LD is not an illness. It requires the presence of three criteria based on the definition derived from extensive consultation in the USA:
Medicines in learning disabilities
LD is not an
illness. It requires the presence of three criteria based on the definition
derived from extensive consultation in the USA:
·
a significant developmental intellectual impairment
·
concurrent deficits in social functioning or adaptive
behaviour
·
the condition is manifest before the age of 18 years.
Significant LD is
usually defined as an intelligence quotient (IQ) more than two standard
deviations below the general population mean (originally fixed at 100). This is
an IQ below 70 on recognised IQ tests. Two per cent of the population have an
IQ below this level. Significant deficits in social functioning are in
communication, daily living skills, socialisation and motor skills.
The term
‘intellectual disability’ is used synonymously with ‘learning dis-ability’ (the
common terminology used in clinical practice in the UK), mental retardation
(used in the International Classification of Illnesses) and mental handicap
(used in the UK until 1994).
People with LD have
significantly more health problems than the rest of the population. Around 50%
have a major psychiatric or behaviour problem requiring specialist help; 25%
have active epilepsy; at least 30% have a sensory impairment; and around 40%
have associated major physical dis-abilities of mobility and incontinence. Most
people with LD have communi-cation difficulties and a lack of supported
communication may compound their problems in receiving the healthcare that they
need. The substantial health needs of this population are often overlooked and
unmet.
Biological,
environmental and social factors may contribute to the devel-opment of LD.
Biological factors are present in about 67–75% of people with LD, the majority
operating before birth. The two most common genetic causes of LD are Down
syndrome and fragile X syndrome. In a third of people with LD, no primary
diagnosis can be made.
Medicines are widely
prescribed for people with LD. The medicines are broadly prescribed for four
problem areas:
1. epilepsy
2. challenging
behaviours
3. physical problems
4. mental illness.
In line with the
government intention to close all LD institutions and to discourage the
development of grouped housing, the management of people with LD has largely
been devolved to the private and voluntary sectors. However, many mental health
trusts (MHTs) remain responsible for the mental health aspects of care and, in
some places, retain treatment beds as well as having community team roles, although
such responsibilities are being transferred to local authority care.
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