what is an intellectual disability and a learning disability?
refers to when somebody has a developmental disorder (ie. autism), whereas a learning disability refers to when a person has difficulty learning in specific academic areas (ie. dyslexia)
what is a learning disability?
state of arrested or incomplete development of the mind, characterised by impairment of skills manifested during the developmental period and skill that contribute to intelligence
what is the LD triad?
low intellectual performance (<70 IQ)
onset at birth or during early childhood
wide range of functional limpairment
what are some types of learning disabilities?
dyslexia
dysgraphia
dyspraxia
auditory processing disorder
non-verbal learning disability
profound and multiple LD
what is the classification of severity of ID based on IQ?
- 55-70: mild
- 40-55: moderate
- 25-40: severe
- under 25: profound
*also can be based on adaptive functioning
what are some causes of LD?
- FHx
- abuse, neglect, psychological trauma
- genetic: downs, fragile X, prader-willi
- antenatal problems: foetal syndrome
- problems at birth
- meningitis in early childhood
- autism
- epilepsy
what are some clinical features of LD?
mild: adequate language, social, self care with academic difficulties
moderate: able to communicate and do simple work, language limited and self care supervision needed
severe: simple communication, marked motor impairment, associated physical disorders
profound: sever motor, no self care, physical disorders and in residential care
what are some physical signs of LD?
ataxia
spasticity
epilepsy
impaired hearing or vision
incontinence
what features are important in LD examination and history taking?
- history: pregnancy history, FHx, ADL, developmental, PMH
- MSE
- CVS, resp, neuro
- weight, height, head circumference
- developmental assessment
- hearing and vision
what investigations would be carried on in LD?
- before birth - amniocentesis, chorionic villus sampling, genetic testing and karyotyping
- DS - serum screening, nuchal translucency
- after birth
- bloods - FBC, TFT, glucose, serology infections
- brain imaging - CT head and MRI
- IQ test
who makes up the MDT team for LD?
- health visitors
- social workers
- schools
- educational psychologists
- paediatricians, GP, nurses
- occupational therapists
- speech and language therapists
how is LD managed?
- involve the child in any discussions where appropriate
- Use tools to assist your communication, such as pictures and emojis
- capacity still decision specific - may require more time and effort but can still meet criteria!!
- medication - antipsychotics for challenging behaviours
- behavioural techniques - positive support, CBT
- family education
- prevention - genetic counselling, antenatal diagnosis
