concept & causes of learning disabilities€¦ · concept & causes of learning disabilities...
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Concept & Causes of Learning
Disabilities
LPT Gondar Mental Health Group
www.le.ac.uk
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Learning Disability or
Mental Retardation
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Important!
Exam questions only from workbook
The lecture names many conditions the aim of
this is to increase your awareness of these
disorders not for you to remember each one!
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Concepts - Learning Disability
A general concept
Intellectual functioning & IQ
Mental Age
Epidemiological concept
Clinical - ICD 10 & DSM IV
Medico-legal concept
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Learning Disability
General Concepts Affects ability to learn
Impairs cognition
Is only one attribute of people with LD
Is a serious disability
Are people first
Have hopes and dreams like everyone else
Face many obstacles
Often require considerable support
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Intellectual functioning
A theoretical construct
A human trait distributed in a predictable
manner
IQ = Mental age X 100
Chronological age
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Mental Age
Is defined as the developmental level acquired
by an individual
Is an outdated way to classify and describe an
individual’s abilities
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Learning Disability
Epidemiological Concept
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Learning Disability
Clinical concept
Six criteria (E. A. Doll, 1941)
social incompetence
due to mental subnormality
which has been developmentally arrested
which obtains at maturity
is of constitutional origin
is essentially incurable
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Learning Disability
Clinical concept
The definition specifies three criteria
significantly subaverage intelligence
impaired adaptive behaviour or functioning
origin during the developmental period
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ICD 10 Definition
Mental Retardation is defined as a condition of arrested
or incomplete development of the mind, which is
characterised by impairment of skills manifested during
the developmental period, which contribute to the overall
level of intelligence, e.g. cognitive, language, motor and
social abilities.
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ICD 10 Definition
Sub average intellectual functioning
At least two limited areas of adaptive
functioning exist concurrently
The disability occurred before the age of 18
years
All three criteria need to be satisfied
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Mental Retardation
Classification based on IQ < 70
Mild MR: IQ 50 – 70
Moderate MR: IQ 35 – 49
Severe MR: IQ 20 – 34
Profound MR: IQ < 20
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Adaptive skill areas
Communication
Self-care
Home living
Social skills
Community use
Self-direction
Health and safety
Functional academics
Leisure
Work
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Causes of Learning Disability
Prenatal - 70%
Perinatal - 9%
Postnatal - 2%
Familial/Cultural -
Unidentifiable - 19%
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Prenatal Causes
Genetic disorders
Chromosomal aberrations
Single gene mutations
Autosomal dominant
Autosomal recessive
X linked disorders
Microdeletions
Congenital malformations
Exposure
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Prenatal causes – Genetic disorders
Chromosomal aberrations
Autosomal abnormalities
Sex chromosomal abnormalities
Microdeletions
Single gene mutations
Autosomal dominant disorders
Autosomal recessive disorders
X linked disorders
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Chromosomal aberrations
Abnormalities of autosomes
Downs syndrome – Trisomy 21
Edwards syndrome – Trisomy 18
Pataus syndrome - Trisomy 13
Abnormalities of sex chromosomes
Fragile X syndrome – fragile site on Xq27-28
Klinefelter’s syndrome – 47, XXY
Turners syndrome – 45, XO
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Partial deletions & Microdeletions
Prader-Willi syndrome
- microdeletion of paternal 15q
Williams syndrome
- microdeletion of 17
Cri du chat syndrome
- partial deletion of 5
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Autosomal dominant disorders
Tuberous sclerosis (Epiloia)
Neurofibromatosis (von Recklinghausen’s
disease)
Encephalofacial angiomatosis (Sturge – Weber
syndrome)
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X – linked disorders
Fragile X syndrome
Lesch-Nyhan syndrome
Haemoglobin (HbH) disease with mental
retardation
ATR-X syndrome (α – thalassaemia/mental
retardation syndrome)
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Prenatal causes - Congenital
anomalies
CNS malformations
Neural tube defects
Multiple malformations syndromes
Cornelia de Lange syndrome
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Epidemiology of Genetic disorders
Genetic disorders/congenital anomalies apparent by age 25:
79 per 1000 livebirths
1. Single gene (Mendelian) disorders Incidence: 3.6/1000
a. Autosomal dominant Incidence: 1.4/1000
b. Autosomal recessive Incidence: 1.7/1000
c. X-linked disorders Incidence: 0.5/1000
2. Chromosome abnormalities Incidence: 1.8/1000
3. Multifactorial conditions (onset <25) Incidence: 46.4/1000
4. Conditions that appear genetic but precise mechanism unknown
Incidence: 1.2/1000
5. Other congenital anomalies Incidence: 26/1000
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Prenatal - Exposure Maternal infections
Congenital rubella (Rubella syndrome), HIV
Teratogens
Fetal alcohol syndrome
Toxaemia, placental insufficiency
Prematurity
Trauma
Iatrogenic
Radiation, Drugs
Severe malnutrition
IUGR
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Perinatal causes
Infections
Delivery
Anoxic brain damage
Others
Hyperbilirubinaemia
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Postnatal causes
Infections Encephalitis
Metabolic Hypoglycaemia
Endocrine Cretinism
Cerebrovascular Thrombo-embolism
Toxins Lead poisoning
Trauma Head injury
Neoplasms Meningioma, Cranipharyngioma
Psychosocial factors Understimulation
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Clinical syndromes
Downs syndrome
Fragile X syndrome
Tuberous sclerosis
Phenylketonuria
Cornelia de Lange syndrome
Edwards syndrome
Prader Willi syndrome
Angelman syndrome
Lesch Nyhan syndrome
Other inborn errors
amino acid metabolism
Fatty acid metabolism
Carbohydrate metabolism
Nucleic acid metabolism
Smith Magenis syndrome
Williams syndrome
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Downs syndrome
Physical features
Facies, somatotype, Congenital anomalies, Infantile spasms,
Hypothyrodism
Psychiatric associations
Dementia
Depression
Hyperactivity
Conduct disorder
Autism
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Phenyketonuria
Physical features
Blond hair, blue eyes, spasticity, epilepsy
Psychiatric associations
Autism
Hyperactivity
Epilepsy
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Management
Assessment is key
Effective communication,
Treat any coexistent mental disorders-
psychosis, depression, anxiety
Adapt environment to meet the needs of the
person
Maintain quality of life as much as possible
Support the family
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Provided by The Leicester Gondar Link
Collaborative Teaching Project
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