CINAPS
Cambridge Independent Neuroscience and Psychiatry Services
Learning disabilities
What is a learning disability?
Learning disabilities can present in many different ways and the degree of disability may vary significantly.
Children with learning disabilities may struggle with all areas of development, for instance, language development, physical development, cognitive development (understanding complex ideas for instance), social and emotional development.
Children may present as much younger than their chronological age and we may refer to developmental age on occasion, which helps professionals to understand the level of support required.
Some children may grow up to become independent and some children may require ongoing help to look after themselves.
Learning disabilities versus difficulties
Children with learning disabilities may find it more difficult to read, learn, understand or do things, compared to other children of the same age. They may struggle in many areas, such as self-care, school work, learning practical skills, language and friendships.
Children with learning difficulties often find specific things difficult and may need support with the specific difficulty or difficulties, but may find other things relatively easy, manage well, independently and without support.
What causes learning disabilities?
There are often several risk factors involved such as,
Genetic role (can run in families)
Brain injury during or after birth
Brain infections
Infections before birth
It is important to note that in more or less 50% of all children with learning disabilities, no cause can be found.
Examples of learning disabilities:
Down's syndrome
Fragile X syndrome
Klinefelter's syndrome
Angelman's syndrome
Cerebral palsy
How is a learning disability diagnosed?
Clinical assessments usually include a general developmental assessment, play (if age appropriate) and interaction with a child or young person.
NORMAL DEVELOPMENTAL GUIDELINES:
Significant variations exist.
Age 4 months: Smiles
Age 6 months: Babbles, sits, holds a bottle, often prefers one carer
Age 9 months: Crawls
Age 12-18 months: Walks, paints or draws (rough), starts to share with others, understands simple commands such as 'no', sleep and feeding pattern more or less established
Age 2: Holds a spoon, runs, jumps, might have a imaginary world and favourite toy, says a few words (between 2 and 50)
Age 3: 2-3 word sentences (e.g. "I go there"), understands 3 part commands (e.g. "take the spoon" and "take a bite"), starts to wash and dress self, starts to brush teeth, starts to ride a tricycle, might still have imaginary friends, can start to understand social cues
Age 4: Starts being able to tell a story (e.g. what happened with the dog? - remember to be specific with questions rather than ask "how was your day?" and remember to ask about very recent and exciting events rather than 2 days ago and bland events), develops empathy, becomes more curious, starts to learn colours and numbers
Age 5: Speech more developed, no faecal incontinence, able to manage buttons and zips
(school ready)
Age 6: No urinary incontinence
Age 7: Less impulsive, becomes safer with roads and possible risky situations such as in the kitchen (remember that children can take a very long time to become 'safe' and responsible in risk settings such as roads or kitchens)
Social development in various settings and contexts can take long to develop, up to 40 years; some would argue that one is constantly developing from a social, emotional and cognitive point of view. Altruism and finding 'meaning' or 'purpose' are some of the final stages of human development in adulthood.
An arrest or deterioration in development in children always causes concern.
Learning disabilities can present in many different ways and the degree of disability may vary significantly.
Children with learning disabilities may struggle with all areas of development, for instance, language development, physical development, cognitive development (understanding complex ideas for instance), social and emotional development.
Children may present as much younger than their chronological age and we may refer to developmental age on occasion, which helps professionals to understand the level of support required.
Some children may grow up to become independent and some children may require ongoing help to look after themselves.
Learning disabilities versus difficulties
Children with learning disabilities may find it more difficult to read, learn, understand or do things, compared to other children of the same age. They may struggle in many areas, such as self-care, school work, learning practical skills, language and friendships.
Children with learning difficulties often find specific things difficult and may need support with the specific difficulty or difficulties, but may find other things relatively easy, manage well, independently and without support.
What causes learning disabilities?
There are often several risk factors involved such as,
Genetic role (can run in families)
Brain injury during or after birth
Brain infections
Infections before birth
It is important to note that in more or less 50% of all children with learning disabilities, no cause can be found.
Examples of learning disabilities:
Down's syndrome
Fragile X syndrome
Klinefelter's syndrome
Angelman's syndrome
Cerebral palsy
How is a learning disability diagnosed?
Clinical assessments usually include a general developmental assessment, play (if age appropriate) and interaction with a child or young person.
NORMAL DEVELOPMENTAL GUIDELINES:
Significant variations exist.
Age 4 months: Smiles
Age 6 months: Babbles, sits, holds a bottle, often prefers one carer
Age 9 months: Crawls
Age 12-18 months: Walks, paints or draws (rough), starts to share with others, understands simple commands such as 'no', sleep and feeding pattern more or less established
Age 2: Holds a spoon, runs, jumps, might have a imaginary world and favourite toy, says a few words (between 2 and 50)
Age 3: 2-3 word sentences (e.g. "I go there"), understands 3 part commands (e.g. "take the spoon" and "take a bite"), starts to wash and dress self, starts to brush teeth, starts to ride a tricycle, might still have imaginary friends, can start to understand social cues
Age 4: Starts being able to tell a story (e.g. what happened with the dog? - remember to be specific with questions rather than ask "how was your day?" and remember to ask about very recent and exciting events rather than 2 days ago and bland events), develops empathy, becomes more curious, starts to learn colours and numbers
Age 5: Speech more developed, no faecal incontinence, able to manage buttons and zips
(school ready)
Age 6: No urinary incontinence
Age 7: Less impulsive, becomes safer with roads and possible risky situations such as in the kitchen (remember that children can take a very long time to become 'safe' and responsible in risk settings such as roads or kitchens)
Social development in various settings and contexts can take long to develop, up to 40 years; some would argue that one is constantly developing from a social, emotional and cognitive point of view. Altruism and finding 'meaning' or 'purpose' are some of the final stages of human development in adulthood.
An arrest or deterioration in development in children always causes concern.
Biological, psychological and social factors are always considered, as physical health, change or stress in an environment can affect development significantly.
Psychometric may be recommended when concerns regarding development are identified. These tests aim to identify a child's profile of strengths and difficulties in his/her ability to learn and develop. The tests are slightly similar to school tests and it is not designed to trick a child or to be very difficult. Quite a few children say they enjoyed it.
The tests are carried out by professionals trained in administering and interpreting the results, usually psychologists. After the psychometric tests, the psychologist interprets the results and writes a report on the child's abilities to learn, commenting on specific aspects, which can often help schools in providing children with specifically tailored support packages.
The information provided through psychometric tests is often very valuable when addressing a child's needs, whether a child has a learning disability or not.
It is important to remember that most children, whether they are generally high functioning or not, have specific areas in learning where they excel and specific areas where they struggle.
How is a learning disability managed?
Psychometric may be recommended when concerns regarding development are identified. These tests aim to identify a child's profile of strengths and difficulties in his/her ability to learn and develop. The tests are slightly similar to school tests and it is not designed to trick a child or to be very difficult. Quite a few children say they enjoyed it.
The tests are carried out by professionals trained in administering and interpreting the results, usually psychologists. After the psychometric tests, the psychologist interprets the results and writes a report on the child's abilities to learn, commenting on specific aspects, which can often help schools in providing children with specifically tailored support packages.
The information provided through psychometric tests is often very valuable when addressing a child's needs, whether a child has a learning disability or not.
It is important to remember that most children, whether they are generally high functioning or not, have specific areas in learning where they excel and specific areas where they struggle.
How is a learning disability managed?
Children can often learn skills, which can positively affect their development and level of independence.
Early diagnosis is important to enable professionals in Education to offer the child the correct support (Statement of Special Educational Needs). Health visitors, GPs and schools often notice concerns in development and refer children for assessment.
Specialist Learning Disabilities teams in CAMHS (Child and Adolescent Mental Health Services) can often offer help with mental health difficulties or general concerns such as aggression or sleep problems.
Early diagnosis is important to enable professionals in Education to offer the child the correct support (Statement of Special Educational Needs). Health visitors, GPs and schools often notice concerns in development and refer children for assessment.
Specialist Learning Disabilities teams in CAMHS (Child and Adolescent Mental Health Services) can often offer help with mental health difficulties or general concerns such as aggression or sleep problems.
Mental health difficulties in children and young people with learning disabilities:
Research indicates that children and young people with learning disabilities are at least 4 times more susceptible to mental health problems.
Comorbidities:
Autism Spectrum Disorder (up to 20%)
ADHD (up to 10%)
Anxiety disorders (up to 20%)
Depression (up to 11%)
Schizophrenia (up to 5%)
This list is not comprehensive.
Children with severe learning disabilities have higher rates of psychiatric disorders compared to children with mild learning disabilities.
It is important to remember that children with learning disabilities experience the same range of psycho-social stressors and challenges, as well as psychiatric problems, as children without learning disabilities.
Comorbidities significantly affect prognosis and outcome, it is therefore important that professionals assess and monitor for comorbidities during initial and follow up appointments to ensure early detection and treatment.
Management and treatment of comorbidities may include family therapy, group therapy or individual psychotherapy, for instance psychodynamic psychotherapy. Medication may be indicated in certain circumstances, such as severe Depression. Social interventions and support are also important to consider.
Predisposing factors for mental health problems in children with learning disabilities:
Limited range of coping strategies
Sensory disability
Communication difficulties
Epilepsy
Physical illness
Side-effects of medication
Abuse
Psycho-social stressors and lack of support
Family Mental Illness
Behavioural phenotypes -
for example children with Down's syndrome are more likely to have difficulties related to obsessionality and ADHD, whilst children with Fragile X syndrome are more likely to have difficulties related to Autism.
Warning signs or indicators of mental health difficulties in children with Learning Disabilities?
Change in everyday pattern of behaviour e.g.
A child isolating himself or herself
A child losing interest in favourite activities
Change in personality
Change in mood (feelings)
Anger, agitation, aggression or violence
Change in self-care
Change in relationships
Change in daily activities or interests
Change in sleep patterns; sleeping more or less
Change in appetite, weight loss or significant weight gain
Concentration deteriorating
Low or high energy
Psychotic phenomena - for instance talking about hearing voices or unusual beliefs - please see Psychotic Disorders
General high levels of distress
Deterioration in ability to function
Medical symptoms without a medical explanation
Themes of death, sadness or anger in play, drawings or conversation
In conclusion, it is important to remember that children and young people with learning disabilities can be significantly more vulnerable to mental illness and psychiatric disorders.
If you have any mental health concerns for children or young people with learning disabilities, please speak to your GP or Child Psychiatrist about your concerns as soon as possible.
Research indicates that children and young people with learning disabilities are at least 4 times more susceptible to mental health problems.
Comorbidities:
Autism Spectrum Disorder (up to 20%)
ADHD (up to 10%)
Anxiety disorders (up to 20%)
Depression (up to 11%)
Schizophrenia (up to 5%)
This list is not comprehensive.
Children with severe learning disabilities have higher rates of psychiatric disorders compared to children with mild learning disabilities.
It is important to remember that children with learning disabilities experience the same range of psycho-social stressors and challenges, as well as psychiatric problems, as children without learning disabilities.
Comorbidities significantly affect prognosis and outcome, it is therefore important that professionals assess and monitor for comorbidities during initial and follow up appointments to ensure early detection and treatment.
Management and treatment of comorbidities may include family therapy, group therapy or individual psychotherapy, for instance psychodynamic psychotherapy. Medication may be indicated in certain circumstances, such as severe Depression. Social interventions and support are also important to consider.
Predisposing factors for mental health problems in children with learning disabilities:
Limited range of coping strategies
Sensory disability
Communication difficulties
Epilepsy
Physical illness
Side-effects of medication
Abuse
Psycho-social stressors and lack of support
Family Mental Illness
Behavioural phenotypes -
for example children with Down's syndrome are more likely to have difficulties related to obsessionality and ADHD, whilst children with Fragile X syndrome are more likely to have difficulties related to Autism.
Warning signs or indicators of mental health difficulties in children with Learning Disabilities?
Change in everyday pattern of behaviour e.g.
A child isolating himself or herself
A child losing interest in favourite activities
Change in personality
Change in mood (feelings)
Anger, agitation, aggression or violence
Change in self-care
Change in relationships
Change in daily activities or interests
Change in sleep patterns; sleeping more or less
Change in appetite, weight loss or significant weight gain
Concentration deteriorating
Low or high energy
Psychotic phenomena - for instance talking about hearing voices or unusual beliefs - please see Psychotic Disorders
General high levels of distress
Deterioration in ability to function
Medical symptoms without a medical explanation
Themes of death, sadness or anger in play, drawings or conversation
In conclusion, it is important to remember that children and young people with learning disabilities can be significantly more vulnerable to mental illness and psychiatric disorders.
If you have any mental health concerns for children or young people with learning disabilities, please speak to your GP or Child Psychiatrist about your concerns as soon as possible.
