Learning Disability

Question 1

how does learning disability affect life expectancy?

Answer 1

females = 18 years lower
males = 15 years lower
more likely to have epilepsy, mental illness, dementia, hypothyroidism, diabetes, heart failure, CKD or stroke

Question 2

what is a learning disability?

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

criteria for learning disability?

Answer 3

IQ <70
developmental aetiology (< 18 years)
deficits in adaptive functioning

Question 4

what psychometric assessments are used in adults and children with learning disability?

Answer 4

adults = WAIS
children = WISC

Question 5

what is the average IQ of the population?

Answer 5

100

Question 6

how common is an IQ <70?

Answer 6

about 3% of the population

Question 7

how is the trend in IQ changing over time?

Answer 7

generally increasing over past 100 years
3 points every decade
10 points every generation
but has slowed down over past few years (more technology, youth culture, less books, immigration, dysgenic decline etc)

Question 8

examples of difficulties which are not a learning disability?

Answer 8

dyslexia
any other educational difficulty
not something that happens to an adult (acquired brain injury, dementia etc)
cognitive decline due to chronic psychosis

Question 9

severity of LD depending on IQ?

Answer 9

borderline = IQ 70+
mild = 50-69
moderate = 35-49
severe = 20-34
profound = <20

Question 10

features of borderline LD?

Answer 10

IQ 70-84
mental age 12-15
not a real category

Question 11

features of mild LD?

Answer 11

IQ 50-69
mental age 9-12
most common
delayed speech (but can use everyday speech)
full independence
difficulties in reading and writing
capable of unskilled/semi-unskilled work
problems if social or emotional immaturity
rarely organic

Question 12

features of moderate LD?

Answer 12

IQ 35-49
mental age 6-9
slow with comprehension and language
limited achievements
delayed self care and motor skills
simple practical tasks - often with supervision
usually fully mobile
discrepant profiles
majority organic aeitiology
epilepsy and physical disability ocmmon

Question 13

features of severe LD?

Answer 13

IQ 20-34
mental age 3-6
generally more marked impairment than in moderate LD and achievements are more restricted
epilepsy

Question 14

features of profound LD?

Answer 14

IQ <20
mental age <3
severe limitation in ability to understand or comply with requests or instructions
little or no self care
often severe mobility restriction
basic or simple tasks may be aquired

Question 15

what can cause a LD at each stage of pregnancy/birth/infancy?

Answer 15

genetic
conception stage = chromosomal abnormality
antenatal period = maternal infection, poor diet, substance abuse
birth = prematurity, birth injury, cerebral anoxia
postnatal period = metabolic causes, hypoglycaemia, high bilirubin
infancy/childhoos = infection, NAI, trauma, toxins

Question 16

what chromosomal abnormalities can cause LD?

Answer 16

down syndrome (trisomy 21)
edwards syndrome (trisomy 18)
angelman (maternal 15Q)
Prader Willi (paternal 15Q)
williams syndrome (7Q)
turners (only one X chromosome)
trisomy X (XXX)
klinefelter (XXY)
XYY male
fraglie X (faulty FMR1 gene)

Question 17

genetic causes of LD?

Answer 17

protein defects (phenylketonuria)
carbohydrate defects (mucopolysaccharidoses)
lipid metabolism defects (neurolipidoses)
tuberous sclerosis
congenital hypothyroidism
lesch nyhan syndrome (X linked)

Question 18

what other conditions of unknown aetiology can cause LD?

Answer 18

CNS malformations (holoprosencephaly, microcephaly, macrocephaly)

Question 19

what pre natal factors can cause LD?

Answer 19

maternal infection, exposure to medication and drugs, alcohol, diet and subatance abuse

Question 20

what perinatal factors can cause LD?

Answer 20

neonatal septicaemia
pneumonia
menigitis/encephalitis
birth injury
newborn complications (resp distress, hyperbilirubinaemia, hypoglycaemia, prematurity)

Question 21

what are the 3 aspects of learning impairment?

Answer 21

the impairment itself (brain injury as result of perinatal trauma etc)
resulting disability (e.g inability to read etc)
the resulting social handicap (e.g problems with regard to occupational, leisure and personal relationship opportunities)

Question 22

why are psychiatric disorders 3X more common in those witha learning disability?

Answer 22

organic vulnerability (“brain damage”)
social deprivation/disadvantage
life events
psychological reasons - learned helplessness

Question 23

why may a psychiatric illness often missed in people with learning disability?

Answer 23

due to intellect
diagnostic overshadowing (symptoms attributed to the LD)
compliance/eager to please (will agree with the doctor, can be talked out of their symptoms - but will return to it etc)

Question 24

what may cause psychotic like symptoms in LD patients?

Answer 24

paranoid ideas may be reality based - misinterpretation of a situation
psychotic symptoms usually reflect developmental level in their content - may lack in detail

Question 25

non-medical management of co-morbidities in LD?

Answer 25

manage therapeutic environment (general support in school etc and specific support for psychiatric problems etc)
education
meet social needs
maximise communication (hearing aids, glasses, pictorial etc)

Question 26

medical management of co-morbidities in LD?

Answer 26

behavioural/cognitive management
pharmacological
physical interventions (headgear, isolation)
admission (respite care, specialist unit)

Question 27

what post natal factor can cause LD?

Answer 27

CNS infections
vascular accidents
tumours
hypoxic brain injury
head injury
NAI
exposure to agents
psychosocial environment
congenital hypothyroidism
cerebral palsies 
epilepsy
ASD
childhoos disintegrative disorders