Learning Disability Flashcards
What diagnostic label will be used for learning disbility in the ICD-11?
Intellectual disability
What percentage of the general population have a learning disability?
3%
Patients with learning disabilities have increased comorbidity and mortality. TRUE/FALSE?
TRUE
Patient with learning difficulty often present with more advanced disease. Why is this?
Poor access to screening programmes (as they do not understand the concept/ how to be screened)
Why are patients disabilities often “invisible” whilst receiving healthcare?
Lack of effective flagging systems on patients records
What do hospital staff often not understand about patients with disabilities?
- specific requirements of people with learning disabilities
- adjustments to services that people may need
- capacity issues
- communication
What is a learning disability?
- condition of incomplete development of mind,
- characterised by impairment of skills usually appearing during developmental period
- contribute to the overall level of intelligence
What are the 3 criteria for a learning disability to be diagnosed?
Deficits in intellectual functioning (IQ < 70) Deficits in adaptive functioning Developmental aetiology (occurs < 18 years)
What different psychometric assessments are used to diagnose learning disabilities in adults vs in children?
Wechsler Adult Intelligence Scale (WAIS)
Wechsler Intelligence Scale for Children (WISC),
What is the average IQ?
100
What is the Flynn effect?
IQ average is increasing (American study)
- roughly by 3 points per decade
Why is the Flynn effect thought to now be “slowing” in developed countries?
youth culture = less books and conversation, more computer gaming
Schooling = training towards test vs general education
What racial differences come across in average IQ?
Average IQ of Asian higher than european
Developed countries higher than developing
How could you potentially tell if someone has a learning disability?
- May be immediately apparent (e.g. dysmorphic features)
- Information from self / carers
- History of special schooling
- Behaviour
- Communication
How is the severity of a learning disability classified by IQ?
Borderline LD IQ 70+ Mild LD IQ 50-69 Moderate LD IQ 35-49 Severe LD IQ 20-34 Profound LD IQ < 20
People with a borderline learning disability have what mental age?
mental age 12 to <15 years.
Patients with a mild learning disability have what mental age?
mental age 9 to <12 years.
What tasks do patients with mild learning disabilities struggle with?
Delayed speech - but are able to use everyday speech
Difficulties in Reading and Writing
Difficulty in high-skilled work
Problems with Social/Emotional Immaturity
What mental age is a patient with a moderate learning disability?
mental age 6 to <9 years
What tasks do patients with a moderate learning disability struggle with?
Slow with Comprehension and Language
Limited Achievements
Delayed Self care and Motor Skills
Simple Practical Tasks often require Supervision
What comorbidities are common in a moderate learning disability?
Epilepsy and Physical Disability
What mental age are patients with severe OR profound learning disabilities?
Severe = mental age 3 to under 6 years Profound = mental age < 3 years.
Explain the restrictions of a patient with a profound learning disability
Severe limitation in understanding/complying with requests or instructions.
Little or no self-care.
Often severe mobility restriction.
In 1959 the Mental Health Act made it possible to detain patients with learning difficulties in hospital, but what problems did this cause?
Meant hospital and community care was very different and MORE patients were admitted in order to be detained and treated
What happened in the 1970s to reduce the number of patients with learning disabilities who were admitted?
- Trend developed towards building of smaller facilities
- Idea of normalisation => person with a learning disability should be able to access mainstream facilities
What are the potential causes of an intellectual disability during the antenatal period?
Maternal infections - e.g. Rubella, CMV
Poor Diet
Substance abuse
What are the potential causes of an intellectual disability when the baby is being born?
Extreme Prematurity
Birth Injury
Cerebral Anoxia
What post-natal problems can cause a baby to develop an intellectual disability?
Metabolic causes
Hypoglycaemia
High Bilirubin
What causes of intellectual disability usually appear in infancy/childhood?
Infections
NAI, Trauma, Toxins
What chromosomal abnormalities can cause an intellectual disability?
Cri du chat (Chromosome 5)
Angelman (maternal)/ Prader-Willi (paternal) (Chromosome15)
Downs Syndrome (Chromosome 21)
Fragile X (common)
What chromosomal abnormalities do not usually cause a learning disability?
Turners 45XO
- learning disabilities = rare in this group
What other genetic causes can result in a learning disability?
Phenylketonuria
Tuberous Sclerosis
Congenital Hypothyroidism
What social symptoms may be experienced by a patient with learning difficulties?
Family Dysfunction Sexual Abuse Poor employment prospects Stigma Poor educational provisions
Psychiatric disorders are more common in patients with a learning disability. TRUE/FALSE?
TRUE
Why are psychiatric disorders often underdiagnosed in patients with learning disorders?
Patients want to please you and act as if they understand
=> often try to disguise the symptoms of their learning disability and other psychiatric 6
symptoms
What should you be aware of when completing a psychiatric assessment on patients with learning disabilities?
- Use open questions
- Check accuracy (are they just saying they understand?)
- Patients may have reduced comprehension and/or verbal skills => answers may be less detailed
- observe their behaviour
- Psychotic symptoms reflect developmental level
- Paranoid” ideas may be due to misinterpretation of a situation
- unusual behaviour may be developmentally appropriate (e.g. interested in many things at young age)
How should patients with learning difficulties be managed?
- General support (eg. school)
- Specific support (eg. psychiatric problems)
- Psychoeducation for Patient, Carers
- Help with communication
e. g. Hearing aids, glasses, Pictorial, Makaton
What psychological treatments can be used for learning disability patients?
Behavioural (often easier for them than CBT)
- Teach/improve basic skills
- Relaxation techniques
- Assertiveness training
Modified Cognitive behavioural therapy (CBT)
- Problem solving skills
- Anxiety and depression
- Offending behaviour
Psychodynamic therapy
- Relationships
- Adjustment to life events
What pharmacological treatments are used for autism and ADHD?
Autism - antipsychotics
ADHD - stimulants
What is the male:female ratio in autism?
3:1
What are the main 3 symptoms of autism?
Abnormal social interaction
Communication impairment
Rigid/restricted or repetitive behaviour
What treatment/support is provided for patients with autism?
- Communication aids / Speech + Language Therapy
- Educational interventions
- Behaviour modification, Social skills training
- Family intervention (education and support)
What is the difference between a Learning Difficulty and a Learning Disability?
Difficulty = Problem in only one area of cognition
e.g. Dyslexia
=> These DO NOT affect global IQ
Disability = global reduction in cognition resulting in lower IQ
