Learning Disability

Question 1

What % of the population have a learning disability?

Answer 1

3%

Question 2

Why is there – to some extent – an ‘invisibility’ of pts with learning disabilities within hospitals?

Answer 2

• Lack of effective flagging systems

* Lack of staff knowledge and willingness to flag this group

Question 3

What is there a poor staff understanding of, in relation to learning disabilities?

Answer 3

• Specific requirements of people with learning disabilities
• Reasonable adjustments to services people may need
• Capacity issues
• Communication

Question 4

What is a learning disability?

Answer 4

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 5

What is the criteria for a learning disability?

Answer 5

1. IQ < 70
2. Developmental aetiology - <18 years
3. Deficits in adaptive functioning

Question 6

What is the most commonly used tool for psychometric assessment?

Answer 6

Wechsler Adult Intelligence Scale (WAIS).

Question 7

What is the diagnosis of an LD based on?

Answer 7

Clinical findings (of adaptive behaviour)

Question 8

What is the average IQ?

Answer 8

100

Question 9

What is the prevalence of an IQ <70 in the general population?

Answer 9

2.5%

Question 10

What does the Flynn effect refer to?

Answer 10

How average rate of increase in IQ seems to be about three IQ points per decade in the USS, as scaled by the Wechsler tests

Question 11

Describe what trend in IQ scores the Flynn effect shows.

Answer 11

10 point increase per generation

Question 12

Suggest possible causes of the Flynn effect.

Answer 12

1. School
2. Test familiarity
3. Stimulation
4. Nutrition
5. Infections

Question 13

What is happening to the Flynn effect now? Especially where?

Answer 13

It is slowing down

Developing countries

Question 14

What is an LD not?

Answer 14

An educational difficulty e.g dyslexia

Question 15

Mild

Answer 15

50-69 (i.e <70)

Question 16

Moderate

Answer 16

35-49

Question 17

Severe

Answer 17

20-34

Question 18

Profound

Answer 18

<20

Question 19

Borderline

Answer 19

70+

Question 20

What is the mental age of someone with an borderline LD?

Answer 20

12-15 years old

Question 21

What is the mental age for someone with a mild LD?

Answer 21

9-12

Question 22

What type of LD is most common?

Answer 22

MILD

Question 23

Describe the typical features of someone with a mild LD.

Answer 23

• Delayed speech – able to use everyday speech though.
• Full independence – self-care, practical and domestic skills.
• Difficulties in reading and writing.
• Capable of unskilled or semi-skilled work.
• Problems if social or emotional immaturity.
• Rarely organic aetiology

Question 24

What is the mental age of someone with a moderate LD?

Answer 24

6-9 years old

Question 25

Describe the typical features of someone with a moderate LD.

Answer 25

* Slow with Comprehension and Language * Limited Achievements * Delayed Self-care and Motor Skills * Simple Practical Tasks - Often with Supervision * Usually Fully Mobile - Physically Active * Discrepant profiles * Majority Organic Aetiology * Epilepsy & Physical Disability common

Question 26

"Generally MORE MARKED IMPAIRMENT than in moderate LD and achievements are more restricted" describes what type of LD?

Answer 26

Severe

Question 27

What is the mental age of someone with a severe LD?

Answer 27

3-6 years old

Question 28

What condition do people with severe LD often have?

Answer 28

Epilepsy

Question 29

What is the mental age of someone with a profound LD?

Answer 29

<3 years old

Question 30

Describe the features of someone with a profound LD.

Answer 30

* Severe limitation in ability to understand or comply with requests or instructions. * Little or no self-care. * Often severe mobility restriction. * Basic or simple tasks may be acquired

Question 31

'Learning disability' refers to an outcome based on what?

Answer 31

An outcome caused by a disparate disease process

Question 32

What is the IQ range of someone with Down's syndrome?

Answer 32

30-55

Question 33

What other disease do people with Down's get?

Answer 33

Alzheimer's

Question 34

Describe the Down's mutation.

Answer 34

Trisomy 21

Question 35

Patau syndrome has what genetic abnormality?

Answer 35

Trisomy 13

Question 36

Edward's syndrome has what genetic abnormality?

Answer 36

Trisomy 18

Question 37

List some prenatal factors which contribute to someone having an LD.

Answer 37

* Maternal infection  Rubella, CMV, Toxoplasmosis. * Exposure to medication or drugs. * Alcohol( Foetal Alcohol Spectrum Disorder may be the cause of 10-20% of cases of mild LD, association with ADHD) * Poor diet, substance abuse.

Question 38

List some perinatal factors which contribute to someone having an LD.

Answer 38

- Neonatal septicaemia - Pneumonia - Meningitis/encephalitis - Other problems at delivery – birth injury - Other newborn complications (respiratory distress, hyperbilirubinaemia, hypoglycaemia, extreme prematurity)

Question 39

List some postnatal factors which contribute to someone having an LD.

Answer 39

- CNS infections, vascular accidents, tumours, hypoxic brain injury, head injury, NAI, exposure to toxic agents, psychosocial environment. - Congenital hypothyroidism – now screened for neonatally, if untreated leads to mental and growth retardation. - Other disorders of unknown aetiology. - Cerebral palsies, epilepsy, autistic spectrum disorders, childhood disintegrative disorders.

Question 40

Outline the 3 features of Angelman 15Q

Answer 40

* Maternally derived LD. * Ataxia. * Paroxysms of laughter

Question 41

Outline the 3 features of Prader-Willi 15Q

Answer 41

* Paternally derived LD. * Over-eating. * Self-injurious behaviour

Question 42

What % of people with Velo-Cardiofacial Syndrome 22Q will have a learning disability?

Answer 42

50%

Question 43

What condition do people with Velo-Cardiofacial Syndrome 22Q have an increased risk of?

Answer 43

Schizophrenia

Question 44

What sex chromosome arrangement is present in the following a) Turner 45 b) Trisomy X c) Klinefelter

Answer 44

a) XO b) 47 XXX c) XXY

Question 45

Name 4 genetic causes of LD.

Answer 45

- Defects of protein (phenylketonuria), carbohydrate (mucopolysaccharidoses), lipid metabolism (neurolipidoses). - Tuberous sclerosis. - Congenital hypothyroidism. - Lesch Nyhan Syndrome (x-linked)