Week 3 - D - Learning disabilities - IQ classification and mental age, causes (chromosomal/pregnancy), Mental disorders

Question 1

Define learning disability?

Answer 1

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.

Question 2

What is the criteria for having a learning disability?

Answer 2

IQ <70

Developmental aetiology is at age of <18

Deficits in adaptive functioning

Question 3

What is the criteria of a learning disability again? What is adaptive functioning?

Answer 3

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

Question 4

What is the diagnosis of a learning difficulty upon?

Answer 4

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

Question 5

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?

Answer 5

This would be the Wesler’s adult intelligence scale

Question 6

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 ?____

Answer 6

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

Question 7

What percentage of the population are thought to have a leaning difficulty?

Answer 7

Only 3% of the population are thought to have a learning difficulty

Question 8

What does learning disabilities increase the risk of acquiring compared to the general population?

Answer 8

People with LD are at an increased risk of acquiring mental illnesses compared to the general population

Question 9

Is dyslexia a learning disability?

Answer 9

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

Question 10

How could you tell if someone has a learning disability?

Answer 10

* 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.

Question 11

What are the different severities of learning disability based on IQ?

Answer 11

* 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

Question 12

Out of the severities of learning disability listed, which is the most common?

Answer 12

Mild learning disability is the most common - accounts for 80% of LD cases IQ = 50-69

Question 13

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?

Answer 13

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

Question 14

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?

Answer 14

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

Question 15

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?

Answer 15

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

Question 16

Describe the presentation of mild learning disability Is the learning disability usually due to an organic cause with mild LD?

Answer 16

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

Question 17

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/

Answer 17

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

Question 18

Is moderate LD usually due to an organic cause? What is commonly seen in moderate disability patients?

Answer 18

Moderate LD is usually due to an organic cause in the majority of patients

Commonly there is epilepsy and physical disability

Question 19

How does severe learning diabilities usually present?7 State the Iq range and the mental age

Answer 19

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

Question 20

How does profound learning disability present? State the IQ range and the mental age

Answer 20

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

Question 21

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)

Answer 21

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%)

Question 22

What chromosomal abnormality occurs with Patau syndrome? What chromosomal abnormality occurs with Edward syndrome?

Answer 22

Patau syndrome - trisomy 13

Edwards syndrome - trisomy 18

Question 23

How does Prader Willi syndrome present? What causes prader willi syndrome?

Answer 23

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

Question 24

What is the syndrome which occurs due to a deletion in the region of chromosome 15 but in the mother known as?

Answer 24

This syndrome is angelman syndorme - it usually presents with a limb ataxia, LD and paroxysms of laughter

Question 25

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?

Answer 25

Turner syndrome - 46X - LD is rare,

Trisomy X

Klinefelter - 47 XXY

Fragile X - commonest form of inherited cognitive impairment

Question 26

Pregnancy factors include drugs, alcohol, poor diet, infections and hypoxia to the child What three aspects of learning disability impede people?

Answer 26

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

Question 27

Why are psychiatric illnesses more common in those with learning disabilities?

Answer 27

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

Question 28

How should you approach a psychiatric assessment in LD?

Answer 28

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

Question 29

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?

Answer 29

They are three times more common

Question 30

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?

Answer 30

Schizophrenia is three times as common in patients with LD

The age of onset is usually early - average around 23

Question 31

What is the main symptom of schizophrenia in someone with a learning disability?

Answer 31

Note the change in behaviour

May also have aggression/ bizzare behaviour / social withdrawal

Question 32

How would depressive disorder in someone with learning disabilities present?

Answer 32

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

Question 33

What is the triad of symptoms in autism spectrum disorder?

Answer 33

This would be

* Impaired social interaction

* Impaired imagination, communication and flexibility of thought

* Rigid/restricted behavior

Question 34

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)

Answer 34

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

Question 35

Treatment/support strategies for autism?

Answer 35

Communication aids and speech and language therapy

Educational and vocational interventions

Behavioural interventions- behavioural modification

Family intervention- support