Learning Disability

Question 1

Define

Answer 1

Impairment = any loss or abnormality of psychological, physiological or anatomical structure or function

Disability = any restriction or lack of ability (from impairment) to perform an activity considered normal

Handicap = a disadvantage for a given individual that limits or prevents the fulfilment of a role that is normal

Definition (x3) =
- IQ <70
- Impaired social/adaptive functioning
- Onset in childhood

• Mild IQ 50-70 often no specific cause
• Moderate IQ 35-50
• Severe IQ 20-35 specific cause (brain damage, genetic)
• Profound IQ <20

Question 2

Symptoms

Answer 2

Most common genetic cause = Down’s > Fragile X

Indicators – LD register, LD school, difficulty reading/writing, Special Education Needs Assessments, etc.

• Children -> milestone delay, difficulty managing schoolwork, poor sleep-wake cycle (tx: melatonin)
• Adolescents -> difficulty with peers, inappropriate sexual behaviour, difficulty transitioning
• Adults -> difficult day-to-day functioning, needs extra support

Question 3

Investigations

Answer 3

Intellectual impairment:

• WAIS III (Wechsler Adult Intelligence Scale) – Verbal IQ + Performance IQ = Full Scale IQ

Adaptive and social functioning:
- ABAS II (Adaptive Behaviour Assessment System)
- Clinical interview (leave plenty of time) – establish presence in childhood
- Physical examination (sight and hearing)
- School reports

Check for other conditions and disorders:
- Poor diet and obesity, epilepsy, sensory impairment
- Schizophrenia 3% prevalence
- Mood disorders 4x more likely to have depression
- Autism 75% of ASD have a learning disabilit

Question 4

Management

Answer 4

Biopsychosocial MDT (psychiatrist, OT, SALT, specialist nurse, educational support, social support)

General help:

• Choice board (coffee or tea?) Scheduling board (wake up, clean teeth, etc.)
• Self-help board (steps to get dressed) Communication aids

Medications – start low, go slow – treat co-morbid medical and psychiatric problems

• Melatonin – helps with poor sleep-wake cycles
• Psychosocial interventions – CBT, family therapy, psychodynamic therapy, art therapy (if talking difficulty)

Challenging behaviours – identify/remove cause -> behavioural analysis (what causes it) à antipsychotics
- Risperidone – short-term use, last line if no cause can be found

• Information to family and carers about support groups – depends on cause of LD, i.e. CP:

SCOPE disability charity § www.cerebralpalsy.org.uk Reasonable Adjustment (disability act, 1995)

Question 5

Complications

Answer 5

Patients with LD have a higher prevalence of psychological symptoms than general population

• Can be difficulty diagnosing other psychological conditions due to language difficulties and atypical presentations (i.e. schizophrenia may present with simple repetitive hallucinations and persecutory delusions)
• Prognosis – chronic problems but handicap can be modified by social support