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LEARNING DISABILITIES AWARENESS Presented by Maureen Major Health Facilitator YOU CAN MAKE A DIFFERENCE No one said it was going to be easy but: By providing ... – PowerPoint PPT presentation

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  • Presented by
  • Maureen Major
  • Health Facilitator

  • Explore the meaning of the term learning
  • Review the causes of learning disabilities
  • Look at some of the specific health needs
    associated with learning disabilities
  • Support ways of working with people whom have a
    learning disability

Learning Disability
  • Learning disability is the term preferred by
    health organisations to describe
  • A significantly reduced ability to understand new
    or complex information or learn new skills
    (impaired intelligence) with
  • A reduced ability to cope independently (social

Learning Disability
  • And
  • Which started before adulthood, with a lasting
    effect on development. (Valuing People 2001)

Degrees of Learning Disability
  • Mild
  • IQ - range 50-69 (accounts for 89 of people with
    a learning disability).
  • Often not diagnosed until a latter age.
  • Usually slow in achieving milestones.
  • May have required special education
  • Often live work independently in the community.
    May not easily be identifiable.

Moderate Learning Disability
  • IQ 35-49 (6 of the learning disability
  • Noticeable delay in achieving milestones
  • Will usually have gained basic mobility,
    continence, communication and some self help
  • May be able to achieve some independence in
    familiar settings.
  • May be able to carry out some semi skilled work
    with supervision. Usually require some support in
    managing everyday affairs.

Severe Learning Disability
  • IQ 20-34 (accounts for 3.5 of all individuals
    with a learning disability)
  • Very slow in achieving milestones.
  • May have additional physical disabilities.
  • Help from specialist likely from an early age.
  • Emphasis on functional, rather than academic
  • Will need help and support with activities of
    daily living.

Profound Learning Disability
  • IQ less than 20 (1.5 of all individuals with a
    learning disability).
  • Development progress very slow.
  • Likely to have additional physical and sensory
  • Almost certain to have involvement from
    specialist services from birth.
  • Health may be very frail.
  • All basic needs are likely to be met by others.
  • Emphasis on meaningful day time activities.
  • Health and physical status likely to be a matter
    of daily concern.

What is NOT a Learning Disability
  • Problems with reading, writing or numeracy only.
  • Emotional difficulties.
  • Conditions like Attention Deficit Hyperactivity
    disorder (ADHD)
  • Aspergers syndrome and some individuals with
  • However you can have a learning difficulty as
    well as a learning disability.

Prevalence of Learning Disability
  • National prevalence estimated at 2-3 of the
  • Mild to moderate 25 per 10000 of the population
    (1.2 million people)
  • Severe to profound 210,000
  • 65,000 of this number are children
  • 120,000 adults of working age and
  • 25,00 older people.
  • A GP practice of 2,000 patients there will be an
    average of 40 individuals with a learning

Causes of Learning Disability
  • Prenatal chromosome, genetics, toxins.
  • Perinatal Birth complications, infections.
  • Post natal- infections or trauma.
  • A learning disability will have started before
    adulthood. After adult hood people may have brain
    damage resulting in significant impairment of
    both intelligence and social functioning, but
    they are not considered to have a learning
    disability, often referred to as having a brain
    acquired injury.

Health needs
  • 26 of people with a learning disability are
    admitted to general hospitals each year compared
    to 14 of the general population.
  • Mortality People with learning disabilities are
    56 more likely to die before the age of fifty.
  • Cancer The pattern of cancer is different in
    Learning Disabilities, with lower rates of lung,
    prostate and urinary tract cancers. There are
    higher rates of oesophageal, stomach and gall
    bladder cancers and leukaemia.

Health needs
  • Helicobacter Pylori Infection Endemic in the
    learning disability population, postulated that
    the higher than normal prevalence of this
    infection leads to higher levels of gastric
  • Congenital Heart Disease (CHD) 2nd most common
    cause of death in LD- nearly 50 of people with
    Downs syndrome have CHD.
  • Respiratory Disease Most common cause of death
    rates 3 times higher than in the general

Health needs
  • Sensory Impairments- common for individuals to
    have a visual impairment and 40 of individuals
    are likely to have a hearing impairment.
  • Epilepsy At 22 of the learning disability
    population it is 20 times more common than in the
    general population 1.
  • SUDEP Sudden Unexplained Death in epilepsy. 5
    more common than in others without a learning
  • (Hollins S, Attard M.T, Von Fraunhofer N,
    McGuigan S and Sedgwick P (1998) Mortality in
    people with a learning disability Risks, causes
    and death certification findings in London,
    developmental medicine and Child Neurology,

Health needs
  • Dementia rates 4 times greater and early onset
    in Downs syndrome.
  • Thyroid Function greater risk of hypothyroidism
  • Mental Health Schizophrenia is 3 times more
  • Osteoporosis often individuals have
    substantially less bone density (important to
    look at individuals (postural care)

Syndrome specific
  • Fragile X Syndrome
  • Dilatation of aortic root, hypoplasia of the
    aorta and mitral valve prolapse affect about
    one-third of all males, and are responsible for
    high mortality rate.
  • The nervous and urogentital systems are
    vulnerable to cancer.
  • 20 have epilepsy
  • Joint laxity, awkward gait and flat feet are
    common problems.
  • (ref Howellls G Adults with learning
    disabilities a practical approach to care 1997)

Downs Syndrome
  • Hearing loss affects more than 50 of people with
    Downs syndrome (DS).
  • Disorders of the eye, including blepharitis,
    errors of refraction, squints, cataracts and poor
    visual accommodation. Loss of interest in
    activities may indicate visual impairment.
  • Hypothyroidism affects about 40 of adults with
    DS, indicating the need for annual thyroid
    function checks.
  • Congenital heart disease is 50 times more common
    than in the general population.
  • Often prone to periods of depression.
  • Increase in prevalence to epilepsy in the fifth
    decade of life.

Downs Syndrome
  • People with DS show an accelarted aging process,
    and may develop Alzheimer- like dementia.

Prader Willi Syndrome (PWS)
  • PWS has an incidence of about 1 10,000, and
    present several medical challenges
  • Obesity Begins in early childhood, characterised
    by Unusual inability to vomit, an insatiable
    appetite and a reduced caloric requirement. Can
    lead scavenging in bins, gardens exposing
    individuals to risk of poisoning. High risk of
    developing diabetes.
  • Behavioural difficulties, including obsessional
  • Skin picking, predispose individuals to infection
    and skin problems.
  • Dental problems are common.

  • Altered responses to potentially painful
    conditions such as ear infections or
    appendicitis, yet in sharp contrast may be
    hypersensitive to touch. These unusual responses
    make the diagnostic process all the more
  • Woman with PWS are infertile with hypoplastic
    ovaries, with low oestrogen levels, and it might
    be worth considering replacement therapy, to
    support health presentation.

  • Feeding, swallowing and nutritional problems have
    a high prevalence among people with a learning
  • This can have serious repercussions including
    poor nutritional status, dehydration, aspiration
    and asphyxiation. Which can be or lead to life
    threatening problems.
  • People with cerebral palsy and those with severe
    intellectual and physical disabilities have a
    high incidence of Dysphagia and patients with
    spastic quadriparesis are at particular risk of
  • There is limited research into people with
    learning disabilities who have Dysphagia, there
    is however evidence that successful management
    decreases risk. (National Patient Safety Agency

Dysphagia 2
  • Carers need to have education to improve their
    awareness of the symptoms of aspiration.
  • As many as quarter of the respiratory disease
    deaths for individuals with a learning disability
    can be directly linked to aspiration pneumonia.
    (Community service Commission 200 Disability,
    death and the responsibility of care. Sydney New
    South Wales Community Service Commission.
  • 36 of individuals in long stay hospitals had
    chewing and/or swallowing problems. (Hickman J
    1997 ALD and Dysphagia issues and practice.
    Speech and language Therapy in Practice Autumn
  • 60 of people with cerebral palsy (CP) have
    difficulties with chewing and or swallowing.
    People with CP show a deterioration in oral motor
    skills and Dysphagia in their early 30s.

Barriers to healthcare
  • Automated multi-service telephone systems.
  • Touch screen technology
  • Physical barriers e.g. Wheelchair accessibility,
    waiting areas and access to consultation rooms.
  • Communication difficulties e.g. An inability to
    describe symptoms clearly.

Barriers to healthcare
  • The attitude of health care professionals, - e.g.
    Lack of confidence, limited experience, negative
    attitudes and assumptions.
  • Recognition of ill health may be difficult or
    delayed because
  • Symptoms may not be easily identified family
    members/carers may not have the skills and
    knowledge to support individuals to obtain health
    care or to maintain health related behaviour.
    Problematic symptoms (such as aggression) may
    be brought to the attention of services earlier,
    others that are equally significant (such as
    withdrawal, loss of interest) may not.

Barriers to healthcare
  • Poor historians.
  • Reluctance by health care professionals to
    consider and/or provide the same range of
    treatment options because of
  • (a) Diagnostic overshadowing the inability to
    see beyond the disability
  • (b) perceived difficulty obtaining consent
  • (c) assumptions and negative predictions about
    how patients might react or cooperate.

Barriers to Healthcare
  • Surgery involving complex rehabilitation may not
    be considered as it is often assumed that
    compliance will be a problem.
  • Health problems may manifest in unusual symptoms
    e.g. demonstrated by self injury.
  • Lack of ability by the individual to recognise
    and responding to their own changing health.

Reasons for not accessing health care
  • May be unaware of the health services available
    to them.
  • Might not understand the benefits of health
  • May not understand consequences of their or
    others decisions about their health.
  • Poor health is associated with low socio economic
    and poverty, which is a group that many people
    with a learning disability may fall into.

  • It is a general legal and ethical principle that
    valid consent must be obtained before starting
    treatment or physical investigations, or in the
    provision of personal care to individuals.
  • Omission to obtain consent can lead to legal
  • Valid consent must be given voluntarily.
  • The Mental Capacity Act 2005 (MCA) came into
    force on 1 October 2007, providing a framework
    for making decisions for people who lack capacity
    to make decisions for themselves.

  • The MCA defines a person who lacks capacity as a
    person who is unable to make a decision for
    themselves because of an impairment or
    disturbance in the functioning of their mind or
  • Capacity is decision specific.
  • Individuals are entitled to make what others may
    perceive to be unwise or irrational decisions, as
    long as they have the capacity to do.
  • All practical steps should be taken to enable an
    individual to make a decision themselves.

Best Interests
  • Must consider all relevant circumstances.
  • Must involve the individual
  • Have regard for the past and the present
  • Be in consultation with others who support the
    care of the individual
  • Should not be discriminatory.

Good Practice
  • Develop Practice Specific development Plans that
    might include the following
  • Identify a lead person within the practice to
    take special interest in learning disabilities,
    collect information, be a link with the health
    facilitator the Community Learning Disability
    Team and advice others.
  • Develop accessible leaflets in suitable formats.
  • Support the teams awareness of learning
    disabilities, with on going access to training
    and professional competencies.
  • Work with the health facilitator in developing
    user groups to provide individuals with a
    learning disability to understand their own
  • Offer preparatory visits.

Good Practice
  • Develop with the health facilitator guidelines on
    syndrome specific care pathways.
  • Support and develop health education promotion to
    meet the needs of the learning disability
  • Allow extra time for appointments.
  • Look at the environment including the lighting,
    noise, accessibility.
  • Communicate Speak with the individual, in a
    clear voice, not too fast. Think about response
    time, it may take longer for an individual to
    process information.
  • Avoid jargon and abbreviations.

Good Practice
  • Check that the person understands, use
    reflection, signs and look for non verbal clues,
    a smile, a frown etc.
  • Make sure you're conversation has a clear
    begining, a middle and an end.
  • Write as you speak.
  • Use consistent words and phrases.

  • No one said it was going to be easy but By
    providing appropriate health care, support and
    taking that extra time, you really can make a
    difference to the healthcare and therefore most
    other needs of people with a learning disability
  • Good Luck on your journey, I am here to help you
    ride the wave.
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