Learning disability Flashcards
define learning disability
developmental condition
characterised by global impairment of intelligence
and difficulties in socially adaptive functioning
what IQ denotes a profound learning difficulty?
<20
what IQ denotes a severe learning difficulty?
20-34
what IQ denotes a moderate leaning difficulty?
35-49
what IQ denotes a mild learning difficulty?
50-69
what is the presentation of learning difficulties?
reduced, delayed or absent skills in;
language, schooling, independent living, social ability
behavioural issues can arise due to issues with communication
name 3 syndromes associated with learning difficulties?
which are most common?
- Down syndrome
- trisomy 21
- most common
Fragile X
- mutation in FMR1 gene on X chromosome
- biggest genetic cause of Autism
- Causes ADHD type sx
Fetal alcohol syndrome
the following physical feautres are associated with which condition;
Upward-slanting palpebral fissures Epicanthic folds Protruding tongue Single palmar crease Hypotonia short neck short ears short stature
down syndrome
the following physical feautres are associated with which condition;
Wide palpebral fissure
Smooth philtrum
Thin top lip
fetal alcohol syndrome
the following physical feautres are associated with which condition;
Elongated face - looks slim Prominent ears High-arched palate Large testes Hyperextensible joints
fragile x
the following problems are associated with which condition;
Congenital heart abnormalities Thyroid problems Epilepsy Depression Early-onset Alzheimer’s disease Leukaemia
down syndrome
may meet such a patienet in exam and have to council them
the following problems are associated with which condition;
Autistic type behaviour Anxiety ! Depression Hyperactivity ! Expressive language deficits - speech issues Shyness !
fragile x
list differentials for learning difficulties
The following are condition that can be associated with learning difficulties
- Autistic spectrum disorders
- Epilepsy may cause transient cognitive impairment.
- Adult brain injury or progressive neurological conditions:
- Psychiatric: severe and enduring mental illness such
as schizophrenia can lead to chronic cognitive impairment. - Educational disadvantage/neglect: lacking the
opportunity to learn must be distinguished from a
learning disability.
ivx for learning difficulties?
- IQ testing: is there global intellectual impairment?
- Functional assessment of skills, strengths and
weaknesses. - Detailed developmental history from parents, e.g.
details of pregnancy and birth, language and motor
skills development, schooling, emotional development,
and relationships. School reports are helpful. - FBC, U&E, LFT, TFT, bone profile—to exclude
reversible disturbances. - genetics if needed
rx for learning disabilities?
- Early detection + Statement of Special Educational Needs (in the UK) allow appropriate support, whether in mainstream or specialized
schools, to maximize the child’s potential. - Psychological therapy
This may include counselling,
group therapy, and modified CBT.
Behavioural therapy
those with severe/profound learning disability likely to require support with ADLs and possibly mobility etc.
whats the difference between learning difficulty and disability?
they are not the same thing
learning difficulty - can probably still function eg in ADHD
in autism - 75% patients have learning disability
what are some scales for intellectual Disabiity?
WAIS III - Wechsler Adult Intelligence Scale
ABAS II
IQ - is an assessment of ability to think and reason.
Presence in childhood -was difficulty present in school?
what is the aetiology of fragile X
Xq27.3 CCG repeats
what is the aetiology of di George and relevance to psychiatry ?
high riisk of schizophrenia
also autism, ADHD in adolescents
schizophrenia like psychoses in adults
90% have learning difficulties
22q 11.2 deletion
what are the considerations in someone presenting with lerning disability?
Mental illness
Physical illness - sight, hearing problems
Behavioural difficulties
Assess them with a bio (physical problems) psycho social (adapting to a new situation, difficult to adapt to new social environment, abusee, low self esteem, rejection, relationships, finances) approach
what is diagnostic overshadowing
when the underlying diagnosis is overshadowed/overlooked due to th intellectual disability - it is assumed that thie presentation or odd behavuiour is just their baseline.
what are reasonable adjusments in the care of people with LD’s?
part of the Disability adjustment act 1995
“to avoid as far as possible the disadvantage they expeirence as part of their disability”
examples include:
longer appointment times
seen quicker in ED
Deisgn of waiting rooms to be LD friendly; less crowded and noisy
Given 1st appointment in day to avoid long wait times
choice board - have pictures to help them choose just in case they have difficulty verbalising
self help boards - sequence of pictures to show them what to do i.e getting dressed
what are some features of di george syndrome?
speech and language:
hypernasality, language delays, and speech sound errors
high risk of early onset parkinsons
Hearing loss
Seizures
amongst lots of congenital heart issues and others
what are some features of di george syndrome that may be relevant to adress in psych?
speech and language:
hypernasality, language delays, and speech sound errors
high risk of early onset parkinsons
Hearing loss
Seizures
amongst lots of congenital heart issues and others
what is prognosis of LD?
life expectancy is about 67.5 in people with mild LD
reduces further as the severity of LDisability increases
Mild learning difficulties may only become
apparent when the child starts school or much
later.
how can we manage challenging behvaiour in LDisability?
identify underlying cause
MDT involvement
Biiopsychosocial approach
assess mental and physical health
psychological - functional assessment, cut, therapy
social - care packagage review, placement
risk assessment
think about ABUSE!
Children with borderline and mild (IQ 70–80) learning
difficulties are usually supported by additional
helpers (learning support assistants) in mainstream
schools.
Whereas children with moderate (IQ 50–70),
severe (IQ 35–50), and profound (IQ < 35) learning
difficulties are likely to need the resources of special
schools.
32 year old MAN with severe LD brought in by carer for physical aggression staing it is out of character. how would you proceed
take detailed collateral hx from carer
notes from gp possibly - has he presented like this before?
if possible take hx from patient - may not be able to verbalise
Physical examination
Bloods, urine dip, u&e, urine drug screen to rule out physical cause
mental health assessment - they could have comorbid mental health issue on top of LD
what is the most common cause of learning difficulty/disability?
low socioeconomic status
tend to have borderline IQs but no/few dysmorphic features
what is a is a disorder of motor planning and/or
execution with no significant findings on standard
neurological examinations.
developmental dyspraxia
how may dyspraxia pesent?
problems of perception (how the child interprets what
he/she sees and hears), use of language and putting
thoughts together
Difficulties in acadaemia
• handwriting, which is typically awkward, messy,
slow, irregular and poorly spaced
• dressing (buttons, laces, clothes)
• cutting up food
• poorly established laterality
• copying and drawing
• messy eating from difficulty in coordinating biting,
chewing, and swallowing (oromotor dyspraxia).
Dribbling of saliva is common.
What kind of help may someone with dyspraxia need?
occupational therapist
a speech and language therapist (oromotor skills/speech)
what is dyslexia and who is involved in the diagnosis?
Dyslexia is a disorder of reading skills disproportionate
to the child’s IQ.
The term is often used when the
child’s reading age is more than 2 years behind his/her
chronological age.
Assessment needs to include vision and hearing and involves an educational psychologist.
what is dyscalculia and dysgraphia?
who is involved in the diagnosis/mx?
These are disorders in the development of calculation
or writing skills
SALT, OT (Eye–hand coordination)
what is the role of an OT?
Eye–hand coordination
Activities of daily living (ADL) – feeding, washing, toileting, dressing, writing
Seating
Housing adaptations
list the genetic associations of Autism spectrum disorders? ASDs
- Fragile X (21-50% have ASD)
- Tuberous Sclerosis Complex (24-60%)
- 22q11 Deletion Syndrome (25 x > likely to have Schizophrenia, 40% meet ADHD criteria, 33% have OCD, 30% meet ASD criteria)
- Mitochondrial Disorders (~25%)
- Down Syndrome (0-17%)
