Learning Disability - Down Syndrome & Severe and Profound Learning Disability

Flashcards from DDoC Lecture 6

what is the definition of learning disability

a reduced intellectual ability and difficulty with everyday activities - for eg household tasks, socialising or managing money - which affects someone for their whole life. people tend to take longer to learn and may need support to develop new skills, understand complicated info and interact with other people

what two things are taken into account when describing and classifying learning disability

IQ / cognition and social functioning

what are the two different types of aetiology associated with learning disability

organic aetiology

genetic aetiology

what is a syndrome of learning disability

a collection of abnormalities of anatomic structure and / or behaviours and / or developmental patterns which are found to cluster together more often than chance

what are some examples at the different levels of causation of congenital syndromes

genetic (fragile x syndrome), chromosomal (Down Syndrome), metabolic (phenylketonuria), environmental (maternal hypoglycaemia)

what is down syndrome

a chromosomal abnormality called trisomy 21 (extra copy, ie: third) of the 21st chromosome

what are some risk factors for down syndrome

advanced maternal age, some environmental factors such as smoking in pregnancy

how many people have down syndrome

1 in 800 (US), 1 in 1000 (UK)

what is the physical phenotype of Down Syndrome

mild to moderate learning disability with a decline in IQ during the lifespan, especially post-40

low muscle tone (hypotonia)

shortening of the front to back dimension of the face (brachycephaly)

hyperflexibility of joints

heart and respiratory problems

eating and swallowing difficulties

ear anomalies and hearing difficulties

upper respiratory tract anomalies

oral-motor difficulties

how much of the learning disabled population have each category of learning disability

mild = 85%

moderate = 10%

severe = 3-4%

profound = 1%

describe cognition in Down Syndrome

mild to moderate IQ with language abilities often below level of NVIQ

decline in IQ over time / age

memory difficulties including working memory, executive function, cognitive flexibility (adapting brain to new info)

superior visual memory than auditory memory

visual abilities stronger than verbal and auditory abilities

describe speech, language and communication in DS

very early language delay evident

variation in severity across children

development usually follows typical sequence but is much slower and plateaus at level very much below chronological age

uneven patterns of language and communication development

significantly delayed onset - communicative intent delayed and later first words

receptive language develop much faster than expressive

vocabulary develop more quickly than grammatical ability

can learn to sign before they are able to say the words they can sign

speech slow to develop

often unintelligible or difficult to understand speech - often due to articulation difficulties resulting from the oral structure anomalies

phonological development slower

describe hearing in Down Syndrome

v short Eustachian tube so lots of ear infections and colds - high risk for ear infections

hearing problems common - usually as a result of recurrent otitis-media which causes transient and repeated conductive hearing loss - due to ear anomalies

hearing difficulties don’t entirely account for language and communication difficulties found in DS

describe social-emotional and behavioural functioning in DS

described as overly friendly - increases individual’s vulnerability

behavioural difficulties become apparent in adolescence due to increasing social demands

increasing incidence of Autism in DS

describe interactions in Down Syndrome

mothers reported to be less responsive than mothers of typically developing infants

mothers may find it difficult to recognise behaviours that are communicative and to then respond to these - including low rates of initiations and responses and slow response time

what is the specific pattern of language and cognition in DS

strengths = receptive language, visual memory, using gesture to communicate, social interaction

weaknesses = expressive language, auditory memory and grammatical abilities

when is the pre-intentional communication stage and what is it

0-6 months, initially reflexive > internal state of child affects his environment, no intentional meaning

what is the intentional communication stage and when is it

6 months - 1;3 years > infant has meaning he wants to convey, caregiver chooses what to respond to

what are the three factors important in infants developing from reflexive to intentional communication

infants communicative intent, caregivers response to infant, interaction between caregiver(s) and infant

how does reflexive turn to intentional communication in typical preverbal development

gaze > smiling (6-7 weeks) > cry (2-4 months) > vocalisation (2-4 months)

what is the difference between MLD progression and SLD and PLD progression

MLD - progress through preverbal stage but difficulties become apparent in verbal stages

SLD & PLD - may never move on from pre verbal stage at any point

what are the three stages of communication development in SLD and pLD

reflexive stage - individuals reflexive responses to own body and environment with familiar people interpret (different cries to indicate hunger, cold, pain)

reactive stage - individual reacts to own bodies and to environment which others interpret (body stiffening is interpreted as dislike)

proactive stage - individual deliberately respond to objects and people (turning head is seen as don’t want)