Learning Disabilities

Question 1

What is the ICD 10 definition of intellectual disability?

Answer 1

A condition of arrested/incomplete development of the mind

characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence - cognitive language, motor and social abilities

Question 1

What is the ICD 10 definition of intellectual disability?

Answer 1

A condition of arrested/incomplete development of the mind

characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence - cognitive language, motor and social abilities

Question 2

What is the intellectual disability criteria?

Answer 2

1. IQ < 79
2. Social or adaptive dysfunction (deficits in 2 or more skills)
3. Onset in the developmental period (before 18yrs)

Question 3

What IQ test is used?

Answer 3

Wechsler Adult intelligence scale

Question 4

How is the social or adaptive dysfunction measured?

Answer 4

Vineland adaptive behaviour scale - by questioning someone who knows the patient very well.

Question 5

What are the social or adaptive skills questioned?

Answer 5

Communication
Self care
Home living
Social skills
Community use
Self-direction
Health and safe
Functional academics
Leisure and work 

(need to have impairments in 2 or more).

Question 6

What is it called if someone acquires disability AFTER they are 18?

Answer 6

Acquired head injury.

Question 7

What is the relationship between intellectual disability and mortality?

Answer 7

The more severe the intellectual disability - the higher the mortality rate.

Question 7

What is the relationship between intellectual disability and mortality?

Answer 7

The more severe the intellectual disability - the higher the mortality rate.

Question 8

What do you need to remember about the IQ test?

Answer 8

If someone has an IQ <70 but does not meet the rest of the criteria, they do NOT have intellectual disability.

Question 9

How many people have an IQ of <70?

Answer 9

Should be 2.5%

Is actually 1-2% - because of mortality differences.

Question 10

What is the mean IQ and standard deviation?

Answer 10

Mean = 100

Standard deviation = +/- 15

Question 11

What is the criteria for a mild intellectual disability? IQ and functional age?

Answer 11

IQ = 50-69
OR
Functional age = 9-12yrs

Question 12

What is the criteria for moderate intellectual disability?

Answer 12

IQ= 35-49
OR
Functional age- 6-9yrs

Question 13

What is the criteria for severe intellectual disability?

Answer 13

IQ= 20-34
OR
Functional age= 3-6yrs

Question 14

What is the criteria for profound intellectual disability?

Answer 14

IQ= <20
OR
Functional age <3yrs

Question 15

How is the diagnosis between severe and profound intellectual disability judged?

Answer 15

Using clinical judgement. Because an IQ < 40 is very unreliable.

Question 16

How would someone with a mild intellectual disability present?

Answer 16

Live alone to some extent
Problems identifying risk and managing difficult situations
Vulnerable to people who might want to exploit them

Question 17

How might someone with a moderate intellectual disability present?

Answer 17

Obvious adaptive functioning difficulties
Some difficulties wit language communication BUT very good at expression communication
Require help with food, going to activities and making sure they are ready.

Question 18

How might someone with a severe intellectual disability present?

Answer 18

Require a big amount of day to day help.
Struggle to do anything themselves
**Difficulties in communication is a key feature.

Question 19

What are the main inherited causes of intellectual disability?

Answer 19

Fragile X syndrome
DiGeorge syndrome
Prader-Willi
Downs syndrome

Question 20

Which genetic/inherited cause of intellectual disabilities is most common?

Answer 20

Downs syndrome

Question 21

What psychiatric disorder does DiGeorge syndrome commonly cause?

Answer 21

Schizophrenia

Question 22

What are the acquired causes of intellectual disability?

Answer 22

MOST - Idiopathic 
Rubella
Zika virus
Hypoxic brain injury during birth (cerebral palsy)
Brain injury during childhood 
Foetal alcohol syndrome

Question 23

What percentage of intellectual disability is idiopathic?

Answer 23

70%

Question 24

Which medication if used by mothers during pregnancy are associated with a lower IQ and disability?

Answer 24

Sodium valproate.

Question 25

What is one of the most common causes of death in people WITHOUT intellectual disability?

Answer 25

Cardiovascular problems

Question 26

What is one of the most common causes of death in people WITH intellectual disabilities?

Answer 26

Respiratory - NOT smoking, often aspiration pneumonia.

Question 27

Which medical conditions are associated with intellectual disability?

Answer 27

Epilepsy Sensory impairment Obesity GI (reflux, constipation, H. pylori, swallowing problems) Respiratory (chest infections, aspiration pneumonia) Cerebral palsy (especially in severe intellectual disability) Orthopaedic problems (joint contractures, osteoporosis) Dermatology and dental problems

Question 28

What is the percentage of people with intellectual disabilities that have hearing impairments?

Answer 28

40%

Question 29

What is the percentage of people with intellectual disability that have vision impairments?

Answer 29

20%

Question 30

What is the association between intellectual disability and psychiatric problems?

Answer 30

The more severe the intellectual disability - the higher the chance of a psychiatric disorder developing.

Question 31

How do people with intellectual difficulties present with a psychiatric problem?

Answer 31

Mild ID - normal psychiatric presentation Moderate/Severe - Very different to normal psychiatric presentation eg - less complex delusions

Question 32

What percentage of the population WITHOUT an intellectual difficulty has schizophrenia/psychosis?

Answer 32

1%

Question 33

What percentage of the population WITH an intellectual difficulty has schizophrenia/psychosis?

Answer 33

3%

Question 34

How are people with intellectual difficulties likely to present if they have a mood disorder?

Answer 34

Change in behaviour rather than report in a change in mood.

Question 35

What is the correlation between intellectual difficulties and autism?

Answer 35

50% of people with autism also have an intellectual disorder.

Question 36

What is diagnostic overshadowing?

Answer 36

For example - when you diagnose someone with poor behaviour being due to their intellectual disability but they are actually acting out because theres something wrong with them (like lack of support, change in carers).