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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