or functional age 6-9yrs
Both Intellectual and Adaptive functioning is used to classify severity of LD:
what is severe LD?
IQ: 20 - 34 or functional age 3-6yrs
Both Intellectual and Adaptive functioning is used to classify severity of LD:
what is profound LD?
IQ: <20 or functional age <3yrs
most people with profound learning disability will need a very high level of 24 hour support in order to manage state state
Aetiology of Intellectual Disabilities:
What are the main causes of intellectual disability?
so we tend to break it down into inherited causes, and acquired causes
Aetiology of LD: what are the Inherited causes?
- Single gene: Fragile X (most common), PKU, Retts Syndrome
- Microdeletion/duplication: DiGeorge Syndrome (22q11 – common cause of inherited schizophrenia), Prader-Willi, Angelman syndrome
- Chromosomal abnormality: Down Syndrome (Trisomy 21 – most common genetic cause of learning disability in the UK)
Aetiology of LD: what are the Acquired causes?
- Infective: e.g Rubella, Zika virus (not common in UK)
- Traumatic: hypoxic injury during birth, head injury in childhood
- Toxic: Foetal alcohol syndrome
- Idiopathic: for most patients the cause of LD is unknown
what Health Inequalities are present in those with LD?
- Social exclusion - Harder for them to make friends, reliant on others
- Socioeconomic deprivation - Unable to support themselves financially
- Inaccessible services - Trouble accessing services
- Discrimination - It is not uncommon for people with intellectual disability not to be offered tests because of the distress it might cause, or they will not be offered treatment because of concerns over the difficulties that people would have in managing to accept it or to go along with it
- Challenges to communication - Often challenging describing what is wrong in the first place
- Lack of appropriate knowledge and skills of professionals
- Minimal evidence base from research - minimal evidence base to treat the kinds of problems that we see in people with intellectual disability. People with intellectual disability struggle to consent to taking part in research
what are Common and/or important physical conditions associated with ID?
- Epilepsy – increased incidence and complexity with severity of learning disability (10-50%)
- Sensory impairments – hearing (40 %) and vision (20%), earwax
- Obesity – predisposes to other health problems (Not much control of weigh as other feeding you and letting you out to exercise)
- Gastrointestinal – swallowing problems, reflux oesophagitis, Helicobacter pylorii, constipation
- Respiratory problems – chest infections, aspiration pneumonia
- Cerebral palsy – especially with severe learning disability
- Orthopaedic problems – joint contractures, osteoporosis
- Dermatological and Dental problems- 33% unhealthy gums, for Down’s Syndrome, 80%
what is the commonest cause of mortality in the learning disability population?
Respiratory problems are amongst the commonest causes of mortality in a learning disability population
Why is there a psychiatric specialty for those with ID?
- Higher incidence of psychiatric disorders in those with LD
- More severe the LD - higher prevalence of psychiatric disorder
- People with mild learning disability may present in broadly similar way to the general population
- Presentation of mental illness different especially in moderate-profound LD
- “Difficulties in describing internal world” e.g. less complex delusions
- Those with lower IQ/ communication difficulties often present with ‘challenging behaviour’
- ‘It’s all about baseline’
- Where there is less verbal communication, observable signs are relied on more in making the diagnosis:
- e.g. weight loss, withdrawal, agitation, tearfulness in depression
- behavioural disturbance in psychotic disorder
- Special training for Psychiatrists
- Multidisciplinary working
