Learning Disability Clinic

Question 1

Management of challenging behaviours

Answer 1

• Identify underlying cause
• Positive behaviour support
• Medication LAST line

Question 2

What is challenging behaviour?

Answer 2

• Evnironmental destruction
• Inappropriate sexual behaviour
• Harming self/others or putting self/others at risk of harm
• Fire starting

Question 3

How common is challenging behaviour?

Answer 3

15% of people with LD will experience this

Question 4

Causes of challenging behaviour

Answer 4

• Biological - eg constipation, UTI, dental infection, GORD, fracture
• Psychological - any MH disorder eg anxiety
• Social - change in environment, carers, environment is too loud/cold

Question 5

What does positive behaviour support involve?

Answer 5

• ABC
• Antecedent - what happens before
• Behaviour
• Consequence
• Create management plan, may involve psychologist/behaviour specialist

Question 6

Criteria for learning disability to be diagnosed

Answer 6

1. Impaired intellectual function - IQ less than 70
2. Associated with impaired adaptive function - physical ADLs, social or perceptual
3. Started within development period of life (before 18)

Question 7

IQ and severity of LD

Answer 7

• 50-69 = mild
• 35-50 = moderate
• 20-35 = severe
• <20 = profound

Question 8

Typical behaviour with questioning someone who has learning disability

Answer 8

• They are agreeable
• Tend to say yes to questions even though they may not mean yes
• Try to ask open questions, avoid leading ons

Question 9

What can risperidone cause?

Answer 9

• Hyperprolactinaemia
• Weight gain

Question 10

Causes of LD

Answer 10

• Genetic - congenital syndromes eg Down syndrome, Fragile X, tuberous sclerosis
• Brain trauma (under 18)
• Infections - TORCH during pregnancy, neonate infections, meningitis/encephalitis
• Malnutrition
• Foetal alcohol syndrome
• Drugs during pregnancy - illicit and teratogenic
• Smoking during pregnancy
• Non-accidental injury
• Birth - hypoxia/haemorrhage

Question 11

Physical problems associated with LD

Answer 11

• Constipation
• UTI
• Dental problems
• GORD + h-pylori
• Ear infections
• Congenital heart problems eg ASD
• GI malformation
• Endocrine disease - eg diabetes, thyroid, growth hormone
• Rare cancers more common (common ones less common)
• Epilepsy - multiple seizure types, difficult to treat
• Osteoporosis/osteopaenia

Question 12

MH disorders associated with LD

Answer 12

• Anxiety - more common
• Depression - as common
• Autism
• Psychiatric diseases eg schizophrenia
• Dementia - affects people younger than

Question 13

Common causes early death in people with LD

Answer 13

• Pneumonia
• Sepsis
• Severe consitpation
• Seizures

Question 14

Bipolar and LD

Answer 14

• Manage with medication - mood stabilisers eg lithium
• Can do therapy alongside (same as ADHD)
• Common to have co-existent anxiety)

Question 15

MMSE

Answer 15

ABS MAT PCI
* Appearance - appropriate dress for weather? disheveled?
* Behaviour - tics/twitch/fiddle, eye contact, crying
* Speech - rate, rhythm, tone, volume, pitch
* Mood - how are you feeling
* Affect - how do they appear mood wise - incongruent?
* Thought - form (how they are relayed) and content. Can be circumstantiality (go around few things and then come back to point) or tangienctiality (go off on tangent and not come back)
* Perceptions - delusions, hallucinations
* Cognition - AMTS (name, DOB, year, where we are, year WW1)
* Insight - do you know why you are in hospital?

Depression and anxiety screen - do they ever feel low, self harm, suicide risk