Learning disabilities

Question 1

How can the degree of learning disabilities be classified?

Answer 1

Learning disability occurs below 70 IQ

• Mild: 50-69
• Moderate: 35-49
• Severe: 20-34
• Profound: below 20

Question 2

What are the main components of learning disabilities?

Answer 2

• Low cognitive ability (below 70 IQ)
• Diminished social or adaptive functioning
• Onset in childhood

Question 3

Describe the typical presentation of learning disabilities

Answer 3

• Poor performance on tasks
  
  • ^eg. learning, short-term memory, problem solving
• Association with specific congenital syndromes
  
  • ^eg. Down’s syndrome, Fragile X syndrome
• Challenging behaviour

Question 4

State five causes of learning disabilities

Answer 4

• Genetic: Down’s syndrome, fragile X syndrome, Turner syndrome
• Metabolic: PKU, galactosaemia
• Structural: tuberous sclerosis, familial hydrocephalus, neurofibromatosis
• Intrauterine: malnutrition, congenital infection
• Perinatal: pre-eclampsia, antepartum haemorrhage, premature labour
• Neonatal: IVH, meningitis, severe neonatal jaundice
• Postnatal: trauma, infection, anoxis, hypothyroidism, malnutrition
• Drugs: alcohol, phenytoin

Question 5

What skills may be impaired in someone with a learning disability?

Answer 5

• Cognition
• Language
• Motor skills
• Social skills

Question 6

Differentiate between impairment, disability, and handicap

Answer 6

• Impairment: Any loss/abnormality of psychological, physiological or anatomical structure or function.
• Disability: Any restriction/lack of ability to perform an action in a normal manner or range.
• Handicap: A disadvantage for a given individual, resulting from impairment or disability that limits/prevents the normal fulfilment of a role.

Question 7

List three physical associated problems of learning disabilities

Answer 7

• Motor and mobility problems
• Speech, hearing and visual impairment
• Epilepsy
• Urinary and faecal incontinence
• Increased risk of obesity and fractures
• Poor oral health
• Poor diet, constipation, GORD
• Sleep disorders
• Premature death

Question 8

Name 3 common comorbid psychiatric disorders seen in people with learning disabilities

Answer 8

• Schizophrenia
• Anxiety disorders
• Depressive disorders
• Bipolar affective disorder
• Personality disorders
• Early-onset dementia
• Autism
• ADHD

Question 9

How does schizophrenia present differently in people with learning disabilities?

Answer 9

• Prevalence is 3x greater
• Earlier age of onset (23yr)
• More commonly associated with epilepsy, negative symptoms, and impaired episodic memory

Question 10

What additional symptoms may present in schizophrenia of severe learning disability?

Answer 10

• Unexplained aggression
• Bizarre behaviour
• Mood lability
• Increased mannerisms and stereotypes

Question 11

How does bipolar affective disorder present differently in people with Learning disabilities?

Answer 11

• Prevalence is greater (2-12%)
• More difficult to diagnose if severe LD also present

Question 12

How does depressive disorder present differently in people with Learning disabilities?

Answer 12

• Commonly missed
• More marked biological features, with diurnal variation
• Suicidal ideation is less frequent in severe LD

Question 13

List five associated behavioural problems alongside learning disabilities

Answer 13

• Difficulty accessing care and support
• Poor self-care: hygiene, diet, exercise, physical and mental health
• Lack of supportive social network
• Lack of regular employment and income
• Boredom
• Harmless behaviour interpreted as aggression
• Temper tantrums
• Criminal activity due to challenging behaviour or misunderstanding
• Challenging behaviour
• Communication difficulties, ASD, sensory impairment

Question 14

What types of behavioural disorders are seen in the LD population?

Answer 14

• Aggression and antisocial
• Social withdrawal
• Stereotypic behaviours
• Hyperactive disruptive behaviours
• Repetitive communication disturbance
• Anxiety/fearfulness

Question 15

Name 3 interventions can be used in behavioural disorders

Answer 15

• Educational and social intervention
• Facilitating communicate needs - e.g. hearing aid
• Behavioural intervention - reinforcement
• Psychotherapy
• Pharmacological treatment for comorbidities
• Physical intervention - protect individual and others

Question 16

Describe the prevalence of epilepsy in LD population

Answer 16

Epilepsy is significantly more common in people with LD, affecting approx 40% of hospitalised LD population.

Can occur at any age, variable presentation, and multiple forms.

Question 17

Outline the co-occurrence of epilepsy and LD

Answer 17

Epilepsy is commoner in patients with LD of various causes. May be due to shared aetiologies. Frequent epileptic seizures may lead to (or worsen) permanent loss of intellectual functioning. Therefore, early diagnosis and treatment is essential to prevent fatal progression.

Question 18

What problem arises in the management of epilepsy if severe LD is present?

Answer 18

A person with a severe learning disability is more likely to have side-effects than someone with a milder learning disability.

Question 19

Describe the cautions of using pharmacological treatment in people with LD

Answer 19

Presence of any comorbid physical disorders (e.g. epilepsy, constipation, cerebral palsy) increase the likelihood of side effects.

Atypical responses are more common ➔ advise lower doses and gradual increases in medication. Evidence base is lacking in LD population

Question 20

What are the indications for antipsychotics in people with LD?

Answer 20

• Comorbid psychiatric disorders (e.g. schizophrenia)
• Acute behavioural disturbances

Question 21

What are the indications for antidepressants in people with LD?

Answer 21

• Depression
• OCD
• Anxiety disorders
• Violence, self-injury, and non-specific distress

Question 22

What are the indications for Lithium in people with LD?

Answer 22

• Bipolar affective disorder
• Augmentation of antidepressant therapy
• Some effect in reducing aggressive outbursts

Question 23

How should cognitive therapies and CBT be delivered to the LD population?

Answer 23

Borderline/mild/moderate LD: Cognitive approaches may be adapted to level of intellectual impairment.

Question 24

What areas may be helpful to address in psychodynamic therapies for LD population?

Answer 24

• Emotional development
• Relationships
• Adjustment to life events

Question 25

What is the aim of behavioural treatments in learning disabilities?

Answer 25

* Teach basic skills: feeding, dressing * Establish normal behaviour patterns: sleep * Teach more complex skills: social skills, relaxation * Alter maladaptive pattens of behaviour: phobias, disinhibition etc.