Causes and manifestation of learning disability

Demographics

• “A lack of consensus of definition and understanding of what is meant by ‘multiple and complex needs’, which makes quantifying the prevalence of multiple and complex needs difficult”

• Varies in studies from 4-16% • Office of Population Censuses and Surveys

• 1985 -1989 Approximately 1-3% of pop.• 1980 476 000• 2005 770 000

• Family Resource Survey• Disability Discrimination act• 2004/05 estimate 7.3% (952 741)

Presentation of disability

• Post head injury/infection• RTA, NAI or meningitis

• In early years• Developmental delay

• Antenatally or at birth• Scan or bloods

Antenatally or at birth

• Genetic• Inborn errors of metabolism• Fragile X syndrome • Muscular dystrophy• http://www.cafamily.org.uk/index.html

• Birth defects• Prematurity 1980 43/1000 2004 48/1000• Cerebral palsy

What is affected by delay

• Gross/fine motor skills

• Speech and language development

• Cognition

• Social/personal activities of daily living• Adaptive Behaviour

Development is predictable

• Sequential trends

• Developmental pace

• Sensitive periods

• Relatively slow !!!

Development is global

• Physical • Brain• Height and weight• Physiological changes• Fine and gross motor • Language

• Intellectual and social• Personality • Cognitive • Personality • Temperament

Best web site SIX MONTHS (approximately) 

• Able to lift the head. • Handles large objects by

banging them, bringing them to the mouth.

• Can balance the head. • Can sit supported in a chair. • Splashes with his hands and

feet in the bath. • Enjoys being bounced on the

knee.  

ONE YEAR (approximately)

• Can walk unaided (mostly unstable).

• Is able to stand balanced on both feet.

• Is able to turn around while standing.

• Enjoys climbing. • Can sit unaided. • Can roll a ball back and

forwards. • Likes to throw things. • Enjoys waving “goodbye”. • Beginning to enjoy rhythmic

movements.

http://www.sabceducation.co.za/portal/site/menuitem.7eafe07f2449143351deadb25401aeb9/

Brain

• Short bursts of growth• At birth 20% of body weight adult 2%• When do you think most rapid growth is ?

• Synaptogenesis • Neural pathways• Repetition of action or behaviour

• Myelination • Maturation of nerve supply

Hearing

• Babies can hear in the womb

• More attuned to high pitch

• Loudness

• Localise sound

Language

• Physical and neurological structures

• language comprehension, language expression and speech

• Linked to neurological and cognitive development

• Broca’s and Wernicke’s area

Language

• Speech development varies

• Environmental circumstances

• Critical period• 18/12 to 4 years

• http://www.childrenshospital.org/az/Site1626/mainpageS1626P0.html

Assessment

• Multiprofessional assessment• Doctor Physiotherapist Psychologist Nurse

• Global assessment of physical and psychological development

• Dysmorphic features

• Family history• GDD epilepsy autism seizures

• Investigations • Genetics and metabolic testing EEG MRI • Hearing and sight test

Impact on parent

• Diagnosis • Very important to families

• Attachment • Depending on age and relationship of parent and

child

• Resolution• To be discussed in more depth

Impact on communication• The commonest and least treated disability' amongst people with

learning disabilities is communication disorders (Hallas et al., 1982)

• 89% had communication difficulties which 'required speech therapy‘ (Noble, 1990).

• Parents and youth with learning disabilities: perceptions of relationships and communication. Journal of Learning Disabilities. (Heiman T. Zinck LC. Heath NL. 2008. 41(6):524-34.)

• Analogical problem solving in children with verbal and nonverbal learning disabilities. Journal of Learning Disabilities. (Schiff R. Bauminger N. Toledo I. 2009. 42(1):3-13.)

Conclusion

• Complex process of development

• Diagnosis can be difficult to obtain

• Communication affected

References • Blackburn C et al 2010. Prevelence of childhood disability and the characteristics and

circumstances of disabled children in the UK: secondary analysis of the Family Resources Survey. BMC Pediatrics 10:21

• Fink et al 2008. A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication. Journal of Clinical Nursing 17, 2102–2115

• Gordon, D., Parker, R., Loughran, F. and Heslop, P. 2000 Disabled children in Britain: a reanalysis of the OPCS disability surveys. London: Stationery Office

• Norman J et al 2009. The Effect of Changing Patterns of Obstetric Care in Scotland (1980–2004) on Rates of Preterm Birth and Its Neonatal Consequences: Perinatal Database Study public library of science

• Shevell M et al. 2003. Practice parameter: Evaluation of the child with global developmental delay Report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. American Academy of Neurology. 60;367-380.

• Williams J. 2006. Learning from mothers: how myths, policies and practices affect the detection of subtle developmental problems in children. Child: care, health and development,33, 3, 282–290.

• www.cafamily.org.uk/index.html About families with disabled children - UK