Week 3 - D - Learning disabilities - IQ classification and mental age, causes (chromosomal/pregnancy), Mental disorders Flashcards
Define learning disability?
A learning disability is a condition of arrest or incomplete development of the mind, which is especially characterized by an impairment of skills, manifested during the developmental period, which contribute to the overall intelligence ie cognitive, language motor and social abilities.
What is the criteria for having a learning disability?
IQ <70
Developmental aetiology is at age of <18
Deficits in adaptive functioning
What is the criteria of a learning disability again? What is adaptive functioning?
IQ < 70
Developmental aetiology <18 years of age
Deficits in adaptive functioning
Adaptive functioning is w how well a person handles commands in life and how independent they are compared to others of a similar age and background
What is the diagnosis of a learning difficulty upon?
The diagnosis is based upon the clinical findings and the patients adaptive behavior - how independent they are for their age and how well they handle commands in life
Psychometric tests are a standard and scientific method used to measure individuals’ mental capabilities and behavioural style Psychometric assessment is used to help with the diagnosis of learning disabilites clinically What is the most common psychometric assessment used in the diagnosis of a learning disability?
This would be the Wesler’s adult intelligence scale
In an approximately normal data set, the values within one standard deviation of the mean account for about ____ of the set; while within two standard deviations account for about ____; and within three standard deviations account for about ?____
From an approx normal date, the values within one standard deviation of the mean account for 68% of the results
The values within two standard deviations of the mean account for 95% of the date
The values within three standard deviations of the date account for 99.7% of the date
What percentage of the population are thought to have a leaning difficulty?
Only 3% of the population are thought to have a learning difficulty
What does learning disabilities increase the risk of acquiring compared to the general population?
People with LD are at an increased risk of acquiring mental illnesses compared to the general population
Is dyslexia a learning disability?
NO - dyslexia is a learning difficulty
Learning disability is often confused with dyslexia and mental health problems.
Mencap describes dyslexia as a “learning difficulty” because, unlike learning disability, it does not affect intellect
How could you tell if someone has a learning disability?
* The features could be immediately apparent ie genetic syndrome, dysmorphic features
* Info from the patient /carers
* Special schoolin
* Behaviour / communication skills
A dysmorphic feature is a difference of body structure.
It can be an isolated finding in an otherwise normal individual, or it can be related to a congenital disorder, genetic syndrome, or birth defect.
What are the different severities of learning disability based on IQ?
* Borderline learning disability - IQ 70+
* Mild learning disability- IQ 50-69
* Moderate learning disability - IQ 35-49
* Severe learning disability - IQ 20-34
* Profound learning disability - IQ<20
Out of the severities of learning disability listed, which is the most common?
Mild learning disability is the most common - accounts for 80% of LD cases IQ = 50-69
What is the range of IQ in borderline LD and what mental age is the patient seen to have ? What is the range of IQ in mild LD and what mental age is the patient seen to have?
Range of IQ in borderline LD is 70-84
The mental age of the patient with borderline learning disability is 12 to under 15 years old
Range of IQ in mild LD is 50-69
The mental age of the patient with mild LD is 9- under 12 years
What is the range of IQ in moderate LD and what mental age is the patient seen to have? What is the range of IQ in severe LD and what mental age is the patient seen to have? What is the range of IQ in profound LD and what mental age is the patient seen to have?
Moderate LD - range of IQ = 35-49 - presents with the mental age of a child aged 6- under 9 years old
Severe LD - range of IQ = 20-34 - presents with the mental age 3 to under 6 years old
Profound LD = range of IQ < 20 - presents with the mental age of under 3 years old
Mental age - 5, what is the IQ likely to be and hence the severity of the learning disability?
Mental age - 11, what is the IQ likely to be and hence the severity of the learning disability?
Mental age of 5
Those typically with severe learning disability present with this mental age = IQ 20-34
Mental age 11
Those typically with a mild learning disability present with this mental age = IQ 50-69
Describe the presentation of mild learning disability Is the learning disability usually due to an organic cause with mild LD?
There is usually useful development of language and learning difficulties
The patient experiences difficulties in reading and writing and performing skilled tasks with mild learning diabilities
Normally presents as school is progressing
Learning disability is not usually due to an organic cause
Moderate LD I.Q. range 35-49, mental age 6 to under 9 years. Describe the presentation of a patient with a moderate learning disability/
They are usually slow with comprehension and language
Limited achievements and a delay in self care and motor skills
They can perform simple practical tasks often with supervision
Is moderate LD usually due to an organic cause? What is commonly seen in moderate disability patients?
Moderate LD is usually due to an organic cause in the majority of patients
Commonly there is epilepsy and physical disability
How does severe learning diabilities usually present?7 State the Iq range and the mental age
There is limited social activity and limited achievements
Usually just highlights a worse picture of moderate LD
IQ range - 20-34 Mental age - 3 to under 6 years
How does profound learning disability present? State the IQ range and the mental age
Profound learning disability - usually presents with the severe inability to comply with requests or instructions - severely limited adaptative functioning
Little to no self care
Often severe mobility restrictions
IQ range - <20 Mental age under 3 years old
Does Down syndrome cause learning disability? What other disease is down syndrome associated with? What are the three types of down syndrome? (in order of commonness)
Down syndrome does indeed cause a learning disability - usually patients have mild, moderate or severe learning disability
Down syndrome has an association with Alzheimers disease
Three types -
* Trisomy 21 - most common 95%
* Transolaction - part of chromosome 21 breaks off and translocates during development (3-4%)
* Mosaicism - some cells contain 46 and some contain 47 chromsomes (1-2%)
What chromosomal abnormality occurs with Patau syndrome? What chromosomal abnormality occurs with Edward syndrome?
Patau syndrome - trisomy 13
Edwards syndrome - trisomy 18
How does Prader Willi syndrome present? What causes prader willi syndrome?
Prader willi syndrome is caused by a deletion in the paternal chromosome 15
Children present with LD, overeating and self-injurious behaviour
There is usually hypogonadism and rapid weight gain
What is the syndrome which occurs due to a deletion in the region of chromosome 15 but in the mother known as?
This syndrome is angelman syndorme - it usually presents with a limb ataxia, LD and paroxysms of laughter
We have named just a few chromosomal abnormalities causing learning difficulties Other abnormalities include genetic, sex chromosome causes, prenatal, antenatal and postnanatal causes Name some sex chromosome abnormalities that can cause LD?
Turner syndrome - 46X - LD is rare,
Trisomy X
Klinefelter - 47 XXY
Fragile X - commonest form of inherited cognitive impairment
Pregnancy factors include drugs, alcohol, poor diet, infections and hypoxia to the child What three aspects of learning disability impede people?
The injury itself impedes people - hypoxic brain damage
The difficulty the injury causes - can have difficulty speaking and following commands/independence
The LD has certain implications for the patient such as difficulty with employment
Why are psychiatric illnesses more common in those with learning disabilities?
The organic cause of the LD eg brain damage makes them vulnerable
There is social deprivation and disadvantages also
There could be potential traumatic life events such as abuse
Psychological reasons such as learned helplessness
How should you approach a psychiatric assessment in LD?
Use open questions
Check accuracy
The level of detail from the patient may be restricted due to reduced comprehension so observing the patients behaviour is paramount
People with LD (PWLD) experience the same range of psychiatric disorders than the general population How much more common are psychiatric disorders in patients with learning disabilites compared to the general population?
They are three times more common
Schizophrenia is twice as common in people with learning disability. T or F? The age of onset of schizophrenia in someone with a learning disability is earlier? T or F?
Schizophrenia is three times as common in patients with LD
The age of onset is usually early - average around 23
What is the main symptom of schizophrenia in someone with a learning disability?
Note the change in behaviour
May also have aggression/ bizzare behaviour / social withdrawal
How would depressive disorder in someone with learning disabilities present?
There is usually somatosisation - the manifesting of psychological distress in the form of physical body symptoms
Reduced verbal expression of the true unhappiness and guilt
The biological symptoms of anergy, amotivation, anhedonia and lack of concnetration are still present
What is the triad of symptoms in autism spectrum disorder?
This would be
* Impaired social interaction
* Impaired imagination, communication and flexibility of thought
* Rigid/restricted behavior
Which sex is autism spectrum disorder more common in? What percentage of the learning disability population account for? (what percentage of the population had a learning disability again)
It is 4 times more common in males 30% of LD are due to autism spectrum disorder 3% of the general population had a LD
Treatment/support strategies for autism?
Communication aids and speech and language therapy
Educational and vocational interventions
Behavioural interventions- behavioural modification
Family intervention- support
