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OPIC > Learning Disabilities > Flashcards

Learning Disabilities Flashcards

1
Q

Define Learning Disability?

A

A state of arrested or incomplete development of the mind. Characterised by impairment of skills manifested during the developmental period and skills that contribute to the overall level of intelligence.

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2
Q

What are the main groups of factors influencing the development of LDs?

A
  • Genetic
  • Antenatal
  • Perinatal
  • Neonatal
  • Postnatal
  • Environmental
  • Psychiatric
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3
Q

What are the main Genetic causes of learning difficulties?

A

Trisomy 21 (Down’s), Trisomy 13 (Patau’s), Trisomy 18 (Edward’s), 45XO (Turner’s syndrome), Fragile X, PKU, Tay Sachs disease, Tuberous sclerosis

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4
Q

What are the main Antenatal causes of learning difficulties?

A

Teratogens: alcohol, cocaine, prescribed drugs e.g. sodium valproate

Infections (TORCH): Toxoplasmosis, Other, Rubella, Cytomegalovirus, HSV)

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5
Q

What are the main Perinatal causes of learning difficulties?

A

Extreme prematurity, Intraventricular haemorrhage, Hypoxic-ischaemic injury, neonatal hyperglycaemia, neonatal hyperbilirubinemia

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6
Q

What are the main Neonatal causes of learning difficulties?

A

Traumatic brain injury, Anoxia (e.g. suffocation, near drowning), Toxin exposure (heavy metals), Infections (meningitis, encephalitis), Abuse, Neglect

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7
Q

What are the main Postnatal causes of learning difficulties?

A

Traumatic brain injury, Shaken baby syndrome, Malnutrition, Lead poisoning, Abuse, Neglect, Seizure disorders, Rett syndrome, CNS haemorrhage, Acquired hypothyroidism, Hearing or visual impairment

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8
Q

What are the main Environmental causes of learning difficulties?

A

Lead exposure, Allergies, Substance abuse, Accidents, Impoverished living conditions

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9
Q

What are the main Psychiatric causes of learning difficulties?

A

Psychological stress, Abuse, Depression, Anxiety, Eating disorders

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10
Q

How are learning difficulties categorised?

A

Mild: IQ between 50-69
Moderate: IQ between 35-49
Severe: IQ of less than 35

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11
Q

What are the 4 key features which distinguish mild, moderate and severe LD (apart from IQ)?

A
  • Ability to Self Care
  • Reading and Writing
  • Social Skills
  • Physical Issues
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12
Q

What are the features of mild LD?

A
  • Independent self care
  • Reasonable reading and writing skills
  • Normal social skills
  • Rarely see physical issues
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13
Q

What are the features of moderate LD?

A
  • Need some assistance with self-care
  • Only basic reading and writing skills
  • Only moderate social skills
  • Some occasional physical issues are seen
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14
Q

What are the features of severe LD?

A
  • Basic to zero self caring
  • Minimal reading and writing ability
  • Few social skills
  • Physical issues are common
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15
Q

What are some common psychiatric co-morbidities seen in patients with LD?

A
  • Adjustment disorders
  • Anxiety
  • ADD/ADHD
  • Depression
  • Substance abuse
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16
Q

Why might people with LDs have worse health than people without LDs.

A
  • Difficulty accessing healthcare
  • Communication difficulties (both from the patient and the doctor)
  • Shrouding effect of other issues (doctors only seeing the LD)
  • Higher rates of co-morbidity
  • Lower SES
  • Difficulty engaging in certain interventions (complexity, pain, therapy)
  • Differences in drug metabolism and the failure of modern medicine to work around this
  • Vulnerability to neglect or abuse
  • Social stigma
17
Q

What are some common physical co-morbidities of LDs?

A
  • Epilepsy
  • Hearing issues
  • Visual issues
  • CVD
  • Hypothyroidism and Leukaemia in Down’s syndrome
18
Q

What is it important to bare in mind when taking a history from someone with LD?

A
  • CONDITIONS; is this environment suitable for them? is it causing unnecessary anxiety
  • COMMUNICATION; ask the carer what the patient’s preferred mode of communication is, and if you could switch to that
  • CONSET and CAPACITY; is this person capable of giving a medical history and do you have their consent
  • CARER; establish relationship, start by talking to patient, involve carer at an appropriate point
  • CO-MORBIDITIES; make sure to ask about the common co-morbidities suffered by LD patients. both physical and psychiatric.
  • Drug history and COMPLIANCE; have their been any issue taking medication
  • CARING; social situation and home setup
19
Q

What is ‘challenging behaviour’? Why is it more common in individuals with LDs?

A

CB = any behaviour that puts them or those around them (such as their carer) at risk, or leads to a poorer quality of life. Examples include; hurting themselves or others, destroying things, spitting, smearing, stripping off, running away, eating inedible things.

More common in people with LD as they might lack the communication and social skills to understand what is acceptable behaviour, may have underlying issues which they can’t verbalise which manifests as CB.

20
Q

What are some causes of CB in people with LD (things to look for when investigating LD)?

A
  • Pain or other heal issues (e.g. banging head due to ear ache)
  • Social attention (everyone needs attention and kids with LDs are often neglected, may resort to CB).
  • Mental health issues
  • To get something (some people with LDs learn CB as a means of getting something specific)
  • Escape (e.g. from a doctor or dentist)
  • Sensory stimulation (they may just enjoy the feeling of whatever they’re doing)
21
Q

What are ‘psychotropic medications’?

A 
anti-anxiety agents.
antidepressants.
antipsychotics.
mood stabilizers.
stimulants.
22
Q

Why is psychotropic medication use in people with learning difficulties complex?

A

Often require them due to increased risk of mental health issues BUT, there is a suggestion that often they are given inappropriately in order to curb challenging behaviour which could be best managed conservatively.

STOMP is a project aiming at monitoring psychotropic medication use in these groups and reducing it as much as possible.

23
Q

When should psychotropic medicine be used in a patient with LD?

A

If…

  • There is a clear indication (in the form of a diagnosis/symptom) AND other options have been trialled first AND use fits in with BNF regulations
  • Consent to treatment OR best interest rationale has been met
  • Regular monitoring of treatment and side effects
  • Continuation /Discontinuation is discusses
24
Q

What are the most common causes of LD?

A
  • Down’s
  • Fragile X
  • Worldwide; Malnutrition
25
Q

What is involved in a risk assessment of a person with LD presenting acutely?

A

Risk assessed over 3 categories:

  • Communication ability
  • Physical health needs
  • Mental health and Behavioural needs

Produces 4 levels of varying risk.

26
Q

How are Learning Difficulties distinct from Learning Disabilities?

A

A Learning Difficulty is a deficiency in a specific area which impacts a person’s ability to learn, and includes dyslexia, dyscalculia, and ADHD.

A Learning Disability is a more all-encompassing deficit which affects all areas of intellect and learning (marked by a reduced IQ).

27
Q

What are some important things to ask for when taking an LD history in an acute setting?

A
  • Physical: Any symptoms that could indicate physical unwellness recently
  • Psychiatric: How has their mood been? Any changes? How do they normally present when they’re upset.
  • Behavioural: Any challenging behaviour? Do they have a history of this?
  • Communication: How is their speech and language? Any changes
  • Social: How is the home environment? Is everyone coping well?
  • Occupational: What do they normally do? Have they been able to maintain this?
28
Q

What NHS professionals/services can be used to assist in the management of patients with LDs?

A
  • In hospitals; Learning Disabilities Liaison Nurses
  • In the community; LD nurses
  • Behavioural therapists, Occupational therapists, Physiotherapists, SALT team can be accessed in either
  • Psychiatry and Psychology teams can be involved
  • Dieticians can be involved, some with specialist LD knowledge
  • Art therapy, Support groups, Day centres
29
Q

How does the mental capacity act relate to patients with a learning disability?

A

The right of people with a learning disability to make their own decisions has not always been respected. Many people have been viewed as incapable because of their label or diagnosis, or were ‘allowed’ to make decisions by those around
them so long as they were seen by others as making the ‘right’ decision. If someone with a learning disability made a decision that was considered to be unwise by their family or people who support them they were often seen as lacking capacity.

30
Q

How would you perform a mental state examination in a patient presenting with a Learning Disability?

A
  • Appearance
  • Behaviour
  • Speech
  • Mood and affect
  • Thought
  • Perception
  • Cognition
  • Insight and judgement
31
Q

Describe how a patient with borderline intellectual functioning may present.

A
  • Not classified as LD but still vulnerable due to cognitive status
  • Living independently
  • Subtle communication difficulties
  • High-school ‘drop-out’ or in special education
  • Difficulty keeping a job, receiving government assistance
32
Q

What classification of intellectual function would a patient fall under with an IQ of 100+?

A

Normal

33
Q

What classification of intellectual function would a patient fall under with an IQ of 70-84?

A

Borderline IQ

34
Q

What classification of intellectual function would a patient fall under with an IQ of 50-69?

A

Mild LD

35
Q

What classification of intellectual function would a patient fall under with an IQ of 35-49?

A

Moderate LD

36
Q

What classification of intellectual function would a patient fall under with an IQ of 20-34?

A

Severe LD

37
Q

What classification of intellectual function would a patient fall under with an IQ of <20?

A

Profound LD

OPIC (6 decks)

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