Learning Disability

Question 1

3 Criteria to diagnose Learning Disability

Answer 1

(IQ<70) Intellectual Impairment
Social and Adaptive Dysfunction
Onset in developmental period

Question 2

Which scale is used for Intellectual Impairment?

Answer 2

Weshcler

Question 3

Which scale is used for Social and Adaptive dysfunction?

Answer 3

Vineland

Question 4

How is Lower IQ classified?

Answer 4

Mild 50-69
Moderate 35-49
Severe 20-34
Profound <20

Question 5

5 Aetilogical Factors for learning disabilities

Answer 5

Genetic
Trauma
Toxic
Infective 
Unknown

Question 6

Which Genetic conditions are associated with learning disabilities?

Answer 6

Fragile X
PKU
Retts DI George
Downs

Question 7

Which infections are associated with risk for learning disability?

Answer 7

Rubella
Encephalitis
Meningitis

Question 8

Which toxic syndrome is linked to learning disabilties?

Answer 8

Foetal alcohol syndrome

Question 9

Which traumatic events can lead to developing a learning disability?

Answer 9

Birth asphyxia

Head injury - developmental period

Question 10

List some comorbidities that coincide with learning disabilities

Answer 10

Epilepsy
Sensory impairments
Obesity
GI- Swallowing, reflux, helicobacter, constipation
Respiratory - chest infections, aspirational pneumonia
Cerebral palsy
Orthopaedic - joint contractures, osteoporosis,
Dermatological
Dental

Question 11

In absence of communication what other symptoms may be observed in diagnosing psychiatric disorders and learning disabilities

Answer 11

Weight loss
Withdrawal
Agitation
Tearfulness in depression
Behavioural disturbance in psychotic disorder

Question 12

4 Assessment factors in psychiatric disorders with learning disabilities

Answer 12

Aetiology of learning disability
Associated biomedical conditions
Severity of learning disability
Psychiatric disorders - causes and consequences

Question 13

What symptoms may be seen in schizophrenia with LD?

Answer 13

Change in personality
Reduced functional ability
Self-talk

Question 14

Overactivity Syndromes

Answer 14

Distracted
Impulsive
Not always to extent of ADHD

Question 15

Why are mood disorders harder to recognise in patients with learning disabilities?

Answer 15

Less likely to complain of mood changes

Need to note behavioural and biological changes

Question 16

Why might patients with OCD take longer to present with Learning disabilities?

Answer 16

Cannot describe compulsions

Question 17

What behaviours can be common in patients with more severe learning disability?

Answer 17

Challenging

Mannerisms - rocking, head banging

Question 18

Strategies to approach consultation

Answer 18

Non-verbal cues
Alternative communication
Rapport
Carers

Question 19

Which factors must be considered to avoid Diagnostic overshadowing?

Answer 19

Social
Psychological
Physical
Psychiatric

Question 20

Fragile X, PKU and Rett’s are what type of genetic conditions?

Answer 20

Single deletion

Question 21

Which conditions are microdeletion genetic abnormalities?

Answer 21

DiGeorge
Prader Willi
Angelman

Question 22

What genetic conditions are an example of imprinting in humans?

Answer 22

Prader Willi and Angelman

Question 23

most common causes of mortality in patients with LD

Answer 23

Pneumonia, aspiration pneumonia

Cancers - but of genetic origin rather than toxic carcinogens eg tobacco

Question 24

Health inequalities in LD

Answer 24

Social exclusion
Socio-economic deprivation (most impacted group by austerity)
Inaccessible services
Discrimintation
Lack of appropriate knowledge and skills in professionals
Minimal evidence base from research

Question 25

How might services be inaccessible to patients with LD?

Answer 25

Many services require use of technology

Reliance on carers to make appointments, travel to appointments etc

Question 26

Case study
45 y/o F lives alone
Little social interaction
Attended special school but no formal diagnosis and no LD contact
Working as domestic in hospital for 20 years
At GP appointment - low mood, feeling tearful, struggling to sleep

Answer 26

Explore low mood course

• mother died
• had managed money and housework ; now in debt
• in trouble with rota, not turning up on time
• hasn’t been able to complete fire safety
• in trouble with manager

Question 27

What are the next steps in case study?

Answer 27

Thinking mother is the carer
Mild LD unidentified

Could possibly be grief reaction and depressive episode