Flashcards in Learning Disability Deck (27)
What is learning disability - how is it defined?
Definition of Learning disability
• Sub average intellectual functioning (IQ below 70)
o 70-84 = borderline,
o 50-69 = Mild, language unaffected and independent
o 35-49 = Moderate, mild language impairment and some independence
o 20-34 = severe, some language and dependent
o <20 = profound, nonverbal, and dependent
• At least two limited areas of adaptive functioning (communications, self-care, home living, social skills, community use, self-direction, health and safety, leisure, work and academics)
• Disability occurred before the age of 18
(All 3 must be present)
Describe borderline learning disability?
Borderline LD are not considered LD but are vulnerable to cognitive status. They may be living independently but have subtle communication difficulties. They often dropped out of school or are in special education, have difficulty keeping a job, receive government assistance and are at risk of abusive relationships.
Describe mild learning disability?
Mild LD are relatively independent with ADLs, can hold a conversation but abstract concepts are difficult e.g. time. They have varying levels of service support and may be in paid employment.
Describe moderate learning disability?
Moderate LD have basic communication skills, okay with most ADLs but will not necessarily know when to do it or do it well. Live in supported accommodation, can engage in a structured day programme or workshop activities. Will need support when going out into the community.
Describe severe learning disability?
Severe LD have limited communication, motor impairment, need 24 supervision and have alternative day programmes focusing on skills and recreational activities.
Describe profound learning disability?
Profound LD require 24 house supervised care, live in nursing home of some variety, often have multiple medical problems.
Are learning disabilities and learning difficulties the same thing?
Learning disability is NOT learning difficulty e.g. dyspraxia, dyslexia, dyscalculia but they can co-exist. Learning difficulties are not emotional of behavioural problems. Learning difficulties are not neurodevelopmental disorders such as autism and ADHD, thought again they can co-exist with learning disability.
What causes learning disabilities?
Often unknown especially in mild and borderline LD
Most common inherited cause of LD is fragile X syndrome – X linked disorder
Most commonly known genetic cause of LD is down’s syndrome
Most common cause worldwide is malnutrition
Iatrogenic – radiation, chemotherapy, or medication
Infections – (TORCHeS) toxoplasmosis, other, rubella, cytomegalovirus, herpes, and syphilis
Delivery – anoxic brain damage and prematurity
Others – hyperbilirubinaemia and foetal alcohol syndrome
Infections (encephalitis), metabolic (hypoglycaemia), endocrine Hypothyroidism – cretinism), cerebrovascular (thrombo-embolism), toxins (lead poisoning), trauma (head injury), neoplasms (meningioma) and psychosocial.
What conditions can mimic learning disability?
Be aware of apparent LD caused by deafness, hypothyroidism and blindness (cataracts).
How and where should you assess someone with learning disabilities?
Issues to be aware of – can mask comprehension difficulties, will say yes to appease, problems with medical terms, are very suggestible and have sensory issues.
Conversation can be superficial and articulation me be difficult. Hugely sensitive to criticism or negative approach and you may only be able to get this wrong once.
Make sure hearing aids are in and switched on, have they got their glasses etc.
Environment – how many people, temperature, lighting, sound, and environmental triggers.
What should you not do when assessing someone with learning disabilities?
• Use yes and no questions
• Feel offended if patient seems disinterested
• Pretend to understand what the patient has said
• Have a long waiting time
What things should you do/allow for to improve a consultation with someone with a learning disability?
Tips and tricks
• Look at their communication passport
• Use simple language and regularly check for understanding
• Avoid leading questions
• Start by talking to them and then move to carers where appropriate
• Write things down/draw pictures to aid understanding
• Introduce yourself clearly and what you are
• Allow extra time
What common medical problems are seen in people with learning disability?
Respiratory tract infections
Medication side effects
What contributes to high levels of constipation in people with learning disability and how can it be managed?
Very common and can be serious.
Factors that contribute – immobility, dehydration, poor nutrition (lack of fibre, fruit + veg).
Managing constipation in LD – food diary, abdominal exam, stool chart, weight and DRE if indicated.
Why is obesity a problem in people with learning disability?
Tend to store a lot of central fat, have raised cholesterol. Childhood obesity is directly associated with asthma, diabetes MSK problems and psychological and behavioural problems. There are problems with patient education and lifestyle factors also a lot of psychiatric medications can increase weight e.g. antipsychotics.
What is STOMP?
STOMP – stop overprescribing of medication to people with LD. Encourage non-drug therapy, have regular check ups about their medicines. LD patients are already more likely to experience SE so polypharmacy can create a particularly high number of SE.
Why can physical health problems be difficult to recognise and deal with in people with learning disability?
Identification of disease both from the patient and doctor
Communication of the problem and possible managements
Understanding of the problems both from the doctor and the patient
Transfer to locations where treatment can happen
Can the patient consent?
What symptoms in a patient with learning disability might suggest an underlying psychiatric disorder?
Are much more prevalent in this population and very difficult to diagnose especially thought disorder and hallucinations.
Change in behaviour e.g. self-harm
Loss of skills e.g. continence
Not doing things they used to enjoy doing
Biological symptoms – sleep disturbance and weight change
When prescribing any kind of medication to patients with learning difficulty what must you do?
Start low and go slow with drugs
Why can it be very difficult to differentiate autism from learning disability?
Can be difficult to differentiate between what is LD and what is autism.
When considering communication make sure you are not confusing autism for what is simply a delayed developmental stage i.e. its normal for children to only play with themselves at some points. So it is important to check whether this is less than the rest of their development or not.
What is a carer?
A person of any age, adult of child, who provides unpaid support to a partner, child, relative or friend who would not manage to live independently or whose health or wellbeing would deteriorate without this help.
What is the role of a carer?
Organisation of person’s life, understanding medical background, food prep, stress management, help with movement around home, take to appointments and finances.
Where can carers get support?
Support for carers: Carers Centre – CLASP, Age UK, Carers assessment (Qs used by social care to determine impact of caring on person’s life so they can determine what support to offer), carers allowance - £67.25/w (benefits if caring for >35h/w) and disability Living allowance.
What barriers can there be for carers to get support?
Lack of awareness, not feeling worthy, cost, physical access
What is a caring crisis?
Crisis: when a carer can no longer cope. To avoid crisis, ensure that carers are known to GP, can access information and services
Why might carer's physical health deteriorate whilst caring?
Physical: diet (often busy), weight (poor diet, lack of exercise), sleep disturbance (stress, night-time care).
Financial: benefits system (understand entitlements, how to apply), transport, equipment, formal support
Emotional: feel invisible (no-one asks how they are), anxiety, guilt, anger
Social: isolation, no time for socialising, change in priorities