9. Learning Disabilities Flashcards
(33 cards)
Define intellectual disability.
- significant impairment of intelligence (IQ ≤ 70)
- significant impairment of ADLs
- both impairments evidence before adulthood*
*Note if these impairments develop in adulthood, the correct term is acquired brain injury.
What is adaptive functioning?
A persons ability to manage activities of daily living.
Significant impairment in this area suggests LD pts need considerable support in navigating ADLs.
What is a learning difficulty?
A person who experiences isolated problems with specific skills only (e.g. reading, writing, numeracy).
What is Fragile X syndrome?
A genetic condition that causes a range of developmental problems, including learning disabilities and cognitive impairments.
Why are males more severely affected by Fragile X syndrome, than females?
X-linked dominant disease.
Since males only have one X chromosome, it’s phenotypic expression is more apparent than in females with two X chromosomes.
Give some pre-natal causes of learning disability.
- Down syndrome
- Fragile X syndrome
- Spinal bifda
- malnutrition
- alcohol
What is the most frequently known cause of LD?
Down syndrome
What is the aetiology of Down syndrome?
Trisomy 21 - it is a genetic condition but cases are sporadic, not inherent.
Presentation of Down syndrome.
Physical signs (see image)
Cognitive signs:
- learning disability
- gross and fine motor skills affected
- depression
Behavioural symptoms of Down syndrome:
- stubbornness
- difficulty paying attention
- obsessive or compulsive behaviours
Give some perinatal causes of LD.
- intrauterine infections (e.g. toxoplasmosis)
- asphyxia
- premature birth
Give some postnatal causes of LD.
- epilepsy
- meningitis
- measles
- head injury
- malnutrition
What are the IQ ranges for
a) mild LD
b) moderate LD
c) severe LD
a) IQ ≤70
b) IQ ≤49
c) IQ ≤34
What are the features of borderline LD (IQ ≤85)?
- living independently
- subtle communication difficulties
- high school drop out / in special education
- difficulty keeping a job
- risk of abusive relationships
What are the features of mild LD (IQ ≤70)?
- relative independence in self-care and ADLs
- can hold conversation and engage in clinical interview
- abstract concepts (e.g. time) are difficult
- requires service support
- may engage in paid employment
What are the features of moderate LD (IQ ≤49)
- basic communication skills
- requires supervision with self-care
- living in supported accommodation
- engage in structures day programmes
- community access with staff
What are the features of severe LD (IQ≤34)?
- limited communication
- motor impairment
- needs supervision in ADLs
- living in 24-hour staffed home
What LD is not
- specific learning difficulty (e.g. dyslexia, dyspraxia)
- emotional or behavioural problems
- ADHD or ASD
- acquired brain injury
What are the physical associations of LD?
- epilepsy
- hypothyroidism
- obesity
- sensory impairments
- recurrent respiratory tract and ear infection
What are the psychiatric associations of LD?
- dementia
- depression
- hyperactivity
- OCD
- ASD
Issues with communication in people with LD:
- mask comprehension difficulties
- difficulty understanding medical terms
- will say ‘yes’ to appease
- suggestible
- sensory issues
Issues with expression in people with LD:
- content of conversation can be superficial
- articulation may be difficult
- may speak too slowly or loudly
What are some factors that can affect communication in LD?
Sensory function:
- hearing impairment
- visual impairment
Cognitive function:
- attention difficulties
- retention difficulties
Environment:
- too many people in room
- temperature
- lighting
- sound
What is a communication passport?
Allows patients with LD and their carers to agree and record all the ways a person communicates, and the best ways you can communicate with the person.
https://www.leicestershospitals.nhs.uk/aboutus/our-hospitals/childrens-hospital/children-and-young-people-with-autism/patientpassport/
Tips for effective consultations for patients with LD.
- minimise waiting time
- double consultation time
- explain basics
- speak to patient before speaking to carer
- offer breaks
