Learning Disability

The term ‘learning disability’ refers to a condition characterized by significant impairment in intellectual functioning. Individuals with a learning disability have difficulty understanding and learning new information, and generalising information to new situations. They also have limitations in two or more areas of adaptive skills, which may include communication, self-care, home living, social skills, self-direction, health and safety, basic schooling and work. These impairments and difficulties are present from childhood, and not the result of a head injury or accident.

Causes of learning disability include genetic factors, infection prior to birth, brain injury at birth, brain infections or brain damage after birth. Examples include Down’s Syndrome, Fragile X syndrome and cerebral palsy. However, in nearly one-half of people with learning disabilities the cause of the disability is unknown. A person’s deficits will vary depending on the nature and severity of their learning disability. Some people are able to lead independent lives with minimal support, while others are unable to look after themselves.

Learning disability used to be known as ‘mental retardation’ or ‘mental handicap’ in Bermuda and Britain, but is still referred to as ‘mental retardation’ in North America.

Mental health problems for people with a learning disability
A learning disability is not a mental illness. However, people with learning disabilities can experience the full range of mental health problems. In fact, mental health problems are more common among people with learning disabilities than in the general population.

Depression, manic-depressive illness and related conditions are the most common mental health problems experienced by people with learning disabilities, but psychotic disorders such as schizophrenia are also more likely in this population.

The degree to which individuals are disadvantaged or ‘handicapped’ by a learning disability is largely dependent on social and cultural factors. Historically, people with learning disabilities have been devalued and misunderstood. They commonly experience prejudice and stigma, repeated experiences of failure, and are often labelled or treated like children. All of these factors may contribute to psychological problems. Social consequences of the learning disability, such as having less control over their lives compared to their peers, and having difficulty finding socially valued employment, may lower self-esteem and contribute to the increased risk of experiencing psychological problems.

Identification and assessment of mental health problems
Identifying mental health problems in people with learning disabilities can be difficult. People with learning disabilities may not recognise their ´symptoms´ as a problem they should see a doctor about. In addition, depending on the severity of the disability, a person’s verbal skills may be limited or absent, making it difficult to communicate how they are feeling to family, friends, caregivers and/or doctors.

Family and caregivers play an important role in the assessment process by providing important background information and observations of changes in the individual’s behaviour and mental state. However, caregivers may not realise the significance of symptoms, or may not think the symptoms are severe enough to warrant medical attention. Some useful indicators are disturbances in appetite; sleep patterns, level of arousal, sexual behaviour, and interest in pleasurable activities.

Getting help
Treatment approaches with books, photographs, pictures or drawings may help individuals with learning disabilities recognize, understand and express their feelings better than words alone. For some individuals, treatment may need to concentrate on the quality of a person’s environment and their ability to interact with that environment.

Medical treatment may also be necessary, depending on the nature and severity of the problem. The prescribing doctor, usually the general practitioner (GP), will monitor the treatment’s effectiveness with regular appointments and will advise when to stop the medication.

If people with a learning disability (or their family members or caregivers) have concerns about their mental health, they can contact their GP, who may refer them to the Learning Disability Service at St Brendan’s Hospital (236-3770, ext. 3296) for specialist advice and help.

Robyn Montarsolo completed her postgraduate training in Australia and has been with Bermuda Hospitals Board for one year. She is employed as a clinical psychologist working with adult clients in both the Learning Disability and Turning Point Programmes at St. Brendan´s Hospital.

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