Learning Disabilities

Question 1

What is a learning disability?

Answer 1

• State of mind or incomplete development of mind
• Somebody with general learning disability said to have significant impairment of intellectual adaptive and social functioning

Question 2

Describe 4 types of learning disability

Answer 2

Mild (IQ 50-70) - Approx 85% of cases, usually live normal lives

Moderate (IQ 35-49) - Approx 10%, use simple language but understand speech better, may require support within special residential environment

Severe (IQ 20-34) - Approx 3-4%, any can look after themselves with careful supervision

Profound (IQ <20) - Approx 1-2%, development level of one year old baby across a range of parameters and require intensive help

Question 3

Describe the demographics of learning difficulties

Answer 3

• 3% of UK population
• Slightly more common in males than females
• More common in poorer family backgrounds
• Numbers have increased over last 35 years
• Improved socio-economic conditions and neonatal care increasing survival

Question 4

Name 3 genetic disorders which cause learning difficulties

Answer 4

1. Trisomy
2. Deletion
3. Sex Chromosome anomaly

Question 5

Name an example of trisomy

Answer 5

Down’s Syndrome

Question 6

Name an example of chromosome deletion

Answer 6

Cri du Chat

Question 7

Name 3 sex chromosome anomalies

Answer 7

1. Fragile X syndrome (most common cause of learning difficulties)
2. Klinefelter’s Syndrome (male with extra X chromosome)
3. Turner’s Syndrome (one X chromosome and partly missing X chromosome)

Question 8

Describe 3 types of metabolic conditions leading to learning difficulties

Answer 8

1. Amino acids
2. Carbohydrates
3. Lipids

Question 9

Describe a common amino acid related metabolic disturbance which can lead to learning difficulties

Answer 9

Phenylketonuria

 - Inherited autosomal recessive version of gene PAH
 - Unable to break down phenylalanine
 - High level of build up in the brain
 - Low protein diet can prevent intellectual disabilities

Question 10

Describe a common carbohydrate related metabolic disturbance which can lead to learning difficulties

Answer 10

Galactosaemia

 - Inability to metabolise sugar galactose properly
 - Causes convulsions, irritability and failure to thrive

Question 11

Describe 2 common lipid related metabolic disturbances which can lead to learning difficulties

Answer 11

Tay-Sachs diseases

 - Lack of vital enzyme needed to break down fatty waste in brain
 - Waste accumulates and causes brain damage

Gaucher’s Disease

 - Fatty substance sphingolipids accumulate in cells and certain organs
 - Organ and neurological damage

Question 12

Describe 3 cerebral degenerations which lead to learning difficulties

Answer 12

1. Tuberous Sclerosis (benign tumours which grow in brain)
2. Familial hydrocephalus
3. Neurofibromatosis (tumours form on nerve tissue)

Question 13

Name 2 drugs which can cause learning difficulties

Answer 13

1. Phenytoin

2. Alcohol

Question 14

Name 3 preinatal causes of learning difficulties

Answer 14

1. Pre-eclampsia
2. Antepartum haemorrhage
3. Premature labour

Question 15

Name an intrapartum cause of learning difficulties

Answer 15

Asphyxia

Question 16

Name 2 neonatal causes of learning difficulties

Answer 16

1. Meningitis

2. Severe neonatal jaundice

Question 17

Name 4 postnatal causes of learning difficulties

Answer 17

1. Injury
2. Infection encephalitis
3. Anoxia / Asphyxia / Status epilepticus
4. Metabolic hypoglycaemia

Question 18

Describe 4 presentations of learning difficulties

Answer 18

1. Developmental delay (eating, speech, intellectual ability, logic)
2. Regression of development
3. Behaviour problems
4. Unusual habits (Hyperkinesis / Pica)

Question 19

Describe the diagnosis of learning disabilities

Answer 19

• Presentation depends on cause
• Generally poor performance on tasks such as short term memory
• Associated with syndromes
• Consideration of family history, birth history and medical difficulties

Question 20

Name 3 major associated problems with learning difficulties

Answer 20

1. Physical
2. Psychological
3. Behaviour

Question 21

Name 4 physical difficulties associated with learning disabilities

Answer 21

1. Motor and mobility
2. Speech, hearing, visual
3. Epilepsy
4. Urinary and faecal incontinence

Question 22

Name 5 psychological difficulties associated with learning disabilities

Answer 22

1. Schizophrenia
2. Anxiety and depression
3. Early onset dementia
4. Autism
5. Hyperactivity and ADHD

Question 23

Name 4 b behavioural difficulties associated with learning disabilities

Answer 23

1. Threatening safety of themselves of others
2. Seemingly violent but harmless behaviour
3. Temper tantrums
4. Criminal activities

Question 24

Describe the important features of communicating with a person who has learning difficulties

Answer 24

• Focus on abilities and not disabilities
• Always greet patient before addressing accompanying person
• Check verbal capacity of patient
• Up to date medical history available
• Communication aids for non verbal patients

Question 25

Describe the management of patient's suffering from learning disabilities

Answer 25

- Multidisciplinary support - Psychological support have positive effects on behaviour - Psychotropic drugs often used but not very significant benefits - Assess for physical sources of discomfort if challenging behaviour

Question 26

Describe how a person is determined capable of giving consent

Answer 26

They must comprehend and retain information material to the decision especially as to the consequences of having or not having the intervention in the decision making process

Question 27

Name 6 things which may impair capacity

Answer 27

1. Alcohol 2. Pain 3. Anxiety 4. Learning disabilities 5. Dementia 6. Medications / Sedation / GA

Question 28

Describe the stages approach to informed consent

Answer 28

- Establish what is understood - Explain nature of conditions and outline options - Explain risk and benefits of treatments - Check what has been said is understood - Inviting further questions and confirming patient's preferred option - Giving and obtaining confirmed and informed consent

Question 29

Describe the things to consider when making a best interests decision

Answer 29

- Not limited to medical and should include wishes of person - General well being, relationships, spiritual and religious welfare - Involve views of close family and health and social care team - Decide what is best for person both now and in future - If no agreement is there, court may decide the outcome

Question 30

Name 3 common learning disabilities

Answer 30

1. Down's Syndrome 2. ADHD (Attention Deficit Hyperactivity Disorder) 3. ASD (Autistic Spectrum Disorder)

Question 31

Describe the demographics of Down's Syndrome

Answer 31

- Trisomy 21 in 95% of cases - Most frequent genetic cause of learning impairment (1:800) - Delay in cognitive ability mental retardation and physical growth - Average IQ of aroudn 50

Question 32

Describe the clinical features of Down's Syndrome

Answer 32

- Short stature - Learning disabilities - Typical facies with brachycephaly and widely spaced eyes - Brushfield spots in iris - Hands show clindoactyly - Simian palmar creases

Question 33

Give a brief overview of the associated conditions with Down's Syndrome

Answer 33

- Congenital cardiac disorders of around 50% - Diabetes prevalent - Dementia may develop - Psychiatric problems - Multiple immune defects (infections of skin, GI etc) - Chronic respiratory infections include TB

Question 34

Give a general overview of the oral considerations of a patient with Down's Syndrome

Answer 34

- Macroglossia (circumvallate papillae enlarge) - Poor anterior and oral seal - Maxilla and molars are small and mandible protrusive - Hypodontia relatively common - Periodontal disease and xerostomia

Question 35

Describe ADHD

Answer 35

- Defined as a psychiatric and neurobehavioural disorder - Characterized by either significant difficulties of inattention or hyperactivity and impulsiveness (or combination) - Symptoms emerge before seven years of age

Question 36

Describe ASD

Answer 36

- Describes range of conditions characterized by social deficits, communication difficulties and repetitive behaviours - Affects approximately 1:100 people

Question 37

Describe the triad of lifelong developmental disorder which characterizes ASD

Answer 37

Social Interaction - Difficulty with social relationships Social Communication - Struggle with verbal and non-verbal Imagination - Lack of pretend play and limited imagination

Question 38

Describe Asperger's Sydrome

Answer 38

- Higher IQ - Language intact - Poor social skills / lack of empathy - Indistinguishable from high functioning autism

Question 39

Describe autism

Answer 39

- Complex developmental disability which impairs communication and social behaviour - May appear distant, aloof and have obsessive routines - Co-existing conditions - Poor eye contact - Hyper or hyposensitive to sound, touch, pain or taste

Question 40

Describe dental treatment for a person suffering from ASD

Answer 40

- Review medical history before appointment - Consult physicians, family and carers - Consent central concern due to communication and mental capabilities - Often restricted diet

Question 41

Describe how an appointment for a patient with autism can be made easier

Answer 41

- Talk with parent / carer to determine intellectual ability - Tell Do Show - Desensitization appointment - First appointment of session so not waiting in busy waiting area - Sensory overload may occur - Know when to refer to specialist