Learning disabilities

Question 1

What is the ICD-10 definition of an intellectual disability / learning disability / mental retardation?

Answer 1

‘A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities’

Question 2

Name the commonly used IQ scale in adults

Answer 2

Wechsler Adult Intelligence Scale

Question 3

To be diagnosed with an intellectual impairment, what does your IQ need to be?

Answer 3

IQ < 70

Question 4

Diagnostic criteria of Intellectual Disability

Answer 4

You have to show/have:

1. An IQ < 70
2. Social or adaptive dysfunction (Vineland Adaptive Behaviour Scale) - Deficits / Impairments in 2 or more of following adaptive skills: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure & work
3. Onset in the developmental period (before age 18)

Question 5

Can you have an IQ < 70 and still not be defined as having a learning disability?

Answer 5

Yes, if you have an IQ<70 but no problems functioning within your environment then you would not be defined as having a learning disability

Question 6

Which 2 factors are used to classify the severity of a learning disability?

Answer 6

• Intellectual functioning
• Adaptive functioning

Question 7

What are the IQ levels and functional ages associated with:

1. Mild LD
2. Moderate LD
3. Severe LD
4. Profound LD

Answer 7

1. Mild - IQ: 50 - 69 or functional age 9-12yrs
2. Moderate - IQ: 35 - 49 or functional age 6-9yrs
3. Severe - IQ: 20 - 34 or functional age 3-6yrs
4. Profound IQ: <20 or functional age <3yrs

Question 8

Intellectual disability can either be inherited or acquired. What are some of the inheritable traits associated with a LD?

Answer 8

• Single gene: Fragile X, PKU, Retts Syndrome
• Microdeletion/duplication: DiGeorge Syndrome, Prader-Willi, Angelman syndrome
• Chromosomal abnormality: Down Syndrome

Question 9

How might someone acquire a learning disability?

Answer 9

• Infective: e.g Rubella, Zika virus
• Traumatic: hypoxic injury during birth, head injury in childhood
• Toxic: Foetal alcohol syndrome
• Idiopathic: for most patients the cause of LD is unknown

Question 10

Name some inequalities people with learning disabilites face

Answer 10

• Social exclusion
• Socioeconomic deprivation
• Inaccessible services
• Discrimination
• Challenges to communication
• Lack of appropriate knowledge and skills of professionals
• Minimal evidence base from research

Question 11

What are some common and/or important physical conditions associated with learning disabilites?

Answer 11

• Epilepsy – increased incidence and complexity with severity of learning disability (10-50%)
• Sensory impairments – hearing (40 %) and vision (20%), earwax
• Obesity – predisposes to other health problems
• Gastrointestinal – swallowing problems, reflux oesophagitis, Helicobacter pylorii, constipation
• Respiratory problems – chest infections, aspiration pneumonia
• Cerebral palsy – especially with severe learning disability
• Orthopaedic problems – joint contractures, osteoporosis
• Dermatological and Dental problems- 33% unhealthy gums, for Down’s Syndrome, 80%

Question 12

Why is there a psychiatric specialty for those with a LD?

Answer 12

Higher incidence of psychiatric disorders in those with LD

• The more severe the LD - higher prevalence of psychiatric disorder
• People with mild learning disability may present in broadly similar way to the general population
• Presentation of mental illness different especially in moderate-profound LD
• Those with lower IQ/ communication difficulties often present with ‘challenging behaviour’
• Where there is less verbal communication, observable signs are relied on more in making the diagnosis

Question 13

How prevalent is Schizophrenia / Psychosis in those with learning disabilities?

Answer 13

3% Point Prevalence compared to 1% in general population

Question 14

How does Schizophrenia / psychosis present in LD patients?

Answer 14

• Associated with change in personality and reduction in functional abilities
• ‘Self-Talk’ common in LD

Question 15

How are mood disorders in LD patients commonly picked up?

Answer 15

People with learning disabilites are less likely to complain of mood changes and so they are noted by change in their behaviour ie biological symptoms instead

Question 16

How do anxiety disorders present in LD patients?

Answer 16

• Ritualistic behaviour and obsessional themes significantly increased in LD
  
  • Obsessions hard to describe by people with LD but compulsions more readily observed

Question 17

Link between LD and autism?

Answer 17

Half of persons with Autism have a LD

Question 18

LD patients in forensic pyschiatry

Answer 18

Mild LD have similar rates of offending to the general population but diff profile of offending

IQ below 70 over-represented for arson and sexual (usually exhibitionism) in prison population

Question 19

If a person with a learning disability presents with a new behaviour or existing ones escalate what should you consider?

Answer 19

• Social cause - change in carers, lack of support, lack of social activities
• Psychological issues - bereavement, abuse
• Physical problems - pain or discomfort, e.g. from ear infection, toothache, constipation, reflux oesophagitis, deterioration in vision or hearing.
• Psychiatric cause - depression, anxiety, psychosis, dementia