OPIC - Intellectual Disabilities

Question 1

Learning Disabilities

Definition
APA Criteria
Classification of Intellectual Function
What LD is NOT/Differential Diagnoses

Answer 1

1. ) Definition - arrested or incomplete development of the mind, characterised by impairment of:
   - skills manifested during the developmental period
   - skills contributing to the overall level of intelligence
2. ) APA Criteria - needs all 3 criteria
   - disability occurred before the age of 18
   - below average intellectual functioning (IQ)
   - 2+ limited areas of adaptive skills exist together: communication, self-care, home living, social skills, health and safety, academics, leisure, work
3. ) Classification of Intellectual Function - IQ
   - normal IQ is 100 +/-15, borderline IQ is 70-85
   - mild LD is 50-70, moderate LD is 35-50
   - severe LD is 30-35, profound LD is <20
4. ) What LD is NOT/Differential Diagnoses
   - learning difficulties: dyslexia, dyspraxia, dyscalculia
   - emotional or behavioural problems
   - ADHD or ASD (autism spectrum disorder)
   - acquired brain injury in adult life

Question 2

Severities of Learning Disabilities

Borderline Intellectual Functioning
Mild Learning Disability
Moderate Learning Disability 
Severe Learning Disability
Profound Learning Disability

Answer 2

1. ) Borderline Intellectual Functioning - 70-85
   - not classed as LD but still vulnerable
   - can live independently but can be difficult to keep a job and may receive government assistance
   - often in special education or drop out in high school
   - subtle communication difficulties, at risk of abusive relationships, challenges around raising children
2. ) Mild Learning Disability - 50-70
   - relative independence in self-care and ADLs
   - can hold a conversation and engage in consultation
   - struggles with abstract concepts (e.g. time)
   - requires varying levels of service support
3. ) Moderate Learning Disability - 35-50
   - requires supervision with self-care and often living in supported accommodation
   - basic communication skills, can engage in a structured day programme or workshop activities
4. ) Severe Learning Disability - 30-35
   - needs supervision in ADLs, lives in 24hr staffed home
   - limited communication, motor impairment
   - in alternative day programmes with a combination of skills-based and recreational activities
5. ) Profound Learning Disability - <20
   - needs 24hr supervision, often lives in a group home
   - extreme communication difficulties
   - multiple medical problems

Question 3

Pathophysiology of Learning Disabilities

Genetic Causes
Perinatal Causes
Postnatal Causes

Answer 3

1. ) Genetic Causes - most common is Down syndrome, most inherited is Fragile X syndrome
   - autosomal abnormalities: Down’s (trisomy 21), Edward’s (trisomy 18), Patau’s (trisomy 13)
   - sex chromosomal abnormalities: Fragile X syndrome, Klinefelter’s (47-XXY), Turner’s (45-XO)
   - many autosomal dominant or recessive disorders
   - can also be due to deletions or could be X-linked
2. ) Perinatal Causes
   - iatrogenic: radiation, chemotherapy, medication
   - congenital infections: TORCH group (Toxoplasma gondii, Other agents, Rubella, CMV, HSV)
   - delivery: prematurity, anoxic brain damage
   - others: hyperbilirubinemia, foetal alcohol syndrome
3. ) Postnatal Causes
   - infection (encephalitis), metabolic (hypoglycaemia)
   - endocrine (hypothyroidism/cretinism), head trauma
   - toxins (lead poisoning), neoplasms (meningioma)
   - cerebrovascular (thromboembolism)
   - psychosocial (malnutrition, deprivation, low socio-economical background)

Question 4

Down’s Syndrome

General Information
Anatomical Features
Associated Conditions

Answer 4

1. ) General Information
   - most frequently known cause of LD
   - due to trisomy 21 (extra chromosome 21)
   - causes mild to moderate LD
   - behaviour: sociable, funny, affectionate, stubborn
2. ) Anatomical Features
   - broad flat face, slanting eyes, short nose, abnormal ears, short and broad hands, flat back of the head
   - congenital heart disease, absence of a rib,
   - enlarged colon, intestinal blockage, umbilical hernia
3. ) Associated Conditions
   - epilepsy: infantile spasms, tonic-clonic seizures
   - recurrent infections: ear and respiratory tract
   - obesity and obstructive sleep apnoea
   - C-spine abnormalities: atlantoaxial instability
   - hypothyroidism, sensory impairments
   - psychiatric: dementia (early onset), depression, OCD, ASD (autism), hyperactivity, conduct disorder

Question 5

Autism Spectrum Disorder (ASD)

Definition
Sensory Sensitivity
Mental Health
Management

Answer 5

1. ) Definition - lifelong neurodevelopmental condition with certain core features:
   - difficulties in social interaction and communication
   - stereotypic (rigid and repetitive) behaviours
   - resistance to change or restricted interests
2. ) Sensory Sensitivity - core diagnostic feature (DSM-5)
   - hypersensitivity to sensory stimuli, can also get hypersensitivity and this is more common in LD
   - sound (most affected), vision, touch, smell and taste
   - propensity to sensory overload
3. ) Mental Health
   - anxiety often presents as challenging behaviour: e.g. aggression, self-injury, destructive, spitting, loud etc.
   - other conditions: depression, psychosis, OCD
4. ) Management
   - support with communication
   - provide structure and routine as well as managing transitions and change
   - regulate environment: lights, people, temperature etc.
   - sensory blocking aids e.g. toys, specific devices
   - medication only given for associated MH issues

Question 6

Challenging Behaviour

What is it?
Examples
Causes and Reasons
Use of Medication

Answer 6

1. ) What is it? - culturally abnormal behaviour which threatens the physical safety of themselves or others
   - this is very vague and is not a diagnosis
   - it is common in patients with LD, may sometimes reflect more on service/carers/care than the individual
2. ) Examples
   - aggressive, destructive or dangerous behaviour
   - self-injury, spitting, smearing, loudness
   - sexist, racist or other upsetting behaviours
   - stereotypic behaviour
3. ) Causes and Reasons
   - communication of need or distress
   - physical illness and pain, sensory impairment
   - mental disorders: PD, dementia, ASD etc.
   - change in environment or abuse, drugs/substances
   - can be learnt behaviour or developmentally normal
4. ) Use of Medication - antipsychotics
   - last-line, must trial all other interventions
   - use the lowest dose possible, stop if not working

Question 7

Physical Health Problems in LD

Primary
Secondary

Answer 7

1. ) Primary - associated with their conditions
   - epilepsy: more common, more chance of treatment resistance means ↑polypharmacy, ↑mortality to SUDEP
   - visual or hearing impairment, hypothyroidism
   - motor problems, cerebral palsy
2. ) Secondary
   - infection: ear and respiratory tract infections
   - GORDs, obesity, fractures, incontinence, constipation
   - dental: cavities, edentulous (lacking teeth)