Learning disability

Question 1

Define intellectual disability.

Answer 1

The presence of:

• a significantly reduced ability to understand new or complex information or to learn new skills;
• a reduced ability to cope independently;
• an impairment that started before adulthood, with a lasting effect on development.

Question 2

What are the components of the Wechsler Adult Intelligence Scale?

Answer 2

2 main components:

Verbal scales: general knowledge, digit span, vocabulary, simple arithmetic, comprehension, similarities

Performance scale: picture completion, arrangement, block design, digit symbol, object assembly.

Question 3

What is the average score for the WAIS scale?

Answer 3

• Average Range: 70-130.
• Average score: 100

Question 4

What are the levels of ID?

Answer 4

• Profound: <20
• Severe: 20-35
• Moderate: 35-50
• Mild: 50-69

Question 5

Define adaptive functioning.

Answer 5

Relates to a person’s performance in coping on a day-to-day basis with the demands of his/her environment

Related to a person’s age and socio-cultural expectancies associated with their environment as any time.

Question 6

List some indicators of ID.

Answer 6

• Reports of difficulty in reading and writing
• Difficulty in achieving skills (academic or daily life skills) considered acceptable for age & socio economic group
• Attendance at specialist school
• LD register
• Special Education Needs Statement
• Experience of having to modify communication
• Previously known to specialist children services

Question 7

How do you assess for ID?

Answer 7

1. Intellectual impairment - assessed using the WAIS IV: 11 subtests to derive Verbal IQ + Performance IQ = Full Scale IQ
2. Adaptive/Social functioning - established via clinical interview and ABAS II (Adaptive Behaviour Assessment System)

Presence in childhood established using clinical interview and school reports

Question 8

How common is ID?

Answer 8

2-3/100 affected

Question 9

What is the aetiology of ID?

Answer 9

Usually no specific cause e.g. brain damage, genetic abnormalities, hypothyroidism

Question 10

What condition causing ID do these patients have?

Answer 10

Fragile X

Question 11

What is the physical health of those with ID like?

Answer 11

• More likely to be obese and have a poor diet
• Epilepsy common (~16-32%)
• Sensory impairment e.g. hearing loss (25-42%), poor visual acuity (40%)

Question 12

What psychiatric comorbidities are common in those with ID?

Answer 12

ALL categories of mental illness can occur in those with ID

• Schizophrenia (3%)
• Mood disorders (x4 depression or anxiety)
• Autism (75% of those diagnosed haveID)

Question 13

What is challenging behaviour?

Answer 13

Culturally abnormal behaviour

Often persistent

Not a diagnosis

Question 14

How do you assess mental health problems in those with ID?

Answer 14

• Bio/psycho/social approach
• Change in baseline behaviour/mental state/skills
• Rule out physical causes
• Consider recent life events/changes
• Consider developmentally normal phenomena

Question 15

What should you do to communicate effectively with someone with ID? What if they are visually or hearing impaired?

Answer 15

Allow time in relaxed environment

Use open questions - be careful not to ask leading questions

Pictorial and symbolised material may be useful

If visually impaired, touch hand before speaking and start sentence with name

If hearing impaired, check that they can see your mouth and face and place yourself on side of best hearing

Question 16

What tool can be used to promote normal daily living e.g. choice-making, in ID?

Answer 16

Choice board - with pictures; fosters sense of control and independance

Self-help board - helps service users learn new skills or activities; each picture is in order of the task

Schedule board calendar - provides structure to person’s day /life

Communication board - with emojis or emotions

Question 17

What is the general management of mental health problems in ID?

Answer 17

General - MDT, use mainstream services, assess capacity to consent (MCA 2005), Care Program Approach

Psychotropic medication - Treat the illness but ‘start low, go slow’ as they may be sensitive to SE and therapeutic effects

Psychological interventions - CBT, family education and therapy, creative/complimentary therapies

Social intervention - community inclusion, skills training, environmental change

Question 18

Who is included in the community learning disability teams?

Answer 18

• Community Learning Disability Nurses
• Psychiatrists
• Psychologists
• Occupational Therapists
• Speech and Language Therapists
• Physiotherapists
• Dieticians
• Care Managers

Question 19

What is the importance of the Equality Act (2010) in treatment of patients with ID?

Answer 19

People with learning disabilities to utilise mainstream services as much as is possible

Ensuring equity of access to health care for people with a learning disability is every health professional’s business.