Learning Disability

Question 1

What is mental handicap and mental disorder?

Answer 1

Mental handicap = “a state of arrested or incomplete development of mind”

Mental disorder = mental illness or mental handicap

Question 2

Describe the intellectual disability criteria?

Answer 2

• Intellectual impairment (IQ < 70)
  
  • Such as Wechsler Adult Intelligence Scale
• Social or adaptive dysfunction
  
  • Vineland Adaptive Behaviour Scale
  • Deficits/impairments in 2 or more of following adaptive skills
    
    • Communication
    • Self-care
    • Home living
    • Social skills
    • Community use
    • Self-direction
    • Health and safety
    • Functional academics
    • Leisure and work
• Onset in the developmental period (before age 18)

Question 3

What scale can be used to measure IQ?

Answer 3

• Such as Wechsler Adult Intelligence Scale

Question 4

What scale can be used to measure social or adaptive dysfunction?

Answer 4

• Vineland Adaptive Behaviour Scale

Question 5

What are examples of adaptive skills?

Answer 5

• Communication
• Self-care
• Home living
• Social skills
• Community use
• Self-direction
• Health and safety
• Functional academics
• Leisure and work

Question 6

Intellectual disability - epidemiology

(prevalence)

Answer 6

• Prevalence of IQ < 70 is 1-2%

Question 7

Intellectual disability - severity

Answer 7

Severity (based on both intellectual and adaptive functioning):

• Mild LD
  
  • IQ 50-69 or functional age 9-12 years
• Moderate LD
  
  • IQ 35-49 or functional age 6-9 years
• Severe LD
  
  • IQ 20-34 or functional age 3-6 years
• Profound LD
  
  • IQ < 20 or functional age <3 years

Question 8

What is the severity of intellectual disability based on?

Answer 8

Severity (based on both intellectual and adaptive functioning):

• Mild LD
  
  • IQ 50-69 or functional age 9-12 years
• Moderate LD
  
  • IQ 35-49 or functional age 6-9 years
• Severe LD
  
  • IQ 20-34 or functional age 3-6 years
• Profound LD
  
  • IQ < 20 or functional age <3 years

Question 9

Intellectual disability - aetiology

Answer 9

• Inherited
  
  • Single gene
    
    • Fragile X, PKU, Retts syndrome
  • Microdeletion/duplication
    
    • DiGeorge Syndrome, Prader-Willi, Angelman syndrome
  • Chromosomal abnormalities
    
    • Down syndrome (most common)
• Acquired
  
  • Infective
    
    • Rubella, Zika virus
  • Traumatic
    
    • Hypoxic injury during birth, head injury in childhood
  • Toxic
    
    • Foetal alcohol syndrome
• Idiopathic (for most patients the cause of LD is unknown)

Question 10

What are some genetic cause of intellectual disability?

Answer 10

• Single gene
  
  • Fragile X, PKU, Retts syndrome
• Microdeletion/duplication
  
  • DiGeorge Syndrome, Prader-Willi, Angelman syndrome
• Chromosomal abnormalities
  
  • Down syndrome (most common)

Question 11

What are some common conditions associated with intellectual disability?

Answer 11

• Epilepsy
• Sensory impairments
• Obesity
• Gastrointestinal
  
  • Swallowing problems, reflux oesophagitis, Helicobacter pylori, constipation
• Respiratory
  
  • Chest infections, aspiration pneumonia
• Cerebral palsy
• Orthopaedic problems
• Dermatological and dental problems
• Psychiatric conditions
  
  • High prevalence in people with LD and more severe
  • Presentation differs the more severe the LD
  • Where less communication is available, observable signs are relied on more to make diagnosis such as weight loss, withdrawal, agitation, tearfulness in depression

Question 12

How do psychiatric illnesses compare in people with learning disability to those without?

Answer 12

• High prevalence in people with LD and more severe
• Presentation differs the more severe the LD
• Where less communication is available, observable signs are relied on more to make diagnosis such as weight loss, withdrawal, agitation, tearfulness in depression

Question 13

What are assessment areas for the psychiatry of learning disability?

Answer 13

• Presence and severity of LD
• Aetiology of LD
• Associated biomedical conditions
• Psycho-social assessment
• Psychiatric disorders, their cause and consequences

Question 14

What are differences in the following between people with learning disabilities and those without:

• schizophrenia/psychosis
• mood disorders
• anxiety disorders
• over-activity syndromes
• challenging behaviour and self-injury
• forensics

Question 15

How many people with autism have learning disability?

Answer 15

• Half of people with autism have LD

Question 16

What are examples of health ineqaulities affecting people with learning disabilities?

Answer 16

Significant problem leading to early death:

• Social exclusion
• Socioeconomic deprivation
• Inaccessible services
• Discrimination
• Challenges to communication
• Lack of appropriate knowledge and skills of professionals
• Minimal evidence base from research

Question 17

What is diagnostic overshadowing?

Answer 17

This is where presenting symptoms are put down to learning disability, rather than seeking another potentially treatable cause

Question 18

When should you consider diagnostic overshadowing?

Answer 18

• Presents with new behaviour
• Existing behaviour escalates
• Consider
  
  • Social cause – change in careers, lack of support, lack of social activity
  • Psychological issues – bereavement, abuse
  • Physical problems – pain or discomfort
  • Psychiatric cause – depression, anxiety, psychosis