Learning Disability

Question 1

What is mental handicap?

Answer 1

Mental handicap = “a state of arrested or incomplete development of mind”

Question 2

What are mental disorders?

Answer 2

Mental disorder = mental illness or mental handicap

Question 3

Describe the criteria for intellectual disability?

Answer 3

• Intellectual impairment (IQ < 70)
  
  • Such as Wechsler Adult Intelligence Scale
• Social or adaptive dysfunction
  
  • Vineland Adaptive Behaviour Scale
  • Deficits/impairments in 2 or more of following adaptive skills
    
    • Communication
    • Self-care
    • Home living
    • Social skills
    • Community use
    • Self-direction
    • Health and safety
    • Functional academics
    • Leisure and work
• Onset in the developmental period (before age 18)

Question 4

What scale is used to measure IQ for diagnosing intellectual disability?

Answer 4

• Intellectual impairment (IQ < 70)
  
  • Such as Wechsler Adult Intelligence Scale

Question 5

What scale is used to measure social or adaptive dysfunction?

Answer 5

• Vineland Adaptive Behaviour Scale

Question 6

What are the different components of the Vineland adaptive behaviour scale?

Answer 6

• Social or adaptive dysfunction
  
  • Vineland Adaptive Behaviour Scale
  • Deficits/impairments in 2 or more of following adaptive skills
    
    • Communication
    • Self-care
    • Home living
    • Social skills
    • Community use
    • Self-direction
    • Health and safety
    • Functional academics
    • Leisure and work

Question 7

Epidemiology - intellectual disability

(prevalence)

Answer 7

• Prevalence of IQ < 70 is 1-2%

Question 8

Severity - intellectual disability

Answer 8

Severity (based on both intellectual and adaptive functioning):

• Mild LD
  
  • IQ 50-69 or functional age 9-12 years
• Moderate LD
  
  • IQ 35-49 or functional age 6-9 years
• Severe LD
  
  • IQ 20-34 or functional age 3-6 years
• Profound LD
  
  • IQ < 20 or functional age <3 years

Question 9

Aetiology - intellectual disability

Answer 9

• Inherited
  
  • Single gene
    
    • Fragile X, PKU, Retts syndrome
  • Microdeletion/duplication
    
    • DiGeorge Syndrome, Prader-Willi, Angelman syndrome
  • Chromosomal abnormalities
    
    • Down syndrome (most common)
• Acquired
  
  • Infective
    
    • Rubella, Zika virus
  • Traumatic
    
    • Hypoxic injury during birth, head injury in childhood
  • Toxic
    
    • Foetal alcohol syndrome
• Idiopathic (for most patients the cause of LD is unknown)

Question 10

What are some common conditions associated with learning disability?

Answer 10

• Epilepsy
• Sensory impairments
• Obesity
• Gastrointestinal
  
  • Swallowing problems, reflux oesophagitis, Helicobacter pylori, constipation
• Respiratory
  
  • Chest infections, aspiration pneumonia
• Cerebral palsy
• Orthopaedic problems
• Dermatological and dental problems
• Psychiatric conditions
  
  • High prevalence in people with LD and more severe
  • Presentation differs the more severe the LD
  • Where less communication is available, observable signs are relied on more to make diagnosis such as weight loss, withdrawal, agitation, tearfulness in depression

Question 11

What are assessment areas for the psychiatry of LD?

Answer 11

• Presence and severity of LD
• Aetiology of LD
• Associated biomedical conditions
• Psycho-social assessment
• Psychiatric disorders, their cause and consequences

Question 12

Common on psychiatric illness in LD for the following:

• schizophrenia/psychosis
• mood disorders
• anxiety disorders
• autism
• over-activity syndromes
• challenging behaviour and self-injury
• forensics

Question 13

What are examples of health inequalities in people with learning disability?

Answer 13

• Social exclusion
• Socioeconomic deprivation
• Inaccessible services
• Discrimination
• Challenges to communication
• Lack of appropriate knowledge and skills of professionals
• Minimal evidence base from research

Question 14

What is diagnostic overshadowing?

Answer 14

This is where presenting symptoms are put down to learning disability, rather than seeking another potentially treatable cause

Consider when:

• Presents with new behaviour
• Existing behaviour escalates
• Consider
  
  • Social cause – change in careers, lack of support, lack of social activity
  • Psychological issues – bereavement, abuse
  • Physical problems – pain or discomfort
  • Psychiatric cause – depression, anxiety, psychosis

Question 15

When should diagnostic overshadowing be considered?

Answer 15

Consider when:

• Presents with new behaviour
• Existing behaviour escalates
• Consider
  
  • Social cause – change in careers, lack of support, lack of social activity
  • Psychological issues – bereavement, abuse
  • Physical problems – pain or discomfort
  • Psychiatric cause – depression, anxiety, psychosis