Learning disability

Question 1

define learning disability

Answer 1

developmental condition

characterised by global impairment of intelligence

and difficulties in socially adaptive functioning

Question 2

what IQ denotes a profound learning difficulty?

Answer 2

<20

Question 3

what IQ denotes a severe learning difficulty?

Answer 3

20-34

Question 4

what IQ denotes a moderate leaning difficulty?

Answer 4

35-49

Question 5

what IQ denotes a mild learning difficulty?

Answer 5

50-69

Question 6

what is the presentation of learning difficulties?

Answer 6

reduced, delayed or absent skills in;

language, schooling, independent living, social ability

behavioural issues can arise due to issues with communication

Question 7

name 3 syndromes associated with learning difficulties?

which are most common?

Answer 7

1. 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

Question 8

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

Answer 8

down syndrome

Question 9

the following physical feautres are associated with which condition;

Wide palpebral fissure
Smooth philtrum
Thin top lip

Answer 9

fetal alcohol syndrome

Question 10

the following physical feautres are associated with which condition;

Elongated face - looks slim
Prominent ears
High-arched palate
Large testes
Hyperextensible joints

Answer 10

fragile x

Question 11

the following problems are associated with which condition;

Congenital heart abnormalities
Thyroid problems
Epilepsy
Depression
Early-onset Alzheimer’s disease
Leukaemia

Answer 11

down syndrome

may meet such a patienet in exam and have to council them

Question 12

the following problems are associated with which condition;

Autistic type behaviour
Anxiety !
Depression
Hyperactivity !
Expressive language deficits - speech issues
Shyness !

Answer 12

fragile x

Question 13

list differentials for learning difficulties

Answer 13

The following are condition that can be associated with learning difficulties

1. Autistic spectrum disorders
2. Epilepsy may cause transient cognitive impairment.
3. Adult brain injury or progressive neurological conditions:
4. Psychiatric: severe and enduring mental illness such
   as schizophrenia can lead to chronic cognitive impairment.
5. Educational disadvantage/neglect: lacking the
   opportunity to learn must be distinguished from a
   learning disability.

Question 14

ivx for learning difficulties?

Answer 14

1. IQ testing: is there global intellectual impairment?
2. Functional assessment of skills, strengths and
   weaknesses.
3. 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.
4. FBC, U&E, LFT, TFT, bone profile—to exclude
   reversible disturbances.
5. genetics if needed

Question 15

rx for learning disabilities?

Answer 15

4. 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.
5. 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.

Question 16

whats the difference between learning difficulty and disability?

Answer 16

they are not the same thing

learning difficulty - can probably still function eg in ADHD

in autism - 75% patients have learning disability

Question 17

what are some scales for intellectual Disabiity?

Answer 17

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?

Question 18

what is the aetiology of fragile X

Answer 18

Xq27.3 CCG repeats

Question 19

what is the aetiology of di George and relevance to psychiatry ?

Answer 19

high riisk of schizophrenia

also autism, ADHD in adolescents
schizophrenia like psychoses in adults

90% have learning difficulties

22q 11.2 deletion

Question 20

what are the considerations in someone presenting with lerning disability?

Answer 20

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

Question 21

what is diagnostic overshadowing

Answer 21

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.

Question 22

what are reasonable adjusments in the care of people with LD’s?

Answer 22

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

Question 23

what are some features of di george syndrome?

Answer 23

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

Question 24

what are some features of di george syndrome that may be relevant to adress in psych?

Answer 24

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

Question 25

what is prognosis of LD?

Answer 25

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.

Question 26

how can we manage challenging behvaiour in LDisability?

Answer 26

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.

Question 27

32 year old MAN with severe LD brought in by carer for physical aggression staing it is out of character. how would you proceed

Answer 27

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

Question 28

what is the most common cause of learning difficulty/disability?

Answer 28

low socioeconomic status

tend to have borderline IQs but no/few dysmorphic features

Question 29

what is a is a disorder of motor planning and/or
execution with no significant findings on standard
neurological examinations.

Answer 29

developmental dyspraxia

Question 30

how may dyspraxia pesent?

Answer 30

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.

Question 31

What kind of help may someone with dyspraxia need?

Answer 31

occupational therapist

a speech and language therapist (oromotor skills/speech)

Question 32

what is dyslexia and who is involved in the diagnosis?

Answer 32

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.

Question 33

what is dyscalculia and dysgraphia?

who is involved in the diagnosis/mx?

Answer 33

These are disorders in the development of calculation
or writing skills

SALT, OT (Eye–hand coordination)

Question 34

what is the role of an OT?

Answer 34

Eye–hand coordination
Activities of daily living (ADL) – feeding, washing, toileting, dressing, writing
Seating
Housing adaptations

Question 35

list the genetic associations of Autism spectrum disorders? ASDs

Answer 35

• 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%)