Learning Disabilities

Question 1

What is a Learning Disability (LD) or Intellectual Disability (ID)?

Answer 1

A group of conditions originating during the developmental period characterized by significantly below average intellectual functioning and adaptive behaviour, ≥2 SD below the mean (IQ < 70).

Question 2

Which terms are used interchangeably with “Learning Disability” in the UK?

Answer 2

ID, intellectual disabilities, learning disability, learning difficulty, developmental delay (for young children).

Question 3

How does ICD terminology differ?

Answer 3

ICD-10: Mental Retardation; ICD-11: Disorders of Intellectual Development (DIDe).

Question 4

What are the 3 domains of adaptive functioning?

Answer 4

Conceptual skills, social skills, practical skills.

Question 5

What is the mean IQ and diagnostic cutoff for ID?

Answer 5

Mean IQ = 100; <70 = intellectual disability.

Question 6

What proportion of ID cases have an unknown cause?

Answer 6

About 60%.

Question 7

Name the main categories of biological causes.

Answer 7

Genetic and non-genetic factors.

Question 8

Give examples of genetic causes of ID.

Answer 8

Chromosomal: Down’s syndrome

Single-gene: Fragile X (FRAX), Phenylketonuria, Rett’s, Duchenne Muscular Dystrophy

Copy number variants: Cri du chat, Angelman’s, Prader-Willi.

Question 9

What are key antenatal risk factors for ID?

Answer 9

Alcohol, drugs, radiation, infections (TORCH), maternal diabetes, malnutrition, hypoxia.

Question 10

Perinatal causes?

Answer 10

Birth asphyxia, prematurity, low birth weight, pre-eclampsia, birth trauma.

Question 11

Postnatal causes?

Answer 11

Encephalitis, brain injury, toxins (lead), malnutrition, neglect, social deprivation.

Question 12

What is the estimated prevalence of ID?

Answer 12

1–3% overall; <1% in developed countries; up to 6% in parts of Eastern Europe.

Question 13

What is the distribution by severity?

Answer 13

Mild 85%, Moderate 10%, Severe 4%, Profound 2%.

Question 14

Is ID more common in males or females?

Answer 14

Males.

Question 15

How much lower is life expectancy in PWID (people with intellectual disability)?

Answer 15

Around 20 years lower than the general population.

Question 16

Why are health problems often under-recognised?

Answer 16

Poor symptom communication; changes in behaviour may be the only sign.

Question 17

List 3 categories of health conditions in ID.

Answer 17

ID-related (e.g. epilepsy)

Syndrome-related (e.g. hypothyroidism in Down’s)

Secondary conditions (e.g. constipation, obesity).

Question 18

Are mental disorders more common in people with ID?

Answer 18

Yes—much higher rates across all ages.

Question 19

What are common coexisting conditions?

Answer 19

Neurodevelopmental disorders (ASD, ADHD, tics)

Acquired mental illnesses (depression, psychosis)

Challenging behaviours

Offending behaviour.

Question 20

What are key signs of anxiety in ID?

Answer 20

Behavioural equivalents—agitation, crying, withdrawal, hyperactivity, physiological changes (sweating, vomiting).

Question 21

Key features of depression in ID?

Answer 21

Sadness, anhedonia, fatigue ≥2 weeks. Behavioural signs: aggression, SIB, irritability, loss of self-care.

Question 22

What are “behavioural equivalents” of mania in ID?

Answer 22

Excessive smiling, reduced sleep, pressured speech, sexualised or hyperactive behaviour.

Question 23

Why is diagnosing psychosis harder in severe ID?

Answer 23

Communication deficits make it difficult to elicit delusions/hallucinations.

Question 24

Define “challenging behaviour.”

Answer 24

Socially unacceptable behaviour causing distress/harm that requires intervention.

Question 25

Give examples of challenging behaviour.

Answer 25

Aggression, self-injury, sexualised or disruptive behaviour.

Question 26

What distinguishes offending from challenging behaviour?

Answer 26

Legal intent (mens rea), seriousness, visibility, advocacy, and forensic involvement.

Question 27

Common offences historically linked with ID?

Answer 27

Fire-setting, sexual offences, violence.

Question 28

Key UK legal acts relevant to ID assessment/treatment?

Answer 28

Human Rights Act 1998 (Arts. 2,3,5,8,14) Equality Act 2010 Mental Health Act (civil & forensic sections) Mental Capacity Act & DoLS.

Question 29

Examples of MHA civil sections?

Answer 29

2, 3, 5(2), 5(4), 135, 136.

Question 30

Forensic sections?

Answer 30

35, 36, 37, 38, 41, 45A, 47, 48.

Question 31

What should a multiaxial assessment include?

Answer 31

Degree & cause of ID Comorbid neurodevelopmental or mental disorders Physical health Psychosocial factors Behavioural assessment.

Question 32

What frameworks guide formulation?

Answer 32

BioPsychoSocial model (predisposing, precipitating, perpetuating, protective) HELP: Health, Environment, Lived experience, Psychiatric problems.

Question 33

Name 3 standardised risk assessment tools.

Answer 33

START, HCR-20, VRAG.

Question 34

What is the “Ten-Point Treatment Programme”?

Answer 34

Comprehensive, multidisciplinary plan including assessment, pharmacology, psychology, rehab, relapse prevention, and discharge.

Question 35

Core treatment components?

Answer 35

Diagnostic clarification PBS (Positive Behaviour Support) Pharmacological & psychological therapy Offence-specific therapy Education/vocational rehab Community transition/discharge planning.

Question 36

What is Positive Behaviour Support (PBS)?

Answer 36

Evidence-based, patient-centred plan focusing on function of behaviour and improving quality of life.