Learning Disability Flashcards
What term does ICD 10 use for LD?
Mental retardation
What term will ICD 11 use for LD?
Intellectual disability
What term does DSM V use for LD?
Intellectual disability
What defines LD?
IQ <70
Presentation in early life - within developmental period
Associated with deficits in social and adaptive functioning
What is the Valuing People 2001’s definition of LD?
Significantly reduced ability to understand new or complex information or learn new skills
Reduced ability to cope independently
Impairment that started before adulthood with lasting effect on development
Define Mild LD
IQ50-69
Define moderate LD
IQ 35-49
Define severe LD
IQ 20-34
Define profound LD
IQ <20
What does adaptive functioning refer to?
How effectively individuals cope with common life demands how well they meet standards of personal independence expected of someone of their age group
How can we measure Adaptive functioning?
Vineland Adaptive Behaviour Scale
Information from more than 1 source
When can borderline intellectual functioning be used according to DSM V?
When an individuals borderline intellectual functioning if the focus of clinical attention or has an impact on the individuals treatment or prognosis
Characteristics of mild LD
Delay in acquiring speech but can develop social and communication skills
Main problems in academic settings but can learn academic skills
Independent with self-care
May be in paid employment
Characteristics of moderate LD
Delays in acquiring speech with deficits in use of language and comprehension
Not able to achieve academically
Can profit from training in social and occupational skills
May achieve self-maintenance in unskilled/semiskilled work with appropriate support and supervision
Majority have identifiable organic aetiology
Characteristics of severe LD
Poor motor development, social skills and minimal verbal speech
Marked motor impairment and associated deficits
May contribute partially to self-maintenance under close supervision
May adapt well to supervised living situations and perform work-related tasks under supervision
Characteristics of profound LD
Comprehension and use of language very limited
Will require assistance with most ADLs
Require nursing care or life support under structured environment
Organic aetiology is usually clear
Commonly associated with neurological and physical disabilities affecting mobility
Other conditions such as epilepsy, visual/hearing impairments
Prevalence of LD
1-3%
Highest incidence of LD is in which age group
School-aged children
Peak incidence of LD
10-14 years
M:F ratio of LD
1.5:1
Most common type of LD
Mild - 85%
Moderate - 10%
How many people with LD have severe LD?
4%
How many people with LD have profound LD?
1-2%
How many people with LD have MH issues?
66%
Correlation of MH issues with LD?
Greater severity correlated with increased chance of MH issues
Greater MH issues in those with neurological conditions
Which MH problems occur more commonly in mild LD?
Disruptive and conduct disorders
What MH problems are higher in severe LD?
ASD
Pervasive developmental disorder
What sx can occur in people with LD outside the context of a mental disorder?
Hyperactivity
Self-injurious behaviour
Short attention span
How many people with LD have hearing loss?
25-42%
Age of death of LD compared to general population
13 years (men) and 20 years (women) earlier than general population
Genetic factors linked to LD
Sex chromosome disorders
Deletions and duplications
AD and AR disorders
X-linked recessive and dominant conditions
Polygenetic conditions (neural tube defects, pervasive developmental disorders)
Mitochondrial and metabolic disorders
External prenatal factors linked to LD
Infections
Exposure to medication, alcohol, drugs and toxins
Maternal illness
Perinatal factors linked to LD
Premature infants Low birth weight Infections Problems during delivery Newborn complications
Post-natal factors linked to LD
CNS infections IC tumours Hypoxic brain injury HI Exposure to toxic agents Psychosocial environment
Examples of psychosocial environments linked to LD
Family instability
Frequent moves
Multiple but inadequate carers may deprive infant of emotional relationships leading to failure to thrive
Primary prevention of LD
Immunization
Provision of Folic acid at time of conception
Good medical follow-up, identification and intervention to reduce risks during pregnancy, delivery and childhood
Lead intoication
Iodine deficiency
Fetal alcohol syndrome
Acidents at home and traffic accidents
What is secondary prevention of LD?
Early recognition, diagnosis, good medical care and rehab of injuries or diseases that can avoid or prevent permanent damage which could lead to development of LD
Examples of secondary prevention of LD
Screening and early treatment f congenital hypothyroidism and PKU
Planning or genetic counselling after birth of child with genetic disorder
What is tertiary prevention of?
Helping individual attain their full developmental potential
Examples of tertiary prevention for LD
Biopsychosocial support
Family support
Education
Environmental adjustment and aids
Who introduced the concept of subcultural handicap?
EO Lewis - 1933
What is subcultural mental retardation?
Lower extreme variant of normal IQ distribution in population
What did EO Lewis divide LD into?
Pathological
Subcultural
In which social classes is pathological LD seen in?
Evenly distributed
In which social classes is subcultural LD seen in?
V
Which type of LD is subcultural LD associated with?
Mild
Features of subcultural LD
Mild More common in low socioeconomic groups Family members may have borderline IQ Dysmorphic characters less likely Syndromic features not seen Behavioural phenotypes rare
Features of pathological LD
Moderate, severe or profound type Evenly distributed across social classes Family members have normal IQ Dysmorphic features common Syndromic features seen Behavioural phenotypes are frequent
What does subcultural LD imply?
Psychosocial causation
What is normalisation?
Social principle that aims to enable the intellectually disabled to experience normal patterns of daily life
When was principle of normalisation developed and by whom?
In Scandinavia in the 1960s by Bengt Nirje
Who furthered the work of normalisation in LD?
Wolf Wolfensberger
What did Wolfensberger argue re normalisation?
Many of the problems with institutions arose from the way they were designed and run.
Residents were dehumanised
Who created Social Role Valorisation?
Wolfensberger
What did Wolfensberger suggest via SRV?
Poor attitudes towards people with LD could be countered through inclusion and opportunities to take on valued social roles.
How has SRV been developed?
Includes key ideas of respect, opportunities, development of competence, independent living and individual choice
What key principles for LD were set out in the Valuing Paper 2001?
Rights
Independence
Choice
Inclusion
What did institutionalisation start being phased out?
1980s
Factors to protect against isolation in the community of those with LD
Development of robust community services with person-centred approach
Collaborative working between primary care, health and social services
Prevalence of LD amongst offenders
1-10%
How many offenders have a LD?
30%
How many prisoners have IQ <70
7%
How many prisoners have IQ <80
25%
What did Bradley’s report on review of people with MH problems or LD in CJS state in 2009?
More information needs to be available on needs and abilities of people with LD in all stages of the CJS.
What is the aim of criminal justice liaison teams?
Link between criminal justice agencies and health and social care services
Prevalence of MH problems in adults with LD
30-50%
Prevalence of epilepsy in LD patients
22.1%
Poor eyesight in LD patients?
19%
8% - general population
How many LD patients are obese?
23.6%
Prevalence of schizophrenia in LD patients
3%
Prevalence of bipolar in LD patients
1.5%
Prevalence of depression in LD patients
4%
Prevalence of agoraphobia in LD patients
1.5%
Prevalence of OCD in LD patients
2.5%
Prevalence of autism in LD patients
7%
Prevalence of severe problem behaviour in LD patients?
10-15%
Difficulties in diagnosing patients with LD with psychiatric diagnoses
Current classifications based on studies that exclude LD patients
Deficits in language and abstract thinking make emotional sx more difficult to identify
MH problems can present differently
What is diagnostic overshadowing?
Once a diagnosis is made of a major condition, there is a tendency to attribute all other problems to that diagnosis, leaving co-existing conditions undiagnosed
What is PAS-ADD?
Psychiatric Assessment Schedule for Adults with Developmental Disabilities