learning disability december 3/12/15. learning disability definition disability vs. difficulty vs....
DESCRIPTION
Definition A learning disability is a reduced intellectual ability and difficulty with everyday activities – for example household tasks, socialising or managing money – which affects someone for their whole life. People with a learning disability tend to take longer to learn and may need support to develop new skills, understand complex information and interact with other people. (Mencap website) A learning disability is defined by 3 core criteria: lower intellectual ability (usually an IQ of less than 70), significant impairment of social or adaptive functioning, and onset in childhood. (NICE 2015) Mild, moderate or severe (profound). Behaviour issues.TRANSCRIPT
Learning DisabilityDecember 3/12/15
Learning DisabilityDefinition
Disability vs. Difficulty vs. Mental Health
CausesDiagnosisManagementGP challenges
DefinitionA learning disability is a reduced intellectual ability and difficulty with everyday activities – for example household tasks, socialising or managing money – which affects someone for their whole life. People with a learning disability tend to take longer to learn and may need support to develop new skills, understand complex information and interact with other people. (Mencap website)A learning disability is defined by 3 core criteria: lower intellectual ability (usually an IQ of less than 70), significant impairment of social or adaptive functioning, and onset in childhood. (NICE 2015)Mild , moderate or severe (profound). Behaviour issues.
Disability vs. Difficulty vs. Mental Health
Learning disability is often confused with dyslexia and mental health problems. Mencap describes dyslexia as a “learning difficulty” because, unlike learning disability, it does not affect intellect. Mental health problems can affect anyone at any time and may be overcome with treatment, which is not true of learning disability.
Learning DisabilityDefinitionDisability vs. Difficulty vs. Mental HealthCauses
DiagnosisManagementGP challenges
CausesPrenatalPerinatalPostnatalOthers
Pre-natal causesMaternal illnessMaternal injuryMaternal stress
Genetic
Foetal Alcohol Syndrome
Prenatal Stress Subjects were eighty-nine 5½-year-old children whose mothers were pregnant during a natural disaster: the January 1998 ice storm crisis in the Canadian province of Québec that resulted in power losses for 3 million people for as long as 40 days. In June 1998, women completed several questionnaires including those about the extent of objective stress (Storm32) and subjective distress (Impact of Events Scale-Revised) experienced due to the storm. Their children were assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised (IQ) and Peabody Picture Vocabulary Test-Revised (language) at 5½ years of age, and mothers completed assessments of recent life events and psychological functioning.Children exposed in utero to high levels of objective stress had lower Full Scale IQs, Verbal IQs, and language abilities compared to children exposed to low or moderate levels of objective prenatal maternal stress; there were no effects of subjective stress or objective stress on Performance Iqs.ConclusionsPrenatal exposure to a moderately severe natural disaster is associated with lower cognitive and language abilities at 5½ years of age. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47:(9):1063–1072.
Prenatal genetic causes Angleman Syndrome / Klinefelter’s
Cri du chat Syndrome /Lennox Gastaut SyndromeDowns Syndrome /Prader-Willi SyndromeFragile X / Rett Syndrome Smith Magenis Syndrome/ William’s syndromeand many more…. Consanguinity
Peri-natal causesProlonged labourAnoxic brain damagePrematurity
Postnatal causesChildhood illnessTrauma Brain damage(NOT vaccination)
Other causesAutismAsperger’sADHD / ADDGlobal developmental delay
Learning DisabilityDefinitionDisability vs. Difficulty vs. Mental HealthCausesDiagnosis
ManagementGP challenges
Learning Disability - Diagnosis
Concern raised: Health visitor, family , school etc.Referral to see GP.Referral to Secondary Care (LD team/ Community Paeds).Assessment tools : home and at school.Review of assessments.Recommendations and Diagnosis
Learning DisabilityDefinitionDisability vs. Difficulty vs. Mental HealthCausesDiagnosisManagement
GP challenges
Management
General principles of care: NICE May 2015Support and interventions for family members or carersEarly identification of the emergence of behaviour that challengesAssessment of behaviour that challengesPsychological and environmental interventionsMedication
ManagementPerson-centred care : Care Act 2014
Aged less than 16 , parents usually decide.Mental Capacity Act 2005
Deprivation of Liberty Safeguards 2005
Safeguarding issues.
Management - Medication
Evidence is not really all that good.http://www.bmj.com/content/351/bmj.h5203
Always started by Secondary Care.Issues re who does the scripts.Medication is ‘off licence’.Are we medicalising/medicating ‘bad behaviour’?
Learning DisabilityDefinitionDisability vs. Difficulty vs. Mental HealthCausesDiagnosisManagementGP challenges
CapacityA presumption of capacity: unless it is proved otherwise.The right for individuals to be supported to make their own decisions: all appropriate help before anyone concludes that they cannot make their own decisions.That individuals must retain the right to make what might be seen as eccentric or unwise decisions.Best interests: anything done for or on behalf of people without capacity must be in their best interests.Least restrictive intervention: anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.Understand, Retain and Weigh the information provided and Communicate their decision.Decision -specific
Restraint or deprivation of liberty
Section 5: If judged by MCA to lack capacity then care/ treatment can be given without the risk of legal liability – ill treatment in these circs liable to 5 years imprisonmentSection 6 :Use or threat of force where an incapacitated person resists, and any restriction of liberty or movement whether or not the person resists.Permitted if the person using it reasonably believes it is necessary to prevent harm to the incapacitated person, and if the restraint used is proportionate to the likelihood and seriousness of the harm.Section 6(5) makes it clear that an act depriving a person of his or her liberty cannot be an act to which section 5 provides any protection.
GP ChallengesWhen is it more than just ‘bad behaviour’?Who, when and where to refer?Communication issues. Dealing with the whole family/care unit.Becoming the coordinator of care.Medication
Communication Exercise
In pairs one person be the doctor one be the patient.Patient choose a relatively common complaint to have.Patient you have moderately severe learning difficulties.Doctor you can ask any questions to get a diagnosis.Patient you can only nod or shake your head to answer.Patient look blank if the question is too complicated. Doctor once you have the diagnosis put your hand up.
Useful ResourcesMencap web siteMental Capacity Act 2005Deprivation of Liberties Safeguards 2005The Care Act 2014Challenging behaviour and learning disabilities : NICE May 2015.B’ham City Council Web site – ‘Learning Disability’
Any questions?