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

2. OBJECTIVES What is learning disability? What is learning disability? How common is it? How common is it? Detection and assessment Detection and assessment Medical management Medical management Educational management Educational management Government policy/resources 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. ….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 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 May be concomitant with, but not the direct result of….other conditions or influences Hammill 1990 Hammill 1990

4. Intelligence quotients (IQ) ‘Summary IQ’ of <70 denotes a general learning disability ‘Summary IQ’ of <70 denotes a general learning disability Mild50-69 Mild50-69 Moderate35-49 Moderate35-49 Severe20-34 Severe20-34 Profound<20 Profound<20

5. How common is LD? Gaussian distribution of intelligence Gaussian distribution of intelligence 95% of population lie within 2 standard deviations of the mean (100) 95% of population lie within 2 standard deviations of the mean (100) UK 0.45-0.6% of children have moderate to severe LD UK 0.45-0.6% of children have moderate to severe LD

6. Specific learning disability US – 15% of children US – 15% of children Applied to academic skills Applied to academic skills Could be appropriately applied to disorders of attention and motor planning Could be appropriately applied to disorders of attention and motor planning Limitation of IQ tests Limitation of IQ tests

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

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

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

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

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

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

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

14. Genetics - 1 Down Syndrome – 1 in 700 Down Syndrome – 1 in 700 Sex chromosome abnormalities Sex chromosome abnormalities 2.5/1,000 females, 1.4/1,000 males 2.5/1,000 females, 1.4/1,000 males XYY, XXY, XXX, XO XYY, XXY, XXX, XO Fragile X – Fragile X – 1 in 1,000 females carriers, 1 in 1,300-3,000 males affected 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 2-10% of children with moderate to severe LD without specific dysmorphic features

15. Genetics - 2 Other specific syndromes Other specific syndromes Rett – MECP2, X chromosome Rett – MECP2, X chromosome Williams – ch 7, defective elastin gene Williams – ch 7, defective elastin gene Soto – deletion(s) 5q35 Soto – deletion(s) 5q35 Smith Magennis – interstitial deletion 17p11.2 Smith Magennis – interstitial deletion 17p11.2

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

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

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

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

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

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