Learning Disability Psychiatry Flashcards
What is the definition of a learning disability?
‘A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities’
What is the criteria for a learning disability?
1) Intellectual impairment (IQ < 70) (Wechsler)
2) Social or adaptive dysfunction (Vineland 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 & work
3) Onset in the developmental period (age 18)
What is the prevalence of intellectual disability?
Statistically the prevalence of people with IQ<70 should be 2.5% (2SD from mean)
Actually the prevalence of people with LD is 1-2%, because of:
1) Differential mortality (the more severe the degree of learning disability, the higher the mortality c.f. general population)
2) The role of functioning - those with IQ<70 but no problems functioning within their environment would not be defined as having a learning disability
IQ is used to classify the level of learning disability what is consider a mild learning disability?
IQ of 50 to 69
IQ is used to classify the level of learning disability what is consider a moderate learning disability?
IQ of 35 to 39
IQ is used to classify the level of learning disability what is consider a severe learning disability?
IQ of 20 to 34
IQ is used to classify the level of learning disability what is consider a profound learning disability?
IQ of <20
Aetiology of learning disabilities?
1) Genetic
2) Infective
3) Toxic
4) Trauma
5) Unknown
Aetiology of learning disabilities - Genetic?
Genetic: e.g.
> Single gene: Fragile X, PKU, Retts Syndrome
> Microdeletion/duplication: DiGeorge Syndrome, Prader-Willi, Angelman syndrome
> Chromosomal abnormality: Down Syndrome
Aetiology of learning disabilities - Infective?
ante-natal e.g. rubella;
post-natal e.g. meningitis, encephalitis
Aetiology of learning disabilities - Toxic?
foetal alcohol syndrome
Aetiology of learning disabilities - Trauma?
birth asphyxia, head injury
What common conditions are associated with learning disabilities?
Epilepsy – increased incidence and complexity with severity of learning disability (10-50%)
Sensory impairments – hearing (40 %) and vision (20%), earwax
Obesity – predisposes to other health problems
Gastrointestinal – swallowing problems, reflux oesophagitis, Helicobacter pylorii, constipation
Respiratory problems – chest infections, aspiration pneumonia
Cerebral palsy – especially with severe learning disability
Orthopaedic problems – joint contractures, osteoporosis
Dermatological and Dental problems- 33% unhealthy gums, for Down’s Syndrome, 80%
Assessment areas of learning disabilities?
Aetiology of LD
Associated biomedical conditions
Severity of LD
Psychiatric Disorders, their cause and consequences
Which mental health problems are associated with learning difficulties?
1) Schizophrenia / Psychosis
2) Mood Disorders
3) OCD
4) Autism
5) Over-activity syndromes
6) Challenging Behaviour and Self Injury
7) Forensic
Which mental health problems are associated with learning difficulties - Schizophrenia / Psychosis?
3% Point Prevalence compared to 1% in general population
Associated with change in personality and reduction in functional abilities
‘Self-Talk’ common in LD, particularly Downs Syndrome
Which mental health problems are associated with learning difficulties - Mood Disorders?
Increased incidence
Less likely to complain of mood changes and noted by change in behaviour ie biological symptoms
Which mental health problems are associated with learning difficulties - OCD?
Ritualistic behaviour and obsessional themes significantly increased in LD
Obsessions hard to describe by people with LD but compulsions more readily observed
Which mental health problems are associated with learning difficulties - Autism?
2/3 of persons with Autism have a LD
Which mental health problems are associated with learning difficulties - Over-activity syndromes?
ADHD much higher incidence
Many severe LD children are overactive, distractible and impulsive but NOT to extent that would indicate diagnosis of ADHD
Which mental health problems are associated with learning difficulties - Challenging Behaviour and Self Injury?
Mannerisms, head banging and rocking common with severe LD
General trend is towards greater prevalence of problem behaviour with increasing severity of LD (but people with profound LD exhibit less outwardly)
Which mental health problems are associated with learning difficulties - Forensic?
Mild LD have similar rates of offending to the general population but diff profile of offending
IQ below 70 over-represented for arson and sexual (usually exhibitionism) in prison population
What is diagnostic overshadowing?
Presenting symptoms are put down to their learning disability, rather than seeking another, potentially treatable cause
E.G: when a person presents with a new behaviour or existing ones escalate, consider:
1) Social cause - change in carers, lack of support, lack of social activities
2) Psychological issues - bereavement, abuse
3) Physical problems - pain or discomfort, e.g. from ear infection, toothache, constipation, reflux oesophagitis, deterioration in vision or hearing.
4) Psychiatric cause - depression, anxiety, psychosis, dementia
