Learning disability Flashcards
Learning disability
Developmental condition characterised by global impairment of intelligence and significant difficulties in socially adaptive functioning
Significant reduced ability to understand new/complex information
Reduced ability to cope independently
Began before adulthood, with lasting effect on development
Not a psychiatric diagnosis, but are at more risk of psych co-morbidities
More common males; 3:2
Prevalence rising partly due to increased survival of very premature babies
Causes of LD
Antenatal
- Genetics (e.g. PKU, Downs, Fragile X)
- Foetal alcohol syndrome
- Drugs
- Medications
- Smoking
- Infection (e.g. rubella)
Perinatal
- Neonatal hypoxia
- Birth trauma
- Hypoglycaemia
- Prematurity
Postnatal
- Social deprivation
- Malnutrition
- Lead
- Infections (e.g. meningitis)
- Head injury
Often, no specific cause found
Clinical features
Presents in childhood
Abilities can be: reduced, delayed, absent
Domains affected: language, schooling, motor ability, independent living, employment, social ability
Behavioural difficulties may arise due to combo of comms problems, psychiatric or physical illness, epilepsy or suboptimal support for individual needs.
Behavioural phenotypes: commonly recognised behaviours in particular syndrome (e.g. self harm in Lesch-Nyhan syndrome)
Mild, moderate, severe and profound LD
Mild: IQ - 50-69
- Language is usually good (development may be delayed)
- Problems may go undiagnosed
- Individuals struggle through school
- May be labelled as having behavioural problems
- May live and work independently with appropriate support
Moderate: IQ - 35-50
- Language and cognitive abilities are less developed
- Reduced self-care abilities and limited motor skills may need support
- May need long-term accommodation with their family or in a staff-supported group home
- Simple practical work should be achievable in supported settings
Severe: 1Q - 20-35
- Marked impairment of motor function
- Little/no speech during early childhood (may develop during school years)
- Simple tasks can be performed without assistance
- Likely to require their family home or 24-hour staffed home
Profound: IQ - <20
- Severely limited language, communication, self-care and mobility
- Significant associated medical problems
- Usually require higher levels of support
Complications/issues with LD
- Often have increased physicla morbidity and mortality
- Resp infections are a leading cause of death
- Many have comorbid mental health problems and autism-spectrum disorders
- Increased risk of mood and anxiety disorders and schizophrenia
- Diagnostic overshadowing - attributing everything to the LD (e.g. changes in behaviour/mental state dismissed); pts may express physical illness as agitation/irritability
Differentials for LD
ASD
Epilepsy
Adult brain injury/progressive neurological conditions - LD occur when brain is still developing, must determine whether intellect was impaired before adult illness
Psychiatric - severe, enduring mental illness, e.g. SCZ can cause chronic cognitive impairment, reduced social functioning and associated speech disorders
Educational disadvantage/neglect
Investigations for LD
IQ testing - is there global impairment; Weschsler Adult Intelligence Scale (WAIS)
Adaptive/social functioning - establish via interview; ask about skills, strengths, weaknessess; adaptive behaviour assessment system (ABAS II)
Detailed developmental history from parents and clin exam - incl. details re pregnancym birth language, motor skills development, schooling, emotional development, relationships; school reports
Exclude reversible disturbances (FBC, U&E, LFT, TFT, bone profile)
Ix for associated physical illness (e.g. EEG for epilepsy)
Genetic testing is appropriate
Management
MDT - Psychologist, OT, nurse, Psychiatrist, SLT
Prevention - education (e.g. risks of alcohol during pregnancy), improved antenatal/perinatal care, genetic counselling, early detection and treatment of reversible causes (e.g. excluding dietary phenylalanine in babies with PKU)
Treat physical comorbidity - poor diet, self neglect, epilepsy, sensory impairment
Treat psych comorbidity - difficult to diagnose, because of cognitive, language and communication difficulties; higher prevalence of psychotic disorder, mood disorder and autism; pts are particular sensitive to medication (slower dose titration)
Educational support - Statement of special educational needs allow appropriate support; mainstream or specialised school; to maximise child’s potential
Other social support - choice board: promotes choice-making and fosters sense of control/independence; self help board; schedule board calendar: structure to persons day; support network for specific help with daily living, housing, employment and finance; assess carers need
Psychological therapy - counselling, group therapy, modified CBT; behavioural therapy; ABC approach (identifying antecedents, behaviour, consequences), complementary therapies e.g. art, music therapy)
