Learning Disabilities

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Learning Disabilities

• Denise McDonald
• Consultant in Community Child Health
• June 9th 2005

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OBJECTIVES

• What is learning disability?
• How common is it?
• Detection and assessment
• Medical management
• Educational management
• Government policy/resources

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Learning disabilities

• .is a general term that refers to a heterogenous
  group of disorders manifested by significant
  difficulties in the acquisition and use of
  listening, speaking, reading, writing or
  mathematical abilities.
• Intrinsic to the individual.presumed to be due
  to some CNS dysfunction
• May be concomitant with, but not the direct
  result of.other conditions or influences
• Hammill 1990

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Intelligence quotients (IQ)

• Summary IQ of lt70 denotes a general learning
  disability
• Mild 50-69
• Moderate 35-49
• Severe 20-34
• Profound lt20

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How common is LD?

• Gaussian distribution of intelligence
• 95 of population lie within 2 standard
  deviations of the mean (100)
• UK 0.45-0.6 of children have moderate to severe
  LD

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Specific learning disability

• US 15 of children
• Applied to academic skills
• Could be appropriately applied to disorders of
  attention and motor planning
• Limitation of IQ tests

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Detection and Assessment

• Cognitive skills rapidly acquired during the
  first 3 years
• Developmental screening programmes
• Early intervention programmes

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Early milestones

• Motor fine, gross
• Vision
• Hearing
• Communication verbal, non-verbal
• Social

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Developmental screening

• 6-8 weeks
• 6-9months
• 18months
• Programme of action for children (PAC)

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Early detection

• Early smiling and reciprocal social interaction
• Early motor milestones ranges of normal
• Communication verbal and non-verbal

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Developmental clinic - AMNCH

• Referrals from AMOs, PHNs, SLTs, GPs
• 95 referrals 2003, 200 in 2004, 270 in 2005
• Predominantly speech and language development
  concerns

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Developmental clinic - AMNCH

• Paediatric assessment
• Detailed early history
• Current developmental abilities
• Medical issues
• Family history
• Social history

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Developmental clinic - AMNCH

• Schedule of Growing Skills II
• General examination
• Investigations
• Genetic
• Metabolic
• Endocrine
• Brain imaging

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Genetics - 1

• Down Syndrome 1 in 700
• Sex chromosome abnormalities
• 2.5/1,000 females, 1.4/1,000 males
• XYY, XXY, XXX, XO
• Fragile X
• 1 in 1,000 females carriers, 1 in 1,300-3,000
  males affected
• 2-10 of children with moderate to severe LD
  without specific dysmorphic features

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Genetics - 2

• Other specific syndromes
• Rett MECP2, X chromosome
• Williams ch 7, defective elastin gene
• Soto deletion(s) 5q35
• Smith Magennis interstitial deletion 17p11.2

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Developmental clinic - AMNCH

• Schedule of Growing Skills II
• General examination
• Investigations
• Genetic
• Metabolic
• Endocrine
• Brain imaging

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Medical management

• Part of multidisciplinary team
• Referral for multi-d assessment
• Medical follow-up
• Investigation results
• Medical and emotional issues
• Gate-keeping
• Coordination

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Educational Management

• Appropriate pre-school placement early
  intervention programme
• Appropriate school placement
• Segregation vs inclusion vs integration

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Local and National Services

• Voluntary organisations
• eg, Brothers of Charity
• Schools attached Cheeverstown, Palmerstown
• Down Syndrome Ireland
• Autism Services Beechpark

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Government Policy

• UK White Paper 2001
• Civil rights
• Independence
• Choice
• Inclusion
• Irish Disability Bill 2004
• Assessment of need, service statements
• Accessibility
• Employment

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SUMMARY

• Learning disability general, specific
• Frequency
• Screening and assessment
• Medical management
• Educational management
• Government policy/resources