1. Learning Disabilities Denise McDonald Consultant in Community Child Health June 9th 2005

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

3. 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

4. Intelligence quotients (IQ) • ‘Summary IQ’ of <70 denotes a general learning disability • Mild 50-69 • Moderate 35-49 • Severe 20-34 • Profound <20

5. 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

6. 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

7. Detection and Assessment • Cognitive skills rapidly acquired during the first 3 years • Developmental screening programmes • Early intervention programmes

8. Early milestones • Motor – fine, gross • Vision • Hearing • Communication – verbal, non-verbal • Social

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

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

11. Developmental clinic - AMNCH • Referrals from AMOs, PHNs, SLTs, GPs • 95 referrals 2003, 200 in 2004, 270 in 2005 • Predominantly speech and language development concerns

12. Developmental clinic - AMNCH • Paediatric assessment • Detailed early history • Current developmental abilities • Medical issues • Family history • Social history

13. Developmental clinic - AMNCH • Schedule of Growing Skills II • General examination • Investigations • Genetic • Metabolic • Endocrine • Brain imaging

14. 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

15. 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

16. Developmental clinic - AMNCH • Schedule of Growing Skills II • General examination • Investigations • Genetic • Metabolic • Endocrine • Brain imaging

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

18. Educational Management • Appropriate pre-school placement – early intervention programme • Appropriate school placement • Segregation vs inclusion vs integration

19. Local and National Services • Voluntary organisations • eg, Brothers of Charity • Schools attached – Cheeverstown, Palmerstown • Down Syndrome Ireland • Autism Services – Beechpark

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

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