Learning Disabilities

Question 1

What terms are used to describe learning difficulties

Answer 1

Mental retardation is still used in the ICD10
Mental handicap is used in legal terms
Intellectual or learning difficulty/disability are the most common and preferable terms to use in practice

Question 2

There is a high level of comorbidity in the learning disabled population - true or false

Answer 2

True
Health need are often unmet and staff have poor understanding
Communication is a big area of difficulty

Question 3

Does having a learning difficulty affect life expectancy

Answer 3

Yes
Females with a learning disability had an 18-year lower life expectancy and males had a 14 year lower life expectancy than the general population
Those with an intellectual or learning disability are 4x more likely to die of avoidable causes than the general population

Question 4

What conditions are more common in those with learning difficulty

Answer 4

26x more likely to have epilepsy (increases as severity of LD increases)
8x more to have severe mental illness
5x more to have dementia
3x more likely to have hypothyroidism
2x more likely to have diabetes, heart failure, chronic kidney disease or stroke

Co-morbid physical disabilities and sensory deficits or hypersensitivity are more common
Higher rates of physical and sexual abuse

Question 5

What learning disability is associated with Alzheimer’s

Answer 5

Down’s Syndrome

Question 6

What is the definition of a learning disability

Answer 6

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

Question 7

What are the criteria for learning difficulty

Answer 7

An IQ<70
Not a good measurement in young kids so need to retest

Developmental aetiology - < 18 years
Onset during the developmental period

Deficits in adaptive functioning (how they cope with change) and a functional impairment

Question 8

How are learning difficulties diagnoses

Answer 8

Based on clinical findings
History
Psychometric assessment - WAIS or Stanford tests
IQ is considered
Also assess function and handicap
Assess for underlying causes - physical exam, bloods, genetics etc.

Question 9

What is the average IQ of the population

Answer 9

100

Rising over time

Question 10

How does iodine deficiency affect IQ

Answer 10

It can lead to learning problems

Question 11

Is dyslexia a learning disability

Answer 11

No

This is an educational difficulty

Question 12

List the severity classifications of learning disabilities

Answer 12

Borderline LD	 = IQ 70+
Mild LD = IQ  50-69 
Moderate LD	= IQ  35-49
Severe LD = IQ  20-34
Profound LD= IQ  < 20

Question 13

How does a borderline LD present

Answer 13

IQ range 70-84
Mental age 12 to under 15
Not a recognised category

Question 14

How does a mild LD present

Answer 14

IQ range 50-69
Mental age 9 to 12
Most Common
Delayed speech - able to use everyday speech
Full independence – Self care, practical & domestic skills
Difficulties in Reading and Writing
Capable of unskilled or semi-skilled work
Problems if Social or Emotional Immaturity
Rarely organic aetiology

Question 15

How does a moderate LD present

Answer 15

Mental age 6 to 9 
Slow with comprehension and language
Limited achievements
Delayed self care and motor skills
Simple practical tasks - often with supervision
Usually fully mobile - physically active
Majority Organic Aetiology
Epilepsy & Physical Disability common

Question 16

How does severe LD present

Answer 16

Mental age 3 to under 6
Generally more marked impairment than in moderate LD and achievements more restricted
Epilepsy very common
Will probably be able to pick this up by meeting the patient

Question 17

How does a profound LD present

Answer 17

Mental age less than 3
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.
Will probably be able to pick this up by meeting the patient

Question 18

How can intellectual disabilities be picked up in children

Answer 18

Developmental screening
Those born prematurely should be followed up
Often seen when children fail to reach milestones
Milder cases may present with slow academic progress

Question 19

What other mental disorders are comorbid with LDs

Answer 19

ADHD

Autism

Question 20

What can cause LDs

Answer 20

Genetics
Maternal infections
Substance abuse in pregnancy or malnutrition
Extreme prematurity or birth injury
Metabolic dysfunction (PKU), hypoglycaemia or high bilirubin in the post-natal period
Infections or trauma in infancy

Question 21

What causes Down’s syndrome

Answer 21

Trisomy 21

Question 22

What is caused by trisomy 13

Answer 22

Patau syndrome

Question 23

What causes Edward’s syndrome

Answer 23

Trisomy 18

Only 10% survive their first year

Question 24

List some LDs caused by chromosomal abnormalities

Answer 24

Cri du chat 
Angelman
Prader-WIlli 
Williams syndrome 
Velo-cardiofacial syndrome - higher risk of schizophrenia

Question 25

List syndromes causes by abnormalities of the sex chromosomes

Answer 25

Turner's - X (LD rare) Trisomy X Klinefelter's - XXY (may have slightly lower IQ)

Question 26

What is the trend in incidence of LD

Answer 26

It is increasing by 1% per year | Due to increased life expectancy and increased survival of premature babies

Question 27

What are the 3 aspects of a LD

Answer 27

The impairment itself, e.g. brain injury as result of perinatal trauma The resulting disability e.g. inability to read The resulting social handicap

Question 28

Are psychiatric disorders common in the LD population

Answer 28

Yes - 3x more than rest of the population | They experience the same range of disorders but are often harder to diagnose and treat

Question 29

Why are psychiatric disorders more common in the LD population

Answer 29

Organic vulnerability – ‘brain damage’ Social deprivation / disadvantage Life events Psychological reasons – learned helplessness

Question 30

What must you consider if someone with a LD has a change in behaviour (becomes challenging)

Answer 30

Physical illness - pain, constipation, epilepsy Environmental stressors - abuse, loss, changes Mental disorders - depression or psychosis

Question 31

How can you manage a LD

Answer 31

Supportive and therapeutic environment - school and home Behavioral support plans Psychoeducation Social support Commutation aids Respite care if needed Pharmacological treatment for comorbid disorders Behavioural therapy - CBT and sensory therapy

Question 32

How does schizophrenia present in those with LD

Answer 32

Earlier age of onset Negative symptoms more common May present with a behaviour change 3 times more common than the rest of the population

Question 33

What are the symptoms of ASD

Answer 33

Abnormal social interaction Communication impairment Rigid/restricted or repetitive behaviour, interests and activities

Question 34

ASD is more common in which sex

Answer 34

Males | 3:1

Question 35

What is the definition of intelligence

Answer 35

A person’s capacity to acquire knowledge, apply knowledge (solve problems), and engage in abstract reasoning

Question 36

How can you measure intelligence

Answer 36

The Intelligence Quotient (IQ)

Question 37

Which features may increase suspicion of a learning disability

Answer 37

``` Delayed developmental milestones Lack of educational attainment Lack of employment Inability to manage financial affairs Difficulty with relationships Inability to attend to basic needs such as cooking, shopping Poor personal hygiene ```

Question 38

What is the most common identifiable cause for a learning disability

Answer 38

Down's Syndrome

Question 39

List genetic causes of arrested intellectual development

Answer 39

Sex chromosomal disorders - Turner’s (45, X0), Trisomy X (47, XXX), Klinefelters (XXY), and XYY males. Deletions and duplications = Prader-Willi syndrome and Angelman syndrome Autosomal dominant conditions - Neurofibromatosis and Tuberous sclerosis Autosomal recessive conditions - phenylketonuria X-linked recessive conditions -Hunter syndrome X-linked dominant conditions - Fragile X Chromosomal - Down's

Question 40

List non-genetic causes of arrested intellectual development

Answer 40

Congenital hypothyroidism Foetal alcohol syndrome Hypoxic damage Infective agents (ToRCH syndromes) CNS and skull development abnormalities (micro and macrocephalies, spina bifida, hydrocephalus) Disorders of unknown aetiology (e.g. Rett syndrome, disintegrative disorder)