Learning Learning DisabilitiesDisabilities

Denise McDonaldDenise McDonald

Consultant in Community Consultant in Community Child HealthChild Health

June 9June 9thth 2005 2005

OBJECTIVESOBJECTIVES

What is learning disability?What is learning disability? How common is it?How common is it? Detection and assessmentDetection and assessment Medical managementMedical management Educational managementEducational management Government policy/resourcesGovernment policy/resources

Learning disabilitiesLearning disabilities

……..is a general term that refers to a is a general term that refers to a heterogenous group of disorders heterogenous group of disorders manifested by significant difficulties in the manifested by significant difficulties in the acquisition and use of listening, speaking, acquisition and use of listening, speaking, reading, writing or mathematical abilities.reading, writing or mathematical abilities.

Intrinsic to the individual….presumed to Intrinsic to the individual….presumed to be due to some CNS dysfunctionbe due to some CNS dysfunction

May be concomitant with, but not the May be concomitant with, but not the direct result of….other conditions or direct result of….other conditions or influencesinfluences

Hammill 1990Hammill 1990

Intelligence quotients Intelligence quotients (IQ)(IQ)

‘‘Summary IQ’ of <70 denotes a Summary IQ’ of <70 denotes a general learning disabilitygeneral learning disability MildMild 50-6950-69 ModerateModerate 35-4935-49 SevereSevere 20-3420-34 ProfoundProfound <20<20

How common is LD?How common is LD?

Gaussian distribution of Gaussian distribution of intelligenceintelligence 95% of population lie within 2 95% of population lie within 2

standard deviations of the mean standard deviations of the mean (100)(100)

UK 0.45-0.6% of children have UK 0.45-0.6% of children have moderate to severe LDmoderate to severe LD

Specific learning Specific learning disabilitydisability

US – 15% of childrenUS – 15% of children

Applied to academic skillsApplied to academic skills Could be appropriately applied to Could be appropriately applied to

disorders of attention and motor disorders of attention and motor planning planning

Limitation of IQ testsLimitation of IQ tests

Detection and Detection and AssessmentAssessment

Cognitive skills rapidly acquired Cognitive skills rapidly acquired during the first 3 yearsduring the first 3 years

Developmental screening Developmental screening programmesprogrammes

Early intervention programmesEarly intervention programmes

Early milestonesEarly milestones

Motor – fine, grossMotor – fine, gross VisionVision HearingHearing Communication – verbal, non-Communication – verbal, non-

verbalverbal SocialSocial

Developmental screeningDevelopmental screening

6-8 weeks6-8 weeks 6-9months6-9months 18months18months

Programme of action for children Programme of action for children (PAC)(PAC)

Early detectionEarly detection

Early smiling and reciprocal Early smiling and reciprocal social interactionsocial interaction

Early motor milestones – ranges Early motor milestones – ranges of normalof normal

Communication – verbal and non-Communication – verbal and non-verbalverbal

Developmental clinic - Developmental clinic - AMNCHAMNCH

Referrals from AMOs, PHNs, Referrals from AMOs, PHNs, SLTs, GPsSLTs, GPs

95 referrals 2003, 200 in 2004, 95 referrals 2003, 200 in 2004, 270 in 2005270 in 2005

Predominantly speech and Predominantly speech and language development concerns language development concerns

Developmental clinic - Developmental clinic - AMNCHAMNCH

Paediatric assessmentPaediatric assessment

Detailed early historyDetailed early history Current developmental abilitiesCurrent developmental abilities Medical issuesMedical issues Family historyFamily history Social historySocial history

Developmental clinic - Developmental clinic - AMNCHAMNCH

Schedule of Growing Skills IISchedule of Growing Skills II General examinationGeneral examination InvestigationsInvestigations

GeneticGenetic MetabolicMetabolic EndocrineEndocrine Brain imagingBrain imaging

Genetics - 1Genetics - 1

Down Syndrome – 1 in 700Down Syndrome – 1 in 700 Sex chromosome abnormalitiesSex chromosome abnormalities

2.5/1,000 females, 1.4/1,000 males2.5/1,000 females, 1.4/1,000 males XYY, XXY, XXX, XOXYY, XXY, XXX, XO

Fragile X – Fragile X – 1 in 1,000 females carriers, 1 in 1 in 1,000 females carriers, 1 in

1,300-3,000 males affected1,300-3,000 males affected 2-10% of children with moderate to 2-10% of children with moderate to

severe LD without specific severe LD without specific dysmorphic featuresdysmorphic features

Genetics - 2Genetics - 2

Other specific syndromesOther specific syndromes Rett – MECP2, X chromosomeRett – MECP2, X chromosome Williams – ch 7, defective elastin Williams – ch 7, defective elastin

genegene Soto – deletion(s) 5q35Soto – deletion(s) 5q35 Smith Magennis – interstitial Smith Magennis – interstitial

deletion 17p11.2deletion 17p11.2

Developmental clinic - Developmental clinic - AMNCHAMNCH

Schedule of Growing Skills IISchedule of Growing Skills II General examinationGeneral examination InvestigationsInvestigations

GeneticGenetic MetabolicMetabolic EndocrineEndocrine Brain imagingBrain imaging

Medical managementMedical management

Part of multidisciplinary teamPart of multidisciplinary team Referral for multi-d assessmentReferral for multi-d assessment

Medical follow-upMedical follow-up Investigation results Investigation results Medical and emotional issuesMedical and emotional issues

‘‘Gate-keeping’ Gate-keeping’ CoordinationCoordination

Educational Educational ManagementManagement

Appropriate pre-school Appropriate pre-school placement – early intervention placement – early intervention programmeprogramme

Appropriate school placementAppropriate school placement

Segregation Segregation vsvs inclusion inclusion vsvs integrationintegration

Local and National Local and National ServicesServices

Voluntary organisationsVoluntary organisations eg, Brothers of Charityeg, Brothers of Charity Schools attached – Cheeverstown, Schools attached – Cheeverstown,

PalmerstownPalmerstown Down Syndrome IrelandDown Syndrome Ireland Autism Services – BeechparkAutism Services – Beechpark

Government PolicyGovernment Policy

UK White Paper 2001UK White Paper 2001 Civil rightsCivil rights IndependenceIndependence ChoiceChoice InclusionInclusion

Irish Disability Bill 2004Irish Disability Bill 2004 Assessment of need, service Assessment of need, service

statementsstatements AccessibilityAccessibility EmploymentEmployment

SUMMARYSUMMARY

Learning disability – general, Learning disability – general, specificspecific

Frequency Frequency Screening and assessmentScreening and assessment Medical managementMedical management Educational managementEducational management Government policy/resourcesGovernment policy/resources