Learning Disabilities

Question 1

Define learning disability

**HINT: FC gives multiple definitions so just get general idea

Answer 1

• “State of arrested or incomplete development of the mind. Characterised by impairment of skills manifested during the developmental period, and skills that contribute to the overall level of intelligence.” WHO
• “A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with a reduced ability to cope independently (impaired social functioning), which started before adulthood.” UK Department of Health
• “Define by 3 core criteria: lower intellectual ability (usually an IQ of less than 70), significant impairment of social or adaptive functioning, and onset in childhood.” NICE CKS

Question 2

What triad MUST exist to constitute a learning disability?

Answer 2

• Low intellectual performance (IQ <70)
• Onset at birth or during childhood
• Significant impairment of adaptive and social functioning

Question 3

What is meant by adaptive functioning?

Answer 3

Ability to manage the demands of day-to-day life (in other words, ability to manage ADLs e.g. self-care, travel, shopping, cooking, fine motor skills and communication)

Question 4

What is the prevalence of learning disabilities?

Answer 4

2%

• 85% = mild
• 10% = moderate
• 5% = severe or profound

*Male:female ration is 3:2 (fragile X has a lot to do with this figure)

Question 5

ICD-10 divides learning disabilities into four categories; what IQ range indicates:

• Mild
• Moderate
• Severe
• Profound

… learning disability?

Answer 5

• Mild= IQ 50-70
• Moderate= IQ 35-49
• Severe= IQ 20-34
• Profound= IQ < 20

Question 6

ICD-10 divides learning disabilities into four categories; what mental age would you expect for individuals with the following severities of learning disability:

• Mild
• Moderate
• Severe
• Profound

Answer 6

• Mild= 9-12yrs
• Moderate= 6-9yrs
• Severe= 3-6yrs
• Profound= <3yrs

Question 7

Causes of learning disability can be broadly grouped into:

• Genetic
• Antenatal
• Perinatal
• Neonatal
• Postnatal
• Environmental
• Psychiatric

… state at least 2-3 causes in each category

Answer 7

Question 8

What is the most common cause of learning disability?

What is the second most common cause of learning disability?

Answer 8

• Most common cause= Down’s syndrome
• Second most common cause= Fragile X syndrome

Question 9

Specific causes are uncommon in mild learning disability whereas they are usually identifiable in severe or profound learning disability; true or false?

Answer 9

True

Question 10

Describe features of mild learning disabilities

Answer 10

• Usually identified at later age when child starts school
• Language: adequate
• Social skills: adequate
• Self care: relatively independent
• May be difficulties in academic work
• May need support with higher order ADLs/tasks e.g. housing & finance
• May have paid employment

Question 11

Describe features of moderate learning disabilities

Answer 11

• Language: basic/limited communication skills
• Social skills: may be impaired hence need assistance/help to engage
• Self care: supervision with self care

Question 12

Describe features of severe learning disabilities

Answer 12

• Marked degree of motor impairment
• Language: little or no speech in early childhood but may eventually use simple communication
• Self care: need supervision
• Live in 24hr staffed home
• May have associated physical disorders

Question 13

Describe features of profound learning disabilities

Answer 13

• Severe motor impairment
• Severe communication difficulties
• Little or no self care
• Often have physical disorders
• Require residential care (24hr supervised care)

Question 14

Summary of features of mild, moderate, severe & profound learning disabilities

Answer 14

Question 15

State some physical disorders which are common in individuals with learning disabilities

Answer 15

• Motor disabilities (e.g. ataxia, spasticity)
• Epilepsy
• Visual impairment
• Hearing impairment
• Incontinence

Question 16

Which psychiatric disorders are more common in individuals with learning disabilities?

Answer 16

• Alzheimer’s disease
• Schizophrenia
• Anxiety (including OCD etc…)
• Depression
• Autism
• ADHD
• Eating disorders
• Personality disorders

Question 17

Learning disabilities can be associated with challenging behaviour; true or false?

Answer 17

True

Question 18

Discuss the management of learning disabilities

Answer 18

• MDT approach including psychiatrist, GP, specialist nurses, SALT, occupational therapists, social workers, psychologists, teachers etc..
• Treatment of co-morbid medical & psychiatric problems
• Challenging behaviour- can use antipsychotics
• Behaviour techniques (e.g. applied behavioural analysis including positive behaviour support)
• CBT
• Family education & support
• Genetic counselling
• Support for carers!
• Safeguarding!

Question 19

Patients with learning disabilities should have annual health checks (be this with their GP if they or a paediatrician); state some things this annual health check should include

Answer 19

• Specific concerns
• Assessment general health
  
  • Weight, height, BMI
  • BP
  • Smoking/alcohol intake
  • Consider glucose, cholesterol etc…
  • Make sure attended any relevant screening
  • Check seeing dentsit regularly
• Check up-to-date with immunisations
  
  • Pts with learning disabilities, their carers & paid support workers are entitled to flu vaccine
• Mental health review
• Full physical examination
• Review of all interventions & medications
• Offer healthy lifestyle advice (e.g. smoking cessation, exercise etc..)
• Enquire about what care services they have and inform if there are any that you think they could have but aren’t getting

Question 20

Outline the roles of carers in supporting patients with learning disabilities

Answer 20

LIST IS NOT EXHAUSTIVE:

• ADLs: this could range from prompting individuals to completing tasks for them e.g. washing, dressing, cooking, when to go to bed and when to wake up etc..
• Higher order ADLs: e.g. finances, applying for support, managing money etc..
• Social support: e.g. helping individual engage in social & leisure activities
• Management of comorbid conditions: e.g. monitoring, ensuring take medications, ensuring attend reviews
• Education: individual may need additional support in education

Question 21

State some charities that can support pts with learning disabilities

Answer 21

• Mencap
• Foundation for People with Learning Disabilities
• Macintryre

Question 22

Why do people with learning disabilities have worse health than people without learning disabilities?

Answer 22

see WB

Question 23

Learning disability is NOT a specific learning difficulty such as those listed below; however, what do the following mean?

• Dyslexia
• Dysgraphia
• Dyspraxia/developmental co-ordination disorder
• Auditory processing disorder
• Non-verbal learning disability
  *

Answer 23

• Dyslexia: difficulty in reading, writing & spelling
• Dysgraphia: difficulty in writing
• Dyspraxia/developmental co-ordination disorder: difficulty in physical coordination
• Auditory processing disorder: difficulty in processing auditory information
• Non-verbal learning disability: difficulty in processing non-verbal information

Question 24

SEE PAEDIATRICS FLASHCARD FOR MORE IN DEPTH REVISION OF FOLLOWING CONDITIONS:

• Down’s syndrome
• Fragile X syndrome
• Prader-Willi synrome
• Cri-du-chat

Answer 24

Image provides a summary:

• ***Fragile-X is X-linked*
• **Prader-Willi: insatiable hunger & hypotonia are key symptoms*

Question 25

Discuss some important questions to ask when taking a learning disabilities history

Answer 25

* Pregnancy, birth, development * Any issues * Scans normal * Premature or on time * Method of delivery * Complications * Condition of baby when born * Any problems in weeks after birth * Reach developmental milestones * Education * Type of school * Assistance * Occupational history (paid & voluntary) * Social history * Who lives with * What kind of accommodation * Support required * What they do * How they cope * PMH, PSH, drugs & allergies *(don't forget about psychiatric problems)* * Family history * Any LDs * Consanguinity *(can ask if they or their partner have any mutual relatives?)* * ICE * Patient * Carer

Question 26

It would be appropriate to perform a MSE on a patient with learning disabilities; remind yourself of the components of MSE

Answer 26

* Appearance & behaviour * Speech * Emotion (mood & affect) * Perception * Thought * Insight * Cognition * Risk

Question 27

Remind yourself of what to consider when doing a risk assessment of a patient; think specifically about any patients with learning disability

Answer 27

* Risk to self (self harm, suicide, self-neglect, financial) * Risk to health (physical & mental health) * Risk from others (safeguarding- financial, emotional, sexual, physical, emotional etc…) * Risk to others (unable to conduct themselves in safe manner, associated psychiatric conditions, emotional instability etc…)

Question 28

State some tips for improving your communication with learning disability patients

Answer 28

* Always greet patient before greeting accompanying individual * Simple language * Slow yourself down & give patient time to respond * Use gestures or pictures to explain if they struggle to understand * Regularly check understanding * Focus on their abilities not their disabilities

Question 29

Remind yourself of what to consider when doing a risk assessment of a patient; think specifically about any patients with learning disability

Answer 29

* Risk to self * Health (e.g. not recognise declining health including physical and psychiatric, not taking medications) * Self-neglect * Financial risks * Risk to others * Unaware of what is right & wrong (may act out physcially) * Risk from others * Safeguarding/abuse (financial, physical, emotional, negletc etc…)

Question 30

What is the STOMP project/programme?

Answer 30

STOMP stands for **stopping over medication of people with a learning disability, autism or both with psychotropic medicines**. It is a national project involving many different organisations which are helping to stop the over use of these medicines. STOMP is about helping people to stay well and have a good quality of life. Psychotropic medicines affect how the brain works and include medicines for **psychosis, depression, anxiety, sleep problems and epilepsy**. Sometimes they are also given to people because their **behaviour is seen as challenging.** People with a learning disability, autism or both are more likely to be given these medicines than other people. These medicines are right for some people. They can help people stay safe and well. **Sometimes there are other ways of helping people** so they need less medicine or none at all.