Learning disabilities

There are thousands of causes of learning disabilities, and often the cause is unknown despite comprehensive assessment. People with learning disabilities have very high rates of physical and mental ill-health, and co-morbidity is typical. Some associated conditions are related to the causes of a person's learning disability (e.g. 'behavioural phenotypes'), and benefit from treatment interventions. Autism, attention deficit hyperactivity disorder (ADHD), schizophrenia, mania, pica and problem behaviours are all more common than in the general population, as are gastro-oesophageal reflux disorder, epilepsy, constipation, sensory impairments, and injuries and falls. Choking and aspiration are frequent and can cause death. Problem behaviours are multi-factorial, and can also be a symptom of other mental or physical disorders or distress. Assessments take longer, and must involve paid carers and relatives as well as the person with learning disabilities. There are other considerations in addition to the standard assessment and standard treatment plans. A biopsychosocial-developmental approach to both is a useful framework to adopt. Care needs to be taken to avoid 'diagnostic overshadowing', where symptoms of medical conditions are attributed inadvertently to the person's learning disabilities and left untreated. People with learning disabilities face many barriers in accessing the healthcare they need, and more proactive approaches by health professionals are required.