Learning Disability Flashcards

1
Q

What term does ICD 10 use for LD?

A

Mental retardation

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2
Q

What term will ICD 11 use for LD?

A

Intellectual disability

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3
Q

What term does DSM V use for LD?

A

Intellectual disability

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4
Q

What defines LD?

A

IQ <70
Presentation in early life - within developmental period
Associated with deficits in social and adaptive functioning

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5
Q

What is the Valuing People 2001’s definition of LD?

A

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

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6
Q

Define Mild LD

A

IQ50-69

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7
Q

Define moderate LD

A

IQ 35-49

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8
Q

Define severe LD

A

IQ 20-34

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9
Q

Define profound LD

A

IQ <20

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10
Q

What does adaptive functioning refer to?

A

How effectively individuals cope with common life demands how well they meet standards of personal independence expected of someone of their age group

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11
Q

How can we measure Adaptive functioning?

A

Vineland Adaptive Behaviour Scale
Information from more than 1 source

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12
Q

When can borderline intellectual functioning be used according to DSM V?

A

When an individuals borderline intellectual functioning if the focus of clinical attention or has an impact on the individuals treatment or prognosis

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13
Q

Characteristics of mild LD

A

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

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14
Q

Characteristics of moderate LD

A

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

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15
Q

Characteristics of severe LD

A

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

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16
Q

Characteristics of profound LD

A

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

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17
Q

Prevalence of LD

A

1-3%

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18
Q

Highest incidence of LD is in which age group

A

School-aged children

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19
Q

Peak incidence of LD

A

10-14 years

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20
Q

M:F ratio of LD

A

1.5:1

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21
Q

Most common type of LD

A

Mild - 85%
Moderate - 10%

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22
Q

How many people with LD have severe LD?

A

4%

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23
Q

How many people with LD have profound LD?

A

1-2%

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24
Q

How many people with LD have MH issues?

A

66%

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25
Correlation of MH issues with LD?
Greater severity correlated with increased chance of MH issues Greater MH issues in those with neurological conditions
26
Which MH problems occur more commonly in mild LD?
Disruptive and conduct disorders
27
What MH problems are higher in severe LD?
ASD Pervasive developmental disorder
28
What sx can occur in people with LD outside the context of a mental disorder?
Hyperactivity Self-injurious behaviour Short attention span
29
How many people with LD have hearing loss?
25-42%
30
Age of death of LD compared to general population
13 years (men) and 20 years (women) earlier than general population
31
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
32
External prenatal factors linked to LD
Infections Exposure to medication, alcohol, drugs and toxins Maternal illness
33
Perinatal factors linked to LD
Premature infants Low birth weight Infections Problems during delivery Newborn complications
34
Post-natal factors linked to LD
CNS infections IC tumours Hypoxic brain injury HI Exposure to toxic agents Psychosocial environment
35
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
36
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
37
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
38
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
39
What is tertiary prevention of?
Helping individual attain their full developmental potential
40
Examples of tertiary prevention for LD
Biopsychosocial support Family support Education Environmental adjustment and aids
41
Who introduced the concept of subcultural handicap?
EO Lewis - 1933
42
What is subcultural mental retardation?
Lower extreme variant of normal IQ distribution in population
43
What did EO Lewis divide LD into?
Pathological Subcultural
44
In which social classes is pathological LD seen in?
Evenly distributed
45
In which social classes is subcultural LD seen in?
V
46
Which type of LD is subcultural LD associated with?
Mild
47
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
48
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
49
What does subcultural LD imply?
Psychosocial causation
50
What is normalisation?
Social principle that aims to enable the intellectually disabled to experience normal patterns of daily life
51
When was principle of normalisation developed and by whom?
In Scandinavia in the 1960s by Bengt Nirje
52
Who furthered the work of normalisation in LD?
Wolf Wolfensberger
53
What did Wolfensberger argue re normalisation?
Many of the problems with institutions arose from the way they were designed and run. Residents were dehumanised
54
Who created Social Role Valorisation?
Wolfensberger
55
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.
56
How has SRV been developed?
Includes key ideas of respect, opportunities, development of competence, independent living and individual choice
57
What key principles for LD were set out in the Valuing Paper 2001?
Rights Independence Choice Inclusion
58
What did institutionalisation start being phased out?
1980s
59
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
60
Prevalence of LD amongst offenders
1-10%
61
How many offenders have a LD?
30%
62
How many prisoners have IQ <70
7%
63
How many prisoners have IQ <80
25%
64
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.
65
What is the aim of criminal justice liaison teams?
Link between criminal justice agencies and health and social care services
66
Prevalence of MH problems in adults with LD
30-50%
67
Prevalence of epilepsy in LD patients
22.1%
68
Poor eyesight in LD patients?
19% 8% - general population
69
How many LD patients are obese?
23.6%
70
Prevalence of schizophrenia in LD patients
3%
71
Prevalence of bipolar in LD patients
1.5%
72
Prevalence of depression in LD patients
4%
73
Prevalence of agoraphobia in LD patients
1.5%
74
Prevalence of OCD in LD patients
2.5%
75
Prevalence of autism in LD patients
7%
76
Prevalence of severe problem behaviour in LD patients?
10-15%
77
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
78
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
79
What is PAS-ADD?
Psychiatric Assessment Schedule for Adults with Developmental Disabilities
80
Structure of PAS-ADD
Semi-structured interview Allows diagnoses under ICD 10
81
What is mini PAS-ADD used for?
Determining psychiatric sx without need for interviewing
82
What is PAS-ADD checklist?
Questionnaire for carers and staff to help decide if individual needs further assessment
83
Risk of schizophrenia in LD
3x increase compared to general population
84
Differences in schizophrenia in LD
Age of onset earlier (23) Severe LD: unexplained aggression, bizarre behaviour, increased mannerism
85
Sx of schizophrenia in moderate LD
Hallucinations with persecutory delusions may lead to fear, social withdrawal and aggressive outbursts
86
Which LDs is self-talk common?
Downs Autism
87
Conditions associated with psychosis
Ushers Velo-cardio-facial Prader WIlli
88
What does Ushers syndrome consist of?
Retinitis pigmentosa Congenital deafness Vestibulo-cochlear ataxia LD - 23% Psychosis - 15%
89
Who suggested Velo-cardio-facial syndrome might be associated with high rate of psychotic illness?
Goldberg et al 1993
90
Clinical features of bipolar in LD
Elevation of mood not expressed verbally Hyperactivity Wandering Mutism Unexplained challenging behaviour
91
Sx of depression in LD
Vegetative symptoms Observable depressed mood Irritability Self-injurious behaviour Marked biological sx
92
Behavioural markers of depression in LD patients who are nonverbal
Self-absorption Regressive behaviours; pica, rocking Psychomotor retardation Tearfulness Refusal to eat Sleep disturbance
93
Which type of LD might have suicidal thoughts?
Borderline-moderate LD
94
What anxiety disorders are children with LD more likely to have?
Simple fears e.g. loud noises, the dark
95
Most commonly reported anxiety disorder in LD
Simple phobia Social phobia GAD
96
What is the most common compulsion in LD patients with OCD
Ordering
97
Genetic associations of social anxiety disorder
Fragile X
98
Genetic association with OCD and LD
Prader Willi Rubinstein-Taybi
99
Genetic associated with phobias and LD
Williams Syndrome
100
Genetic association with LD and compulsive behaviour
Cornelia de Lange syndrome
101
Prevalence of CD and ODD in mild/borderline LD
30%
102
What influences antisocial behaviour and low verbal intelligence skills in LD?
Family Sociocultural deprivation
103
How many children with autism have LD?
75-80%
104
What psychiatric sx is autism associated with?
Emotional and behavioural problems ADHD OCD
105
How many people with mild LD have ASD?
10%
106
How many people with severe LD have ASD?
40%
107
Rate of dementia in those aged 30-39 with Downs
1 in 50
108
Rate of dementia in those aged 40-49 with Downs
1 in 10
109
Rate of dementia in those aged 50-59 with Downs
1 in 3
110
Rate of dementia in those over 60 with Downs
>50%
111
Why is diagnosis of dementia difficult in LD?
Pre-existing baseline cognitive, functional & behavioural impairment Dementia presents atypically in LD
112
Behavioural problems noticeable in patients with dementia who have LD
Nocturnal confusion Transient psychosis Late-onset epilepsy
113
Medical risk factors of dementia in LD
Hx of HTN, ischaemic episodes, neurological sx, organic brain damage FHx of dementia
114
What is the definition of challenging behaviour
Culturally abnormal behaviour of such intensity, frequency or duration that physical safety of the person or others is in jeopardy, or behaviour which is to seriously limit use of or result in person being denied access to ordinary community facilities
115
What is challenging behaviour a result of?
Communication of ones frustration, anxiety or stress
116
Criteria for clinically significant challenging behaviour
Behaviour caused more than minor injuries to themselves or others or destroyed immediate living or working environment At least weekly behaviours requiring intervention by staff; placed them in danger; caused damage that could not be rectified; caused at least 1 hour of disruption Behaviour has caused over a few minutes disruption on at least a daily basis
117
Predisposing factors for behavioural problems in LD
Sensory disabilities Poor communication Epilepsy Physical illnesses Medication Limited coping strategies Abuse Environmental factors
118
How many people with LD have challenging behaviour?
7%
119
Rate of challenging behaviour in hospital settings for LD
14%
120
Age range of challenging behaviour
15-34
121
What is aggressive behaviour often a feature of?
Mental disorder such as psychosis, depression or antisocial PD
122
Which genetic conditions show aggressive behaviour?
Fragile X Prader Willi Klinefelters
123
How many people with LD at some point display self-injurious behaviour?
10-50%
124
What influences prevalence of self-injurious behaviour in LD?
Sensory deficits Profound D Autism Limited expressive communication skills Ambulatory difficulties
125
Which type of LD sees more self-injurious behaviour?
Moderate Severe
126
Most common age group in which self-injurious behaviours occur?
10-30
127
Peak ages of self-injurious behaviour in LD
15 and 20 years of age
128
Common forms of self-injurious behaviour in LD
Head banging Banging other body parts Punching Biting Hair pulling Pica
129
Which genetic conditions increase risk of self-injurious behaviour?
Prader-Willi Fragile X Tourettes Smith-Magenis Cornelia de Lange Lesch-Nyhan
130
Who identified that endogenous opioids produce morphine-like effect that accounts for development of some self-injurious behaviour?
Wiseley et al 2002
131
What are the hypothesis for self-injurious behaviour and endorphins
Self-injurious behaviour stimulates production of endogenous opioids creating analgesic effect and pleasurable feelings and euphoria.
132
What backs up the theory of self-injurious behaviour and endorphins?
Opiate blockers and endogenous opiates serotonin and dopamine reduce self-injurious behaviour
133
How many patients with Prader WIlli show self-injury?
81%
134
Most prevalent form of self-injury in Prader Willi?
Skin picking
135
Most common mode of self-injury in Lesch-Nyan?
Biting of lips and fingers
136
How many children aged 1-4 have pica?
30%
137
Prevalence of pica in adults with LD in hospital and the community
10-20% - hospital 5% - community
138
Risk factors for pica
Male Poor cognitive functioning Autism Non-verbal
139
Protective factor for pica?
Good level of ADLs
140
Age and pica?
Less common in advancing age
141
Treatment of pica
Based on behavioural principles
142
What type of SEs are people with LD more susceptible to?
CNS side effects
143
What are antipsychotics used for in patients wit LD?
Psychosis Acute behavioural disturbance Reduce stereotypies
144
What are antidepressants used for in patients with LD?
Depression OCD Self-injury Anxiety
145
What are anticonvulsants useful for in LD patients?
Episodic dyscontrol Epilepsy Rapid cycling mood disorder Mixed affective states
146
What is Lithium used for in LD patients?
Bipolar Augmentation of antidepressant Reducing agressive outbursts Self-harm
147
What is required before Lithium can be started in LD patients
Baseline EEG, renal function and FBC
148
Why is extra monitoring required in LD patients on Lithium?
It can induce seizures in those with epilepsy
149
Which patients with LD are more prone to lithium toxicity?
Pre-existing EEG changes
150
Common causes of dysphagia in LD
Medications altering levels of alertness Medications altering muscle tone/coordination e.g. baclofen, benzos Antipsychotic medications that delay swallow process or increase salivation
151
Who carried out a survey on therapies used in LD?
Nagel and Leiper
152
What did Nagel and Leiper find re therapies used in LD?
80% use behavioural interventions 35% use CBT 17% use psychodynamic methods
153
What conditions is CBT helpful for in LD?
Anxiety Depression Anger management Sex offending
154
What are behavioural treatments useful for?
Teach basic skills like feeding, toileting Establishing normal behavioural patterns Learning complex skills like social skills Changing maladaptive patterns of behaviour
155
What can behavioural analysts be used for?
Analyse challenging behaviour and develop management guidelines
156
Behavioural phenotype of Downs in childhood
Oppositional, attention deficit problems
157
Behavioural phenotype of Downs in adulthood
Early onset dementia
158
Behavioural penotype of Fragile X
Shy Gaze avoidance Social anxiety Schizotypal Hyperactive
159
Behavioural phenotype of Prader Willi
Food obsession Insatiable appetite Hyperphagia Obesity Impulsivity Skin picking Aggression OCD
160
Behavioural phenotype of Smith Magenis
Hyperactive Impulsive Aggressive Stereotypic movements Self0injury
161
Behavioural phenotype of Williams syndrome
Elfin-face Endearing Affectionate Phobias & anxiety Hyperactivity Sleep disorder Hyperacusis Visuospatial/motor deficits
162
Behavioural phenotype of Cornelia de Lange
Self-injury
163
Behavioural phenotype of Lesch Nyhan
Compulsive and severe self-injury
164
Behavioural phenotype of velo-cardio facial syndrome
Schizophrenia Schizoaffective disorder
165
Behavioural phenotype of Retts syndrome
Stereotypic hand movements Reduced interest in play in early infancy followed by autistic like sx
166
Behavioural phenotype of Angelman syndrome
Puppet like gait Attraction to water Happy disposition Laughing at minimal provocation
167
Behavioural phenotype of Cri du chat
Inappropriate laughter Cat-like cry during infancy
168
Behavioural phenotype of Sanflippo syndrome
Prominent sleep disorder
169
Most common genetic cause of LD
Downs
170
Major risk factor of having Downs child
Maternal age over 40
171
Incidence of Downs
1/1000 live births
172
Incidence of Downs in women <30
1:2500
173
Incidence of Downs in women >40
1:80
174
Incidence of Downs in women aged >45
1:32
175
How many Downs are due to non-disjunction
92-95%
176
How many Downs are due to Robertsonian translocation
2-4%
177
What happens in Robertsonian translocation for Downs
Long arm of chromosome 21 is attached to another chromosome, usually 14.
178
What is Mosaic Downs?
Mixture of normal and trisomic cell lines
179
How many cases are Mosaic Downs?
1-2.5%
180
Signs of Downs in newborn
General hypotonia Oblique palpebral fissures Small flattened skull High cheekbones Protruding tongue
181
General features of Downs
Short Overweight Hypotonia Upward slanting palpebral fissures Flat wide nasal bridge High arched palate Instability of atlanto-axial joints Close togethre eyes Brushfields spots Epicanthic folds ow set ears Simian crease Syndactyly Clincodactyly
182
What are Brushfields spots
Grey or light yellow spots of the iris
183
What is syndactyly?
Webbed fingers
184
What is clinodactyly?
Incurving of fingers
185
Congenital GI defects in Downs
Oesophageal atresia, Hirschprungs Inguinal and umbilical hernias
186
Eye defects in Downs
Strabismus Myopia
187
Hearing defects in Downs
Otitis media Sensorineural deafness
188
Endocrine defects in Downs
Hypothyroidism Diabetes
189
Average IQ in Downs
50
190
When does mental development appear to progress normally in Downs?
Birth to 6 months
191
When do IQ scores decrease in Downs
From near normal at 1 year to about 30 at older ages
192
Neuropathology in Downs
Changes similar to Alzheimers in those >40 High incidence of senile plaques and neurofibrillary tangles
193
What scale can be used for dx of dementia in Downs
Dementia Questionnaire for persons with mental retardation
194
Epilepsy in Downs
10%
195
Epilepsy in those >40 years in Downs
40%
196
Epilepsy in those with Downs and Alzheimers
80%
197
Cause of death <1 year of age in Downs
Congenital heart disease
198
When is there highest absolute risk of death in Downs?
<1 year
199
Cause of death up to age 30 in Downs
Bronchopneumonia