Learning Disability Flashcards
What is learning disability?
A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of sills, manifested during the developmental period, which contribute to the overall level of intelligence
What is the LD criteria?
IQ <70
Developmental aetiology <18yo
Deficits in adaptive functioning
What is the commonly used psychometric assessment?
Wechsler Adult Intelligence Scale (WAIS)`
How is LD diagnosed?
Clinical Findings
Adaptive Behaviour
Psychometric Assessment
What is the average IQ?
100
What is the prevalence of an IQ < 70 in gen. population?
About 3%
What is the Flynn effect?
Average rate of increase in IQ seems to be about 3 points per decade in US
About 10 points per generation
Also increases in attention and semantic and episodic memory
What are the causes of the Flynn effect?
Schooling- less evidence for tests, but regular attendance causes higher score
Test familiarity- internet, MENSA
Stimulation- Baby Einstein, Sesame Street, different intelligence
Nutrition- height increase, iodine deficiency-iodised salt
Infections- Metabolically demanding to fight off infections in the developmental period
How could you tell if someone has a learning disability?
May be apparent: genetic testing, dysmorphic features
Information from self/carers
History of special schooling
Behaviour/communication
What is the scale of LD severity?
Mild: 50-69 Moderate: 35-49 Severe: 20-34 Profound: <20 Borderline: 70+
How does Mild LD present?
IQ 50-59 Mental age 9 to under 12yo Most common Delated speech-able to use everyday speech Full independence Reading/writing difficulties Unskilled/semi skilled work Problems if social or emotional immaturity Rarely organic aetiology
How does Moderate LD present?
I.Q. range 35-49 Mental age 6 to under 9 years Slow with Comprehension and Language Limited Achievements Delayed Self care and Motor Skills Simple Practical Tasks - Often with Supervision Usually Fully Mobile - Physically Active Discrepant profiles Majority Organic Aetiology Epilepsy & Physical Disability common
How does Severe LD present?
IQ 20-34
Mental age 3 to under 6yo
More marked impairment than in moderate LD, and achievements more restricted
Epilepsy
How does Profound LD present?
IQ <20 Mental age <3yo Severe limitation to understand or comply with requests or instructions Little or no self care Often severe mobility restriction Basic or simple tasks may be acquired
Prior to conception, what is the aetiology of LD?
Genetics
At conception, what is the cause of LD?
Chromosomal
During the antenatal period, what are the causes of LD?
Maternal infections
Poor diet
Substance abuse
At birth, what are the causes of LD?
Extreme prematurity
Birth injury
Cerebral anoxia
During the postnatal period, what are the causes for LD?
Metabolic causes
Hypoglycaemia
High bilirubin
During infancy/childhood, what are the causes for LD?
Infections
NAI
Trauma
Toxins
What chromosomal abnormality causes Patau syndrome?
Trisomy 13
What chromosomal abnormality causes Edwards syndrome?
Trisomy 18
What chromosomal abnormality causes Turners?
45, XO
What chromosomal abnormality causes Klinefelters?
XXY
What gene causes Fragile X?
Faulty FMR1 gene
What maternal infections cause cause LD?
Rubella
CMV
Toxoplasmosis
What % of mild LD cases may be causes by Foetal alcohol spectrum disorder?
10-20%
association with ADHD
What perinatal factors can cause LD?
Neonatal septicaemia
Pneumonia
Meningitis/encephalitis
Other problems at delivery – birth injury
Other newborn complications (respiratory distress, hyperbilirubinaemia, hypoglycaemia, extreme prematurity)
What postnatal factors can cause LD?
CNS infections, vascular accidents, tumours, hypoxic brain injury, head injury, NAI, exposure to toxic agents, psychosocial environment
Congenital hypothyroidism – now screened for neonatally, if untreated leads to mental and growth retardation.
Other disorders of unknown aetiology
Cerebral palsies, epilepsy, autistic spectrum disorders, childhood disintegrative disorders.
What are some associated features of LD?
Mental Illness Epilepsy Discrimination Substance Misuse Physical Disability Sensory problems Mobility problems Autistic Spectrum Disorder Sexual Abuse Family Dysfunction Different Appearance Poor employment prospects Low expectation of success Stigma Poor educational provisions
How many times more common is a psychiatric disorder in someone with LD?
3x
Why is mental disorder more common in people with LD?
Organic vulnerability-brain damage
Social deprivation/disadvantage
Life events
Psychological reasons- learned helplessness
What is important to note regarding psychotic symptoms in LD patients?
Psychotic symptoms reflect developmental level- may lack in detail
What is important to note regarding paranoid ideas in LD patients?
May be reality based- misinterpretation of a situation
How should comorbidities be managed generally in patients with LD?
Therapeutic environment- general support, specific support (psychiatric problems)
Education
Social needs
Communication- hearing aids, glasses, pictorial, Makaton
What behavioural treatment can be used in LD?
Teach/improve basic skills
Establish normal patterns
Relaxation techniques
Assertiveness training
What CBT can be used in LD?
Problem solving skills
Anxiety and depression
Offending behaviour
What psychodynamic therapy can be used in LD?
Relationships
Adjustment to life events
What cautions are involved in pharmacological treatment of LD patients?
Comorbid physical disorders-epilepsy, constipation
Atypical responses- decreased or increased sensitivity, paradoxical reactions
Evidence base often lacking
What is different in Schizophrenia in LD patients?
3x more common Age of onset earlier (mean 23) -ve symptoms more common Main PC may be behaviour change Severe LD
What is different in Depression in LD patients?
3x more common
Somatisation ++
Reduced verbal expression of unhappiness, guilt
Biological symptoms- sleep, appetite, energy, concentration, anhedonia
