learning disability

Question 1

what is the WHO definition of learning disability (calls it mental retardation but term used in UK is learning disability.) ?

Answer 1

• general impairment of intellectual functioning
• consequences in terms of severe impairment of social functioning
• onset before physical maturity
• therefore excludes people who develop cognitive impairments in adult life, and people with specific impairments such as dyslexia.

Question 2

What is the population mean score in IQ tests?

Answer 2

100

Question 3

what are the problems with IQ tests?

Answer 3

• narrow range of skills tested (not like everyday life)
• under-performance may not be due to learning disability
• invalid application - not designed for people with LD

Question 4

How is disability measured in an adaptive behaviour test?

Answer 4

• measure skills in daily living by checklists, interviews with carers and observations in activities e.g. self-help, basic academic skills, everyday coping skills and social competence
• generate a series of rating scales rather than an overall score

Question 5

what are the problems with adaptive behaviour tests?

Answer 5

• ignore extent of support from carer
• variability in performance between settings - better at home maybe?
• assumptions about activities appropriate to culture
• poor performance may indicate lack of opportunity rather than lack of skills - haven’t had much practice
• core skills can change over time e.g. cooking becomes less important but computer skills become more important

Question 6

what are the differences between mild LD and more severe LD?

Answer 6

• mild LD is more common than severe LD
• much more likely to have an identified organic cause for severe LD
• mild LD is much more strongly associated with poverty and disadvantage
• high mortality rates in severe LD
• mild LD do not usually have contact with specialist services while severe LD do.

Question 7

what is the difference between receptive and expressive communication?

Answer 7

receptive communication is the ability to understand information. It involves understanding words, sentences, meanings behind what people say or what is read.

expressive communication is being able to put thoughts into words and sentences, in a way that makes sense and is grammatically accurate.

Question 8

how can we assist communication?

Answer 8

• environmental adaptations: signs, colour coding
• interpreters: translators, sign language incl. Makaton (form of sign language that uses signs and symbols WITH SPEECH in spoken word order)
• assisted communication: braille, symbol systems, message boards, use of simpler english
• communication therapists

Question 9

what is universalism? how has it changed the way disabled people are treated in society?

Answer 9

idea that all human life is of worth

• closure of large mental institutions, instead ordinary domesticated settings
• greater access for disabled people to universal public services, employment and community facilities.

Question 10

how does having a learning disability affect morbidity and mortality?

Answer 10

• 60% of people with LD have an additional chronic disorder/disability
• higher rate of injuries amongst people with LD as less capacity to asses risk
• higher prevalence of epilepsy, mobility probs, sensory impairments
• more likely to suffer common mental disorders is have LD (can result from stress involved in coping with dependence or social exclusion)
• higher prevalence of autistic disorders
• life expectancy is increasing for people with LD (mean age at death = around 60)
• but mortality rates still 10-18 times higher than in general population
• most common causes are bronchopneumonia, cvd, consequences of epilepsy.

Question 11

how is access to healthcare for people with LDs?

Answer 11

• poor access
• see GP same amount as everyone else but higher rates of untreated/undiagnosed conditions and lower uptake of routine screenings/tests

Question 12

what is diagnostic overshadowing?

Answer 12

attributing discomfort/symptoms to a patient’s mental condition when symptoms actually suggest a comorbid condition.

Question 13

what problems may occur for people with LD in hospitals?

Answer 13

• staff unfamiliar and embarrassed in communication with patient > fear and distress
• hospitals unwilling to make concessions to special needs
• no adapted facilities e.g. room for wheelchairs
• hospital unwilling to meet additional care costs
• hospital staff often not informed in advance that patient has LD > unprepared
• little staff training to deal with patients with LD

Question 14

how can GP practices improve care for patients with LD?

Answer 14

• identification on practice register
• programme of routine health checks
• more appropriate waiting arrangements
• double appointment times for communication issues
• training for staff to improve awareness

Question 15

how can hospitals improve care for patients with LD?

Answer 15

• prep for admissions
• access for staff to communication therapists
• specialist community support for in-patients
• improved communication
• training for hospital staff