Mild Learning Disabilities Research Articles

From Dare I say … ? to I dare say: a case example illustrating the extension of the use of Talking Mats to people with learning disabilities who are able to speak well but unwilling to do so

Accessible summary Sometimes people are worried about saying things to staff even if they are usually good at talking. Sometimes they think if they say something then someone might blame them. It can help to use picture symbols to help you say what you want. Symbols help you remember what you have said because the pictures are there in front of you. This article tells you how these picture symbols in Talking Mats work. It also tells you how one woman was helped to say what she wanted. AbstractThis article presents the case of a woman with mild learning disability and with good verbal and expressive language ability. However, she was unable to explore verbally with her clinical psychologist issues concerning her low mood and to discuss strategies to address this. Talking Mats provided a low‐tech communication framework to help the woman think about the issues and express her views. This article explores this approach and the woman’s response and considers the advantages of using Talking Mats in such cases.

Contiguous gene deletions involving EFNB1, OPHN1, PJA1 and EDA in patients with craniofrontonasal syndrome

Craniofrontonasal syndrome (CFNS [MIM 304110]) is an X-linked malformation syndrome characterized by craniofrontonasal dysplasia and extracranial manifestations in heterozygous females. In the majority of patients CFNS is caused by mutations in the EFNB1 gene (MIM 300035). We identified three girls with classical CFNS and mild developmental delay harboring de novo deletions of the EFNB1 gene. Applying haplotype analysis, Southern blot hybridization and array-comparative genomic hybridization, deletion of EFNB1 was found to be part of contiguous gene deletions in the patients. In one patient the deletion interval includes the genes for oligophrenin-1 (OPHN1 [MIM 300127]) and praja 1 (PJA1 [MIM 300420]). In the second patient the deletion includes OPHN1, PJA1 and the gene for ectodysplasin A (EDA [MIM 300451]). In the third patient EFNB1 gene deletion may include deletion of regulatory regions 5' of OPHN1. Previously, the OPHN1 gene has been shown to be responsible for recessive X-linked mental retardation. Although it is too early to predict the future cognitive performance of the two infant patients with contiguous gene deletions of OPHN1-EFNB1-PJA1, mild learning disabilities have been recognized in the older, third patient. It is important for genetic counseling to be aware that their male offspring may not only be carriers of CFNS but may also be affected by mental retardation and anhidrotic ectodermal dysplasia.

Prevalence and influences on self-reported smoking among adolescents with mild learning disabilities, attention deficit hyperactivity disorder, and their typically developing peers

Many adolescents take up the smoking habit despite its well-documented adverse health effects. This study explores the prevalence and influences on smoking among 89 adolescents with mild learning disabilities, 108 with attention deficit hyperactivity disorder (ADHD), and 124 typically developing peers aged 12-16 years. All the participants were attending mainstream secondary schools and they were asked to complete a self-report questionnaire on smoking. It was found that adolescents with ADHD smoked more than adolescents with mild learning disabilities, who in turned smoked more than adolescents not diagnosed with any disability. More adolescents with ADHD reported that the majority of their friends smoked and they were less well informed about the health effects of smoking. No differences were identified between the three groups in terms of the smoking behaviour of their parents and the perceived attitudes of their parents and friends towards smoking. Findings are discussed and suggestions are made for further research.

Delivering cognitive behavioural therapy in community services for people with learning disabilities: difficulties, dilemmas, confounds

This case study describes an attempt to use cognitive behavioural therapy (CBT) to treat anger problems in a young man with mild learning disabilities. The skills necessary to engage in CBT were assessed in addition to an assessment of support available, motivation to engage in therapy and belief in ability to make changes. Despite this assessment environmental factors undermined the therapy, which was not completed. Some of the difficulties and dilemmas involved in delivering CBT in ‘ordinary’ community services are discussed, concluding with learning points for consideration by other practitioners.

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.

Autism spectrum disorder and underlying brain mechanism in the oculoauriculovertebral spectrum

As part of a multidisciplinary study, the rate of autism spectrum disorder (ASD), learning disability (LD), and brain abnormalities was examined in 20 participants (12 males, 8 females; age range 8mo-17y, mean age 8y 1mo) diagnosed as falling within the oculoauriculovertebral spectrum (OAV). A neuropsychiatric examination was performed, including standardized autism diagnostic interviews. Two individuals met diagnostic criteria for autism, one for autistic-like condition, and five for autistic traits. Four patients had mild LD, three severe LD, two profound LD, and two borderline intellectual functioning. Neuroimaging indicated cerebral abnormalities in more than half of the patients. Abnormalities of white/grey matter were found in more than half of examined individuals; enlargement of ventricles in more than a third. Results indicate that at least a subgroup of ASD may be associated with errors in early embryonic brain development. Awareness of the coexistence of OAV/ASD is important in habilitation care of individuals with OAV.

Exploring the financial world, its meaning and barriers, for people with a mild learning disability

Exploring the financial world, its meaning and barriers, for people with a mild learning disability

Behavioural treatment of urinary incontinence and encopresis in children with learning disabilities: transfer of stimulus control

Urinary and faecal incontinence present a considerable problem in people with learning disabilities, despite the general effectiveness of behavioural techniques in continence training. Children with learning disabilities and obsessional behaviour may be particularly resistant to toilet training, even where relatively cognitively able, and often despite a substantial degree of control over their eliminatory functions. Their resistance may be more appropriately regarded as a challenging behaviour and their incontinence better explained by factors other than a simple failure to learn. A 'stimulus-control’hypothesis proposes that the child's nappy (diaper) /potty/underwear has developed strong stimulus control over the elimination response. This report describes three case studies in which treatment-resistant children, aged between 8 and 12 years, with mild or moderate learning disabilities, were successfully treated for nappy-dependent nocturnal encopresis or diurnal urinary incontinence. The children were routine case referrals for whom previous attempts to train bowel or bladder control had failed. Behavioural techniques, such as 'shaping’(gradually increasing the proximity to the toilet),‘fading’(reducing the presence of the nappy), and rewards for eliminating, effected successful transfer of stimulus control over elimination from nappy to toilet. Treatment times varied, depending on the degree of the child's obsession and resistance to change.

Modifying the Clinical Outcomes in Routine Evaluation measure for use with people who have a learning disability

Accessible summaryThis article looks at a simplified version of a widely used assessment tool called Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM). The main reason for carrying out this piece of research was to help people with a learning disability understand a simplified version of CORE‐OM, and help them tell people how distressed they were feeling. People with learning disabilities helped us test out the measure in different ways to see if it worked properly. We found one particular way worked really well, but we will have to check this out with more people to make sure. The people we tested found the simplified CORE‐OM very helpful; they also made some suggestions on how to make it better. We are enthusiastic about developing this, so other people with a learning disability can use the measure in the future. SummaryThere are few reliable self‐report measures suitable for people with a learning disability in reporting psychological distress. This study examines the modification of the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM), exploring its reliability, using two different presentation styles. One style included a sequencing task then use of a visual histogram scale to facilitate rating; the other prompted participants to indicate presence or absence of symptoms before using the histogram. The study was conducted on a small sample of people with mental health problems who have a mild learning disability. The modified CORE‐OM was found to have an excellent test–retest correlation with the group who completed the sequencing task, then the histogram scale, but the other group produced less favourable results. The preliminary results are encouraging, highlighting the need to conduct a larger study after further modifications of the measure.

Anger Management Group for adults with a mild learning disability: Evaluating efficacy of a CBT approach (including video and three-month follow-up)

Psychology and Nursing ran an Anger Management Group, using a CBT approach, on 15 consecutive weeks. Following this, each client received a video summarising relaxation and other coping strategies, and carers were briefed on using this resource. The group initially consisted of six adults having a mild learning disability, mixed gender, and ages ranging from 17 up to 43 years. Early on, three clients dropped out, but the remaining three attended well and provided positive feedback. Attendees were formally assessed in terms of anger, both directly and indirectly, at pre- and post-group and two were assessed at three month follow up. In support of the existing literature, the group showed improvement as a result of this CBT approach. In particular, their anticipated responses to pictured provoking scenarios improved. At three-month follow-up, where data was available, improvement was best maintained when the client received full-time support at home, including more encouragement to use the video. It is speculated that an ongoing ‘rolling programme’ may be a better investment of professional time and effort, in order that improvements in clients coping skills may be maintained more effectively.

This is my story: I've got cancer

Accessible summary This is the story of John Davies. John has learning disabilities. He has cancer. He tells his story in his own words. John found a lump on his penis (willie). It was cancer. He didn't go to the doctor. He left it too late. Now he is very ill with cancer. Maybe he will die of it. If he had gone to the doctor sooner, he could have got better. This is what John is telling you: If you find something wrong with you, you should tell someone. You should go to the doctor. We are doing a study. We want to find out what it is like to have cancer. We want to find out what helps people who have cancer. We are listening to their stories. There will be 20 people in our study. John is one of them. His story helps us to look after people with cancer better. SummaryAs people with learning disabilities live longer, and the incidence of cancer is rising, it is of increasing importance to understand the lived cancer experience of this group. Consideration of the viewpoints of people with learning disabilities themselves will facilitate the development of cancer support services that are appropriate and sensitive to their needs. This paper presents preliminary findings of an ethnographic study into the experiences of people with learning disabilities who have cancer. One of the study participants, John Davies (who has mild learning disabilities), relates his cancer experience in his own words. Having ignored his symptoms until it was too late, he now urges others to go to the doctor as soon as possible. The study is ongoing, but findings to date highlight the importance of listening to the story of people's lives and illness.

Respiratory failure due to morbid obesity in a patient with Prader-Willi syndrome: an experience of long-term mechanical ventilation

Prader-Willi syndrome (PWS) is characterized by obesity, mild mental retardation or learning disability, and behavior problems, especially in association with food and eating. A 19 year-old man, 150 cm, 140 kg (body mass index [BMI], 62.2 kg.m(-2)), whose condition had been diagnosed as PWS, received 41-day mechanical ventilation because of respiratory failure, chiefly due to morbid obesity. Because the patient frequently developed bronchoconstriction, metered-dose inhalers of a corticosteroid (beclomethasone dipropionate) and a beta2 agonist (salbutamol) were needed. To achieve adequate sedation, which was also crucial to control the bronchoconstriction, the concurrent use of midazolam, fentanyl, ketamine, and propofol was required. Pressure-control ventilation was useful to avoid high airway pressure due to low respiratory system compliance associated with the morbid obesity. Because it appeared that the basic problem leading to respiratory failure in this patient was morbid obesity, body weight reduction was considered to be mandatory. Thus, caloric intake was limited to 1000 kcal.day(-1), resulting in body weight reduction by 50 kg during the patient's stay in the intensive care unit (ICU). The patient was successfully extubated on ICU day 35.

Suggestibility and children with mild learning disabilities: The use of the cognitive interview

The aims of this paper were firstly to identify any differences in the level of suggestibility between 20 7–9-year-old children with mild learning disabilities and 20 children with average academic ability using the Gudjonsson Suggestibility Scale 2 (GSS2) and, secondly, to note the impact of the cognitive interview on the response patterns of children with mild learning disabilities. On the GSS2, average academic ability children recalled significantly more correct details than children with mild learning disabilities. There was no significant difference between the two groups of children on distortions, fabrications, total confabulations or on any of the four measures of suggestibility. In the second part of the study, 38 children with mild learning disabilities watched a filmed event and then were interviewed using either a standard or a modified version of the cognitive interview. Following this, all participants were asked specific questions, some of which incorporated misleading information. One week later each participant was re-questioned. This time critical questions were included about the truth of the presuppositions introduced in the initial interview session. It was found that the cognitive interview elicited significantly more correct and incorrect details than a standard interview with no significant difference in fabrications. Use of the cognitive interview did not significantly affect susceptibility to subsequent misleading suggestions.

Scope for more genetic testing in learning disability

There have been major advances in the past few years in our understanding of the X-linked learning disabilities. The most common of these is the fragile-X syndrome, but the number of other gene defects that are now recognised to be linked with learning disability is increasing year on year. We describe one family displaying a family displaying a rare X-linked abnormality. Repeat genetic testing was requested for a family member with mild learning disability when, following chromosomal analysis for her brother, it became known that he had a genetic defect. The genetic defect 46, Xdup(X) (p22.13 p22.31) was identified. To our knowledge this is the first time this precise configuration has been demonstrated. We conclude that genetic testing for individuals with learning disability is worthwhile, even when there may be only a low index of suspicion.

Cytogenetic and genetic evidence supports a role for the kainate-type glutamate receptor gene, GRIK4, in schizophrenia and bipolar disorder

In the search for the biological causes of schizophrenia and bipolar disorder, glutamate neurotransmission has emerged as one of a number of candidate processes and pathways where underlying gene deficits may be present. The analysis of chromosomal rearrangements in individuals diagnosed with neuropsychiatric disorders is an established route to candidate gene identification in both Mendelian and complex disorders. Here we describe a set of genes disrupted by, or proximal to, chromosomal breakpoints (2p12, 2q31.3, 2q21.2, 11q23.3 and 11q24.2) in a patient where chronic schizophrenia coexists with mild learning disability (US: mental retardation). Of these disrupted genes, the most promising candidate is a member of the kainate-type ionotropic glutamate receptor family, GRIK4 (KA1). A subsequent systematic case-control association study on GRIK4 assessed its contribution to psychiatric illness in the karyotypically normal population. This identified two discrete regions of disease risk within the GRIK4 locus: three single single nucleotide polymorphism (SNP) markers with a corresponding underlying haplotype associated with susceptibility to schizophrenia (P=0.0005, odds ratio (OR) of 1.453, 95% CI 1.182-1.787) and two single SNP markers and a haplotype associated with a protective effect against bipolar disorder (P=0.0002, OR of 0.624, 95% CI 0.485-0.802). After permutation analysis to correct for multiple testing, schizophrenia and bipolar disorder haplotypes remained significant (P=0.0430, s.e. 0.0064 and P=0.0190, s.e. 0.0043, respectively). We propose that these convergent cytogenetic and genetic findings provide molecular evidence for common aetiologies for different psychiatric conditions and further support the 'glutamate hypothesis' of psychotic illness.

Working with a man with mild learning disabilities: Solution-focused and narrative approaches

This article describes the psychological work I carried out with ‘Robert’, a young man with mild learning disabilities. Robert was referred to Psychology in a Community Health Team for People with Learning Disabilities by his GP. The referral letter stated that Robert’s mother was worried about his mood swings, and finding it increasingly difficult to cope with him. Robert chose to attend individual psychology sessions. Using solution-focused and narrative approaches, psychological intervention initially concentrated on what Robert had identified as his main concerns: his anxiety around meeting new people, making friends and engaging in activities with them. Robert’s emotions, as well as some of the family conflicts that had prompted his mother’s visit to the GP, were later explored. At therapy termination, Robert reported having gained confidence in his ability to manage some of his painful feelings, as well as some of the difficulties at home and in his social life. As he decided he no longer needed input from Psychology, I discharged him from the service.Drawing on solution-focused, narrative and cognitive behavioural models, this article explores the referral, assessment, formulation, intervention, and evaluation stages of the work I conducted with Robert. A number of reflective practice points are provided at the end, to encourage discussion amongst practitioners in the field.

Understanding of basic financial concepts among adults with mild learning disabilities

In the context of recent legal and social policy developments, which encourage clinicians to support vulnerable adults in making their own financial decisions, we explored understanding of basic financial concepts among adults with mild learning disabilities. Using the literature about typically developing children, five measures entailing identification and ordering tasks were devised and were used to examine understanding of quantity, numbers and money among 30 men and women using specialist clinical services (mean FSIQ = 61.80; SD=10.59). The concept of quantity was easier to understand than those of numbers and money, and task difficulties increased with the magnitudes involved. The different types of conceptual understanding were closely related. These measures may be useful for analysing difficulties in, and informing interventions to maximize, independent financial decision making.

‘Are you allowed to say that?’ using video materials to provide accessible information about psychology services

SummaryThe White Paper ‘Valuing People’ [Department of Health (DoH) (2001)Valuing people: a new strategy for learning disability for the 21st century, London, HMSO] indicates that people with a learning disability need to become more actively involved in the decisions that affect their lives. This includes being offered active choices in access to health services. Psychologists, therefore, need to think about how to give people with learning disabilities enough relevant information in an accessible way to promote informed consent to treatment. This study investigates how much information adults with mild and moderate learning disabilities understand about psychology services, before and after watching a video designed to explain what seeing a psychologist entails. The video was shown to 19 participants at a local Social Education Centre. Participants’ knowledge increased significantly after watching the video. They were able to answer questions about its content better when asked after short sections of the video when presented, rather than after an uninterrupted presentation.

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.

Ocular Findings in Gillespie-Like Syndrome: Association with a New PAX6 Mutation

Background: Gillespie syndrome is a rare variant form of aniridia, characterized by mental retardation, nonprogressive cerebellar ataxia, and iris hypoplasia. Unlike the more common dominant and sporadic forms of aniridia, there have been no associated PAX6 mutations or Wilms' tumor reported in Gillespie syndrome patients. Ocular findings in 21 cases published since Gillespie's initial description in 1965 include iris and foveal hypoplasia, nystagmus, and small optic discs with pigmentary retinopathy. Case report: We herein report a case of atypical Gillespie syndrome associated with bilateral ptosis, exotropia, corectopia, iris hypoplasia, anterior capsular lens opacities, foveal hypoplasia, retinal vascular tortuosity, and retinal hypopigmentation. Neurologic evaluation revealed a mild hand tremor and learning disability, but no ataxia or cerebellar abnormalities on neuroimaging. Sequencing studies revealed a substitution in intron 2 of the PAX6 gene (IVS2 + 2T > A). To our knowledge, this is the first mutation of PAX6 gene reported in association with a Gillespie-like syndrome.