Learning disability

Question 1

Definition of intellectual disability

Answer 1

• Condition of arrested/ incomplete development of the mind
• Characterised by impairments during developmental periods
• Causes altered overall level of intelligence → cognitive, language, motor and social abilities

Question 2

Criteria for intellectual disability

Answer 2

1. Intellectual impairment (IQ <70 → e.g. Wechsler dult Intelligence scale
2. Social or adaptive dysfunction (communication, self-care, home living, social skills, community use, self-direction, health and safety)
3. Onset of disorder (before age of 18)

Question 3

Severity of learning disability

Answer 3

• Mild → IQ 50-69 or functional age 9-12
• Moderate → IQ 35-49 or function age 6-9
• Severe → IQ 20-34 or functional age 3-6
• Profound → IQ <20 or functional age <3

Question 4

Aetiology of learning disability

Answer 4

• Inherited
  
  • Single gene → fragile x, PKU, Retts sybdrome
  • Microdeletion/ duplication → Di George syndrome, Prader-Willi, Angelman syndrome
  • Chromosomal abnormality → Down syndrome
• Acquired
  
  • Infective → rubella, zika
  • Traumatic → hypoxic brain injury in childhoo
  • Toxin → fetal alcohol syndrome
• Idiopathic → most common is unknown

Question 5

Health inequalities of those with learning difficulties

Answer 5

• Social exclusion
• Socioeconomic deprivation
• Inaccessible services
• Discrimination
• Challenge to communication
• Lack of appropriate knowledge and skills in professionals
• Minimal evidence base for research → poor health outcomes

Question 6

Comorbid physical conditions with learning difficulties

Answer 6

• Epilespy → increased incidence and severity
• Sensory impairment → hearing and vision
• Obesity → risk factor for other problems
• GI → swelling problems, reflux oesophagi’s, H. pylori disease, constipation
• Respiratory → chest infections, aspiration pneumonia
• Cerebral palsy
• Orthopedic problems → joint contractors, osteoporosis
• Derm and dental problems → particular gum disease

Question 7

Why is psychiatric care required for those with LD

Answer 7

• Higher incidence of psychiatric conditions in those with LD
• More severe form of mental illness in LD
• Altered presentation of mental illness in those with moderate to severe LD
• Difficulties explaining their thoughts → “making sense of their internal world’’
• Present with more ‘challenging behaviours’
  
  • Lower IQ/ difficulty communicating
• Detailed understanding of non-verbal signs to make diagnosis → weight loss, agitation, withdrawal, depression, behaviour disturbances
• Requires specialty training
• MDT approach

Question 8

Roles of the psychiatric in LD care

Answer 8

• Assessment of disorders
  
  • Presence and severity
  • Aetiology
  • Associated comorbidities
  • Pscyho-social assessment
  • Causes and consequences of their disorder

Question 9

Presentation of common comorbid conditions with learning disability

Answer 9

• Schizophrenia and psychosis
  
  • Higher prevalence in ld
  • Causes personality change, altered functional abilities
  • Common to have ‘self-talk’
• Mood disorder
  
  • Increased incidence
  • Less likely to complain mood changes
  • Noted by change in behaviours
• Anxiety disorder
  
  • Ritualistic behaviours and obsessional traits
  • Can be described by third party as compulsive behaviours
• Autism → at least ½ of those with LD
• Overactivity syndromes
  
  • Higher incidence of ADHD
  • Can be overactivity, distractibility and impulsivity without extent of ADHD
• Challenging behaviour/ self-injury
• Forensive
  
  • Higher incidence of arson and sexual behaviours with more severe disorder

Question 10

Diagnostic overshadowing

Answer 10

• Presenting symptom put down to learning disability rather than seeking additional and potentially treatable causes
• E.g
  
  • social cause → change in carer, lack of support
  • Psychological → bereavement, abuse
  • Physical → pain, discomfort from toothache, constipation, reflux and deteriorating senses
  • Psychiatric → depression, anxiety, psychosis, dementia

Question 11

General guidelines for professionals

Answer 11

• Time and patience to get history
• Value what’s being said
• Recognise non-verbal cues
• Use alternative communication strategies (if verbal is difficult) → sign language, symbols
• Personal communication → appropriate, simple, short and free of jargon
• Time to build rapport and trust
• Good knowledge and support of patients carers