Learning disability

Question 1

• To be able to discuss the aetiology of learning disabilities.
• Be familiar with the relationship between learning disability and other forms of mental disorder
• Consider the health inequalities of those with a learning disability.
• Outline the importance of communication skills and aids to enable assessment and management

Answer 1

.

Question 2

Define a learning disability

Answer 2

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

Question 3

3 criteria for a learning disability

Answer 3

1. Intellectual impairment (IQ < 70)
2. Social or adaptive dysfunction (Vineland 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 (age 18)

Question 4

IQ is used to classify level of learning disability (LD)

What is the IQ range for
-mild
-moderate
-severe
-profound
LD

Answer 4

Mild: 50 to 69

Moderate: 35 to 49

Severe: 20 to 34

Profound: <20

Question 5

Causes of LD (4)

Answer 5

Genetic, e.g. single gene (fragile X syndrome), micro deletion/duplication (digeorge, prader-willi)

Infection, e.g. antenatal (rubella), postnatal (meningitis)

Toxic syndromes, e.g. foetal alcohol syndrome

Trauma, e.g. birth asphyxia

Question 6

Common physical conditions associated with LD

Answer 6

Epilepsy
Sensory impairments (hearing, vision)
Obesity
GI - dysphagia, reflux oesophagi's
Resp - infections, aspiration pneumonia
Cerebral palsy
MSK - joint contractures, osteoporosis
Dermatology + dental - dental problems

Question 7

Mental health problems that can present in those with LD

Answer 7

Schizophrenia - self talk common

Mood disorders - but less likely to complain of mood changes

OCD - even more significant ritualistic behaviour

Autism - 2/3 OF THOSE WITH LD HAVE THIS

Hyperactivity syndromes, e.g. ADHD

Challenging behaviour + self injury, e.g. mannerisms, head banging

(INCREASE INCIDENCE OF ALL OF THESE IN THOSE WITH LD COMPARED TO GENERAL POPULATION)

Question 8

Important communication skill to enable assessment and management

Answer 8

Patience
Good listening
Recognise non-verbal cues
Explain in an appropriate way, e.g. simple jargon free for with pictures

Question 9

What is diagnostic overshadowing

beware of this

Answer 9

Automatically thinking presenting symptoms are put down to a specific cause (IN THIS CASE, LEARNING DISABILITY), rather than seeking another potentially treatable cause