Learning disability

Question 1

What lexicon are used in different places to describe different disabilities?

Answer 1

USA: mental retardation 
International: Intellectual disability 
UK: learning disability 
UK (educational): Learning difficulty 
DDA and mental health acts: mental impairment

Question 2

What is the WHO’s definition of mental retardation?

Answer 2

condition of arrested or incomplete development of the mind which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive language, motor, and social abilities

Question 3

What is another definition of somebody with a learning disability?

Answer 3

• impairment of intellectual function
• consequences in terms of severe impairment of social functioning
• onset before physical maturity
• excludes those that develop impairments later in life and people with dyslexia for example

Question 4

What is the purpose of IQ test?

Answer 4

determine if a children needed special educational support

it was soon made made concrete and used as a measure of innate and fixed ability and therefore used to determine fi people were incapable of education

Question 5

What is the adaptive behaviour test?

Answer 5

scale mesures skills of daily living by checklists, interviews with carers and observations in activities such as self-help, basic academic skills, comms, mobility, everyday coping skills and social competence
- series of ratings instead of overall score

Question 6

What are some of the problems with IQ tests?

Answer 6

measures narrow range of skills
doesn’t reflect how someone copes day to day
people can under perform by not understanding purpose of test and other disabilities that may affect it
not standardised for people with learning disabilities that may have uneven balances of strengths and weaknesses

Question 7

What are some of the problems with adaptive behaviour tests?

Answer 7

doesn’t take into account the support / aids they are using
variability in performance between settings
assumptions about activities appropriate to particular culture
poor performance may simply be due to lack of experience not that they actually can’t do it
core skills change over time e.g. cooking

Question 8

Why do we use tests to measure someones learning disabilities?

Answer 8

find out where an individual requires most support
- determine strengths and weaknesses

measure changes in performance over time

determine eligibility for specific services or if there are any risks of mistreatment (criminal proceedings)

Question 9

What are the different grades?

Answer 9

MILD: IQ 50-70- conversations, full independence in self care. basic literacy

MODERATE: IQ 35-50 - limited language, requires supervision in self-care. fully mobile

SEVERE: IQ 20-35 - words/gestures for basic needs- activities supervised, marked motor impairments

PROFOUND: <20 - very limited words/gestures or none- severely limited mobility. incontinent

Question 10

What are some important notes to consider about the grading system?

Answer 10

not discrete groups
should incorporate sensory impairment (understanding)
Profound and multiple learning disability tend to be used in UK

Question 11

What are some of the issues with epidemiology?

Answer 11

no UK national registers of learning disabilities

local registras are the best bet, as people are in contact with the local services

GP records now more effective but number are still under-recorded

Question 12

What is the predicted number of people with mild LD?

Answer 12

18/1000 people across all age ranges

• most no identified organic cause
• strongly associated with poverty and disadvantage
• most not in contact with services and rates decrease after leaving school

Question 13

What is the predicted number of people with more severe LD?

Answer 13

3-4/1000 (moderate, severe or profound)

• more likely to have identified organic cause
• less associated wth poverty
• tend to be in contact with specialist services
• high mortality rates means declining proportion among elderly

Question 14

What are some of the trends in LD?

Answer 14

Possible increase due to…

• limited preventative measures
• increasing number of premature babies surviving
• increased number of children with LD surviving into adulthood
• greater life-expectancy

Question 15

Why is it important to distinguish between receptive communications and expressive communications?

Answer 15

More can understand language than can speak it
But
Many more can communicate than can understand language

The understanding may be limited to key word

Question 16

Why is communications so significant?

Answer 16

challenging behaviours can often be a substitute form of communication

Question 17

How can you assist someones communications?

Answer 17

Environmental adaptation: using signs, colours and coding for example

Interpreters: using translators, sign language

Assisted communication: braille, symbol system, message boards

But also just use simpler English

Question 18

What is the total communication approach?

Answer 18

Using all the above methods (environmental adaptations, interpreters and assisted comms) to help someone = this requires a lot of commitment from staff and a common failure to do so and staff use the excuse that special actions defeats the principle of normalisation

Question 19

What are the 3 evangelical phases?

Answer 19

1) early 19th century = commitment to human care and education = special schools and residences
2) early 20th century = century eugenics - application of social darwinism - total institutions
3) late 20th century = century normalisation - community integration

Question 20

What did Galton develop in the 1880s?

Answer 20

Eugenics

• fitness of race imperilled by higher reproduction of lead intelligent and social welfare preserving the weak
• he aimed to prevent reproduction by the weak and encourage strongest to reproduce

Question 21

What was the impact of Galton’s eugenics approach?

Answer 21

Prevention of reproduction - sterilisation and separation
Failure to educate = children classed as uneducatable
Failure to treat= high mortality rates as health needs not investigated
Discrediting = seen as a threat to survival

Question 22

What is the link between eugenics and the nazis?

Answer 22

they adopted this theory and murdered 200,000 + disabled people - hadamar clinic

Question 23

What was “universalism” post 1945?

Answer 23

a triumph in which all human life is of worth, expressed in declaration for rights

Question 24

What is normalisation ?

Answer 24

Scandinavian approach: importance for disabled person to attain adulthood by overcoming ordinary challenges

• compensatory service required to support them
• this will allow them a comparable life in society

Question 25

What does it mean by social role valorisation?

Answer 25

US were concerned about the derogatory terms used for disabled people due to their separateness in society

• therefore they were concerned with specialst services that assigned them as different
• therefore proposed importance of them being associate with valued social role

Question 26

what was the impact of universalism?

Answer 26

Large institutions closed
- removal of suspicions around separate schools

Greater access to universal public services, employment and community facilities

Question 27

What were the challenges to universalism?

Answer 27

Culture of fear

rise of consumerism - disabled seen as negative consumers

Question 28

What are the different times and examples of causes that disabilities can occur?

Answer 28

Preconceptional = DS, PKU
Prenatal = Foetal alcohol syndrome
Perinatal = obstetrical trauma 
Postnatal = meningitis, cerebral anoxia

Question 29

What prevention strategies are there?

Answer 29

Preconceptional = prenatal or newborn screening 
Prenatal = folate therapy in pregnancy, health education to reduce alcohol consumption in pregnancy 
Perinatal = optimal obstetric, neonatal care
Postnatal= health education to reduce accidents, vaccinations

Question 30

How many people with learning disabilities have chronic disorders?

Answer 30

60% have chronic disorders/disabilities in addition to LD

they also demonstrate high rates of injuries as less capacity to assess risk, higher prevalence of epilepsy, sensory impairments and mobility problems

Question 31

How much more likely to suffer from psychiatric disorders are people with learning disabilities ?

Answer 31

4 times more likely than rest of population
- may result from stress involved in coping with dependence, social exclusion

Higher prevalence of autistic disorders - 10x

Question 32

What are “challenging behaviours” associated with?

Answer 32

specific syndrome, or resulting from physical distress, abuse, poor care

Question 33

What is the life expectancy for people with learning disabilities?

Answer 33

risen since early 20th century when minority survived to adulthood
low life expectancy in old hospitals because of infectious diseases, untreated illnesses

trend is still continuing and mean age at death for people with more severe LD now in late 50s/early 60s

Question 34

Are people with learning disabilities at high risk of mortality?

Answer 34

sex-adjusted mortality rates for people with severe LD still 10-18 times higher
- higher risk among people with greater severity of LD, DS, epilepsy and tube feeding

Question 35

What are the most common causes of death?

Answer 35

Bronchopneumonia, cardiovascular disorders

and consequences of epilepsy

Question 36

What disorders are associated with high mortality rates in people with learning disabilities?

Answer 36

Down syndrome patients have an earlier onset of AD- type dementia and cardiovascular disorders and reduced immunity to infections

Higher prevalence of other neurological disorders - 20-30% with severe LD also have epilepsy

Question 37

What are some other causes of the higher mortality rates in people with learning disabilities?

Answer 37

unhealthy lifestyles

• sedentary lifestyles
• poor diet
• rates of obesity are double that of rest of the population
• chronic constipation- low fibre diet
• limited exercise
• inadequate fluid intake

poor access to healthcare

Question 38

What are some of the issues of people with learning disabilities in hospital?

Answer 38

hospital staff are often unfamiliar and embarrassed in comms with PLD- do not speak to patients and often use expertise of carer
Poor information is shared with the patient before admission, about procedures and at discharge
Results in fear and distress with limited alleviate by nurses

Question 39

What are some other issues in hospitals that should be considered?

Answer 39

hospitals unwilling to make “concessions” to special needs
lacks of adapted facilities
families expected to provide 24hr care
hospitals unwilling to meet additional care costs unless they could offset it to other agencies

Question 40

Why are there so many issues at hospitals?

Answer 40

Hospitals often not informed in advance that patient has a LD
Little training in comms with people with LD and limited policy commitments
concerns about risks to other patients
consent and liability issues not resolved

Question 41

What can be put in place by primary care to improve their care?

Answer 41

Identification of patients on a practice register
Programme of routine health checks
More appropriate waiting arrangements
Double length of time appointments as comms is more complex
Training to improve awareness

Question 42

What can be put in place by hospitals to improve their care?

Answer 42

Patient held data
Preparation for admission
Access by staff to communication therapists
Specialist community support for PLD in hospital
improved comms environment
training for hospital staff