Borderline Learning Disability Research Articles

The Birmingham Provocation Hierarchy: For adults with mild to borderline learning disabilities

Using data from clinical interventions, this paper describes how the Birmingham Provocation Hierarchy was developed. This hierarchy highlights both situations which make people with learning disabilities most angry and the proportion of people who are made angry by these situations.

Personality disorder and offending in people with learning disabilities

This article reviews the literature on personality disorder in offenders with learning disabilities, using Medline, PsychoInfo and CINAHL databases, and search terms ‘offending’, ‘personality disorder and intellectual disabilities’, ‘learning disabilities’ and related terms. Methods of defining offending population, personality disorder and learning disabilities vary greatly, and few studies focus specifically on personality disorder, learning disability and offending. The definition of learning disability often encompasses both borderline learning disability and low average intelligence. Personality disorder, especially anti‐social personality disorder, is prevalent in offenders with learning disabilities, but less than in the general population, and is associated with higher levels of security and poorer outcomes. The study concludes that there is a continuum of offenders with borderline and mild learning disabilities, reflected in learning disability forensic services.

A Comparison of WAIS‐R and WAIS‐III in the Lower IQ Range: Implications for Learning Disability Diagnosis

Background Whether the Flynn effect (the increase in the populations’ IQ over time) affects the IQ scores of people with learning disability or borderline learning disability remains unclear. The issue is important as the Flynn effect should alter the number of people eligible for health service resources. A comparison of the Wechsler Adult Intelligence Scale‐Revised (WAIS‐R) with the Wechsler Adult Intelligence Scale‐Third Edition (WAIS‐III) in individuals with learning disability or borderline learning disability was conducted.Method All participants completed the WAIS‐R and the WAIS‐III. Discrepancy scores were calculated for the Full Scale IQ score and the Verbal and Performance subscale scores.Results WAIS‐III Full Scale scores were significantly lower by over 4 IQ points. Verbal and Performance Scale IQ scores were also significantly lower than the corresponding WAIS‐R scores.Conclusion The shift from WAIS‐R to WAIS‐III means that 66% more people meet criterion A for the diagnosis of learning disability and hence this has major resource implications for health service providers.

Symbols can improve the reading comprehension of adults with learning disabilities

This study aimed to test the hypothesis that adding symbols to written text can improve its comprehensibility for adults with learning disabilities. Nineteen adults with mild or borderline learning disabilities attempted to read four short passages of text, two of which had Widgit Rebus symbols added to them. Following each passage, they were asked questions to test their comprehension. A counterbalanced design was employed. Participants' comprehension scores were significantly higher for the symbolized passages than the non-symbolized ones. Adding symbols to written text can make comprehension easier for some adults with mild and borderline learning disabilities. Future research, exploring how to do this most effectively, would be worthwhile.

Assessing the reading comprehension of adults with learning disabilities

This study's aim was to begin the process of measuring the reading comprehension of adults with mild and borderline learning disabilities, in order to generate information to help clinicians and other professionals to make written material for adults with learning disabilities more comprehensible. The Test for the Reception of Grammar (TROG), with items presented visually rather than orally, and the Reading Comprehension sub-test of the Wechsler Objective Reading Dimensions (WORD) battery were given to 24 service-users of a metropolitan community learning disability team who had an estimated IQ in the range 50-79. These tests were demonstrated to have satisfactory split-half reliability and convergent validity with this population, supporting both their use in this study and in clinical work. Data are presented concerning the distribution across the sample of reading-ages and the comprehension of written grammatical constructions. These data should be useful to those who are preparing written material for adults with learning disabilities.

Management of bullying on an NHS open forensic unit for people with borderline/mild learning disabilities

The purpose of the study discussed here was to review the experience and management of bullying on an open forensic borderline learning disability unit. Semi‐structured interviews were used to gather the perceptions, experiences and recommendations of service users about current and future management of bullying. Staff completed a questionnaire seeking information on the incidence and characteristics of bullying, management techniques and training requirements. Service users' results highlighted the importance of the level and predictability of staff presence on the ward, difficulties in reporting episodes for fear of retribution, and improving availability of information about bullying. Staff results highlighted a consistent response to bullying but reluctance to rate highly the strategies used or their confidence in assessing bullying, and a desire for bullying‐specific training. Both groups were interested in unitwide interventions to promote greater openness and wider involvement in dealing with bullying and to reduce the impact of negative factors such as fear and secrecy.

Brain Anatomy in Adults With Velocardiofacial Syndrome With and WithoutSchizophrenia

Velocardiofacial syndrome is associated with interstitial deletions of chromosome 22q11, mild to borderline learning disability, characteristic dysmorphology, and a high prevalence of schizophrenia. The biological basis for this increased risk for schizophrenia is unknown, but people with velocardiofacial syndrome may have genetically determined differences in brain anatomy that predispose to the development of schizophrenia. To determine whether there are differences in brain structure between subjects with velocardiofacial syndrome with and without schizophrenia. A cross-sectional quantitative structural magnetic resonance imaging study in 39 adult subjects. Referrals were made through medical genetics clinics and psychiatric services throughout the United Kingdom. Thirteen subjects with velocardiofacial syndrome and schizophrenia, 12 with velocardiofacial syndrome without history of a psychosis, and 14 healthy controls volunteered to participate after screening for eligibility. Total and regional brain volumes were analyzed by means of manual tracing, and gray- and white-matter densities were obtained by computerized voxel-based methods. People with velocardiofacial syndrome and schizophrenia, compared with both controls and nonschizophrenic patients with velocardiofacial syndrome, had a significant (P<.05) reduction in volume of whole-brain (white + gray) matter and whole-brain white matter, and an increase in total and sulcal cerebrospinal fluid volume. Both velocardiofacial syndrome groups had a reduced cerebellar volume compared with controls. Within velocardiofacial syndrome, schizophrenia is associated with generalized differences in brain anatomy, but white matter may be particularly implicated. Studies with larger samples are needed to replicate our findings.

The behavioural phenotype in velo-cardio-facial syndrome.

Velo—cardio—facial syndrome (VCFS), the most frequent known interstitial deletion found in humans, occurs with an incidence of approx 1/4000 live births (1). VCFS is associated with chromosomal microdeletions in the ql l band of chromosome 22 in over 90% of those with the disorder (2). The VCFS phenotype is complex, with multiple congenital abnormalities affecting a wide range of tissues and organs, often occurring in different combinations and with widely differing severity. Although in excess of 100 phenotypic features have been described, the most common include characteristic dysmorphology, congenital heart disease, cleft palate, borderline learning disability, and psychiatric disorder (Fig. 1). Variability in phenotypic expression has resulted in the same deletion being linked to several syndromes including DiGeorge syndrome, conotruncal anomaly face syndrome, Cayler syndrome, and Opitz GBBB syndrome, and the term “22q11 deletion syndrome” has been proposed as a replacement term for these other designators.

Using literature as a therapeutic tool with people with moderate and borderline learning disabilities in a forensic setting

SummaryIn the past, it was rare for services for people with learning disabilities to focus on meeting the emotional and personal development needs of their clients, concentrating instead on interventions that aimed to improve self‐care, develop appropriate social skills and reduce challenging behaviours. However, recent work using psychotherapeutic interventions and art therapies has started to remedy this traditional shortfall. The purpose of this paper is to discuss the successful use of an art‐based therapy, using literature (often termed Biblio‐therapy and Poetry Therapy in published research) that has been hitherto generally overlooked with a client group of men with learning disabilities who have offended, on account of their lack of literacy skills and likely lack of understanding of the use of metaphor. The paper describes the background to the work, the preparation of materials, the presentation of the psychotherapeutically‐based group work and it's effectiveness in encouraging the development of emotional maturity and self‐expression within a mixed‐ability client group of young men in a high security setting.

How does the severity of a learning disability affect working memory performance?

Working memory performance was examined in children aged 11-12 years who had borderline, mild, and moderate learning disabilities. Comparisons with children of average abilities were used to determine whether those with more severe learning disabilities had greater impairments in working memory. Seven measures of working memory span were used to assess temporary phonological short-term storage (digit span, word span), temporary visuo-spatial short-term storage (pattern span, spatial span), and temporary short-term storage with additional processing, or central executive, demands (listening span, odd one out span, reverse digit span). Children with mild and moderate learning disabilities were impaired on all measures of working memory compared to children of average abilities. Children with borderline learning disabilities were just as good as children with average abilities on visuo-spatial and complex span tasks, but showed an impairment on phonological span tasks. Children with moderate learning disabilities were indistinguishable from children with mild learning disabilities on simple span tasks, but were significantly poorer than the mild group on the more demanding complex span tasks. For the group as a whole, working memory was strongly related to mental age.

The diagnosis of schizophrenia in the borderline learning-disabled forensic population: six case-reports

Population surveys indicate an increased prevalence of schizophrenia in the learning-disabled population. Extensive assessment and observation may be necessary to detect schizophrenia which may be undiagnosed and directly related to offending behaviour. Six male patients admitted to an open forensic psychiatric unit for people with mild and borderline learning disability are presented: in these men schizophrenia was previously unrecognized. Treatment led to a marked clinical improvement. There is a need to be particularly aware of the possibility of schizophrenia in this population.

Intensive case management for psychotic patients with borderline intelligence

Patients with recurrent psychotic disorder and borderline learning disability who were randomly assigned intensive case management spent less than half the subsequent time in hospital than those who were assigned standard case management.

Making contact – bereavement and Asperger's syndrome

AbstractA case of abnormal bereavement is described in a man with borderline learning disability and Asperger's syndrome. Bereavement issues and concurrent assessment of psychiatric illness in people with pervasive developmental disorders are discussed. Particular reference is made to relevant psychopathology and possible underlying psychodynamic mechanisms.

One hundred admissions to a regional secure unit for people with a learning disability

Abstract Information was collected about 100 successive admissions to a regional secure unit for people with a learning disability (mental handicap). Most of the patients were males under the age of 30, with a mild or borderline learning disability. A majority also had a psychiatric disorder. The most common offences committed were sexual, arson and assault. After discharge, most patients returned either to the community or to a mental handicap hospital. A comparison of the first cohort of 50 admissions with the second cohort of 50 admissions showed that the unit had changed its admission policy and had increasingly admitted those with a mild or moderate learning disability referred by the courts. In addition, the average length of stay had doubled, and the number of admissions each year had halved. This reflects a lack of local facilities which can provide intensive supervision.