Learning disability Flashcards
Define general learning disabilities
Lower intellectual ability (IQ <70)
Significant impairment of social or adaptive functioning
Onset in childhood (<18 years)
Define specific learning disability
the skill described is more delayed than would be expected for the child’s level of cognitive ability
The person has difficulty in one area but has no problem with learning in other areas
Give examples of specific learning disabilities
Dyslexia (80%): language processing, speaking, reading, writing
Dyspraxia: physical coordination
Dyscalculia: disorders related to maths, numbers, concepts, reasoning
Dysgraphia: writing, vocabulary, spelling, grammar, memory
What are the causes and risk factors of learning disabilities
55-75% have physical causes
Low socioeconomic status (MOST COMMON)
Neurodevelopmental disorders: Autism spectrum disorder, ADHD
Chromosomal and genetic anomalies: Down’s syndrome, William’s syndrome, Rhett syndrome, fragile X syndrome
Non-genetic congenital malformations: spina bifida, hydrocephalus, microcephaly
Prenatal exposure: alcohol, sodium valproate, congenital rubella infection, zika virus
Birth complications that would results in hypoxic brain injury/cerebral palsy e.g. shoulder dystocia
Extreme prematurity (<33 weeks)
Childhood illness: meningitis, encephalitis, measles
Childhood brain injury
Childhood neglect and/or lack of stimulation in early life
What is the epidemiology of learning disabilities
3M : 2F ratio
1.1 million people live in England with a learning disability
What is overshadowing and give examples of where this may occur
when a patient’s presenting symptoms are assumed to be related to their LD rather than another potential treatable cause
Physical problems- delirium, pain or discomfort e.g. from infections, toothache, constipation, reflux oesophagitis, deterioration in vision or hearing
Psychiatric cause- depression, anxiety, psychosis, dementia
Social cause- change in carers or routine, bereavement, abuse
What are the most common comorbidities with learning disabilities
Epilepsy
Sensory impairment- hearing, poor visual acuity
Psychiatric: autism, mood disorders, schizophrenia
What classifies mild intellectual disability
IQ 50-69
Often identified at later stage
Difficulties in academic work (reading + writing) but greatly helped by educational programs
Capable of unskilled or semi-skilled manual labour
Able to live independently or with minimal support
What classifies moderate intellectual disability
IQ 35-49
Language and comprehension limited
Self-care and motor skills impaired (may need supervision)
May able to do some practical work with supervision
Usually unable to live completely independently
What classifies severe intellectual disability
IQ 20-34
Marked degree of motor impairment
Little or no speech during early childhood, may learn to talk in school-age period
Capable of only elementary self-care skills
May be able to perform simple tasks under close supervision
What classifies profound intellectual disability
IQ <20
Severely limited ability to communicate needs
Severe motor impairment with restricted mobility and incontinence
Little or no self-care
Often need residential care
What are the differentials for learning disabilities
Autism spectrum disorder
Epilepsy
Adult brain injury
Psychiatric e.g. schizophrenia
Educational disadvantage/neglect
What investigations should be done for learning disabilities
- Assess adaptive function: Adaptive Behaviour Assessment System (ABAS-II) + clinical interview + physical exam + school reports
- Assess intelligence quotient (IQ): Wechsler Intelligence Scale for Adults (WAIS) and for children (WCIS) (IQ score = mental age/chronological age)
(Bloods: FBC, U&Es, LFTs, TFTs, bone profile)
What is the management for first presentation of learning disability
Refer to the local community learning disability service/team
- Children- refer to (Local) Paediatrician, Child Psychiatrist
- Adults- community with Local Authority Community Learning Disability services
→ specialist assessment, diagnosis, support, interventions
MDT approach: psychologists | Psychiatrists | Behavioural analysts | Nurses | Social care staff | SALT | educational staff | occupational therapists | physiotherapists | physicians | paediatricians | pharmacists
What is the long-term management for learning disabilities
Bio: treat comorbidities, melatonin for poor sleep-wake cycles
Psycho
- Behavioural therapy: ABC (Antecedents, behaviour, consequences)
- Counselling, group therapy, modified CBT, psychodynamic, family therapy
- Creative/complimentary therapy (art, drama, aroma)
Social:
Clinical psychologist referral (access to benefits, determining capacity or fitness to plead)
?maltreatment or exploitation → safeguarding referral
EHCP (Education and Health Care Plan) - AKA SENCO
Occupational support (engaging in community activities, paid or voluntary work)
Choice boards, scheduling boards, self-help boards
Communication aids
Charities: SCOPE disability
Carer support
