LD Teaching

Question 1

What is learning disability? (3 criteria)

Answer 1

• Intellectual disability - impairment of intelligence (IQ less than 70)
• AND impairment of adaptive functioning
• Must begin within developmental period of life (before 18)

Question 2

What is adaptive functioning?

Answer 2

• Practical skills - ADLs (eg dressing/bathing)
• Social skills
• Conceptual functioning - learning, memory, reading/writing

Question 3

IQ LD levels

Answer 3

• Mild - 50-69 - MOST
• Moderate - 35-50 (10%)
• Severe 20-35 (4%)
• Profound - under 20 (1%)

More severe = reduced level of functioning

Question 4

Mild LD

Answer 4

• Relatively independent
• Struggle under stress, find it difficult to cope
• May be working in paid job
• Support with more complex things eg finances

Question 5

Moderate LD

Answer 5

• More impaired communication than moderate
• Can usually do ADLs

Question 6

Severe

Answer 6

• Few words/short sentences
• Need help with most ADLs

Question 7

Important genetic syndrome which can cause LD

Answer 7

• Down syndrome - most common, can cause early onset dementia
• Fragile X - self conscious, self harm sometimes, socially anxious
• Prader-Willi - deletion Chr15 from father, always hungry, mild-mod LD
• Angelman syndrome - PW but if deleted from mother, severe LD, problems with speech
• Cornellia de lange - self harming, autism
• Tuberous sclerosis - multiple benign tumours in lots of organs

Question 8

Mental health problems associated with LD

Answer 8

• Mental illness - depression, anxiety, OCD, bipolar, adjustment disorder, psychotic (eg schizophrenia), anorexia nervosa
• Neuro-developmental disorders - autism spectum disorder, ADHD
• Neuro-cognitive disorders - dementia
• Behaviour problems

Question 9

What is adjustment disorder?

Answer 9

• Emotional/behavioural reaction to stressful event/change in life
• May cause symptoms of depression/anxiety
• Finds difficult to cope
• Last around 6/12

Question 10

Autistic spectrum disorder features

Answer 10

• Deficits in social interaction, communication and behaviour
• Restrictive/repetitive behaviours
• Sensory problems
• Lack empathy
• Cognitive rigidity

Question 11

Features of social problems in autism

Answer 11

• Struggles with social cues
• Understanding,
• Empathy
• Can be non-verbal/limited language

Question 12

Management of autism

Answer 12

• MDT - SALT, OT, physio
• Biopsychosocial approach - treat co-morbidities
• Early intervention important

Question 13

Dementia in LD

Answer 13

• Common
• Begins at earlier age
• Diagnostic challenge - may not present with ‘memory problems’
• Screen for with DLD (dementia questionaire in LD) and DSDS (dementia screen for down syndrome)

Question 14

Examples of challenging behaviour seen in LD

Answer 14

• Putting themselves in danger/at risk
• Putting others in danger/at risk
• Aggression
• Self harm
• Environmental damage - walls/windows
• Inappropriate sexual behaviour

Can result in banning from school/day centre, 15% of those with LD have

Question 15

Underlying cause of challenging behaviour

Answer 15

Biopsychosocial model

Biological
* Pain - constipation, injury, dental infection

Psychological
* Depression
* Anxiety
* Hypomanic/manic episode
* ADHD

Social
* Environment - new? busy?
* Bullying?

Question 16

Management of challenging behaviour

Answer 16

• Positive behaviour support
• Last line - medication

Question 17

Physical health problems in those with LD

Answer 17

• Epilepsy
• GI - GORD, H-pylori, cancers
• CVS - congenital heart diseases eg atrial septal defect
• Endocrine - hypothyroidism, GH
• MSK - osteoporosis
• Weight problems - obesity and underweight
• Visual/hearing impairment

Question 18

Why is there increased mortality in those with LD?

Answer 18

• Attitudes from medical professionals - difficult to communicate, lack knowledge and confidence
• Prejudice - believe symptoms are due to LD and not invetsigate underlying cause
• Mental capacity act and best interests decisions
• Barriers to accessing healthcare

Question 19

What is reasonable adjustment?

Answer 19

• Patients with LD are legally entitled to this
• E.g providing information in different formats, extended consultation times, timing of appt (end/start of day)

Question 20

What is diagnostic overshadowing?

Answer 20

• Suspect that symptoms are caused by another already known disease (eg LD) and missing a new underlying cause
• Can lead to premature death

Question 21

What medications are used to manage LD?

Answer 21

• Same medications used in general populations for the underlying diagnoses eg SSRI for depression etc
• BUT start low and go slow, (titrate carefully)

Question 22

Services for people with LD

Answer 22

• Community LD team
• GP/primary care
• Secondary care specialist services
• Social services
• Voluntary services
• Advocacy services
• Private hospitals

Question 23

Community with LD teams

Answer 23

• LD community nurse
• Community therapists eg SALT
• Psychiatrists

Question 24

What is LD liason nurse?

Answer 24

Work with hospitals and GP’s to ensure people with LD can access health services

Question 25

Intensive support team for those with LD

Answer 25

* Specialist team * Work alongside community team * Behaviour therapists, psychologists * Work 7 days a week - when people become unsettled/challenging

Question 26

Medication management tools for those with LD

Answer 26

* STOMP - stopping overmedication in people with LD - all psychotropic * STAMP - Supporting Treatment and Appropriate Medication in Paediatrics

Question 27

Physical health problem management for those with LD

Answer 27

* GP * LD register - annual health check, bloods * Health screening

Question 28

Mortality in those with LD management

Answer 28

* Investigating premature death - LeDer - mortality reviews * Ensure DNACPR is not used inappropriately

Question 29

Preventing admissions to hopsital for those with LD

Answer 29

* Care and treatment review (CTR) - ensure all healthcare professionals agree admission is needed * Keep near home if needing admission if possible

Question 30

Assessment of someone with LD presenting with problem

Answer 30

* MSE (mental state exam) * Simple cognitive assessment - AMTS-10 * Basic physical examination - eg A-E * Bedside - ECG, observations, urine MSU * Bloods - FBC, U&E, LFT, TFTs, CRP, bone profile * Imaging - CXR if ?infection, brain imaging if ?infection * Special - ABC recording (antecedent behaviour and consequence)

Question 31

Management of someone with LD

Answer 31

* Biopsychosocial management * Positive behaviour support