###### Created: 2023-01-27 16:05 ###### Areas & Topics: #medicine #disability ###### Note Type: #permanent ###### Connected to: [[Down's Syndrome]] ### Definition A learning disability (LD) is described by NICE as generally being defined by 3 core criteria: 1. Lower intellectual ability (usually an IQ of less than 70) 2. Significant impairment of social or adaptive functioning 3. Onset in childhood **PMLD/PIMD** - A profound and multiple learning disability (PMLD), also known as profound intellectual and multiple disability (PIMD), is when a person has a severe learning disability and other disabilities that significantly affect their ability to communicate and be independent. - Patients with PMLD/PIMD has multiple disabilities, with the most significant being an profound intellectual disability. - People with PMLD are some of the most disabled and vulnerable people in society, with most having - an estimated IQ below 20. ### Severity The WHO classifies the severity of learning disabilities as: **Mild** - Approximate IQ range of 50 to 69 (in adults, mental age from 9 to under 12 years) - Likely to result in some learning difficulties in school - Many adults will be able to work and maintain good social relationships and contribute to society. **Moderate** - Approximate IQ range of 35 to 49 (in adults, mental age from 6 to under 9 years) - Likely to result in marked developmental delays in childhood but most can learn to develop some degree of independence in self-care and acquire adequate communication and academic skills. - Adults will need varying degrees of support to live and work in the community. **Severe** - Approximate IQ range of 20 to 34 (in adults, mental age from 3 to under 6 years). - Likely to result in continuous need of support. **Profound** - IQ under 20 (in adults, mental age below 3 years). - Results in severe limitation in self-care, continence, communication and mobility. ### Causes and Aetiology - The precise causes of learning disabilities are not fully understood. - Experts believe however that LDs may be a result of a mixture of hereditary and environmental factors. ### Risk Factors - Essentially, the main risk factors for learning disabilities seem to be related to a potential issue in the development or function of the CNS. - This can occur developmentally, from biological reasons or environmental reasons in childhood or from specific events such as illness or injury. NICE lists a variety of risk factors including: - Some chromosomal and genetic anomalies (e.g. Down's syndrome, [[William's syndrome]], Rett syndrome, fragile X syndrome etc.) - Some non-genetic congenital malformations (e.g. spina bifida, hydrocephalus, microcephaly etc.) - Prenatal exposures (including alcohol, sodium valproate, congenital rubella infection, zika virus) - Birth complications resulting in hypoxic brain injury/cerebral palsy - Extreme prematurity (usually <33 weeks' gestation) - Childhood illness (e.g. meningitis, encephalitis, measles) - Childhood brain injury caused by accident/physical abuse - Childhood neglect and/or lack of stimulation in early life ### Epidemiology - LDs are commonly comorbid with other medical and psychiatric disorders. - Learning disabilities are present in approximately 5% of school-aged children globally. ### Diagnosis - Most people with a learning disability will have been seen and diagnosed by a specialist. - When seeing a patient with an LD yourself, a thorough history is the cornerstone of diagnosis and appropriate management. - This should be done in a manner that is sensitive to the needs and ability of the patient in question. - The patients decision-making capacity should also be assessed for better understanding of their situation. - You should also enquire about various LD risk factors such as conditions, trauma and previous neglect or abuse. - You should also attempt to assess the severity of their learning disability if possible. ### Management **Suspected Learning Disability** - If an LD is suspected, you should offer a referral to the local community LD team, who can then signpost the patient for appropriate diagnosis and treatment. - You can also consider referrals to psychology, mental health services, clinical genetics and safeguarding if appropriate. **Confirmed Learning Disability** If you are seeing a patient with a confirmed learning disability, general steps to take include: 1. Understand the role their local MDT LD team has in their care already. 2. Gain an understanding of their current capacity and independence. 3. Offer an annual health check for those who currently do not have one arranged (this will include checking their general health, specific concerns, mental health, dental needs, medication review amongst other things). 4. Be prepared to give information and leaflets to the patient and any relevant parties about various treatments and screenings they might need/receive (this may also include guidance for families and end of life care). ### Sources https://cks.nice.org.uk/topics/learning-disabilities/background-information/definition/ https://www.nhs.uk/conditions/learning-disabilities/ https://www.ncbi.nlm.nih.gov/books/NBK554371/