Associated problems
Please refer to the relevant help screen if any of these are present.
Physical disorders
Serious physical disorders are more common as the severity of learning disability increases. People with severe learning disability usually have one or often several of these problems. People with mild learning disability may have similar problems but these occur less frequently.
The presence of physical disorders tends to increase the overall level of disability.
The most important physical disorders are:
- Visual impairment - Severe visual impairment is present in 8% of people with severe learning disability and 5% of people with mild learning disability.
- Hearing impairment - Severe hearing impairment is present in 9% of people with severe learning disability and 4.5% of people with mild learning disability.
- Motor disabilities - These include spasticity, ataxia [unsteadiness] and abnormal movements.
- Abnormal movements - Abnormal movements including head banging and rocking are common in people with severe learning disability, occurring in 20% of adults. Although they may be due to motor pathology, in the majority they are due to behavioural problems.
- Epilepsy - Epilepsy is common among people with learning disability, especially those with severe learning disability. It occurs in approximately 22% of people with learning disability compared to 1% of the general population.
People with learning disability often have the same types of epilepsy that occur in the general population. However, severe and mixed epilepsy syndromes are more common.
Also, there are some specific types of epilepsy associated with specific syndromes, for example “infantile spasms” or “salaam attacks.” These are associated with West’s syndrome, which is a form of myoclonic epilepsy with onset in infancy or early childhood. It is characterised by seizures involving the muscles of the neck, trunk and limbs with nodding of the head and flexion and outward movement of the arms. Learning disability is associated in most cases.
Some epilepsy syndromes tend to improve with age but others may worsen, especially if there is an associated neuro-degenerative disorder, for example Tay Sachs disease (See other syndromes).
Psychiatric disorders
Psychiatric disorders are reported to be more common in people with learning disability than in the general population. Estimates vary due to difficulties in definition and recognition but it is thought that up to one third of people with a learning disability also have mental health problems.
People with learning disability experience psychiatric disturbances similar to those affecting the general population. However the symptoms are often greatly modified by low intelligence. The person with learning disability may not be able to clearly communicate psychiatric symptoms and therefore more emphasis has to be given to the behavioural effects of the psychiatric symptoms.
- Schizophrenia - This affects approximately 3% of people with learning disability compared to 1% of the general population. Poverty of thinking is common, delusions tend to be less elaborate and hallucinations have a simple repetitive content.
- Depression - People with learning disability are less likely to complain of symptoms of depression than people in the normal population and the diagnosis has to be made on the appearance of sadness, changes in appetite and sleep and behavioural changes of retardation or agitation.
- Anxiety disorders - Adjustment disorders are common in people with learning disability, occurring when there are changes to life routine. Anxiety disorders are common especially at times of stress. Phobic disorders also develop but are often overlooked. Obsessive-compulsive disorders are more common than in the general population.
- Eating disorders - Anorexia and bulimia are less common in people with learning disability than in the general population. However overeating and unusual dietary preferences are common.
- Personality disorders - These are common in people with learning disability but they are difficult to diagnose and may lead to increased difficulties with management.
- Dementia - Dementia affects people with learning disability at a younger age than the general population. A progressive decline in intellectual and social functioning may be the first manifestation of dementia. As the life expectancy of people with learning disability is increasing, dementia in later life is becoming more common. There is a particular association between Downs Syndrome and Alzheimer’s disease.
Other problems
Behavioural disorder/problems [Challenging behaviour]
This is behaviour that impairs the physical safety of the person or others or makes participation in the community difficult. It affects about 15% of adults with learning disability. The causes are multi-factorial and include difficulties in communication, side effects of medication and psychiatric disorders.
The following behaviours are likely to be associated with severe disability:
- Threatening and violent behaviour including assault and verbal abuse
- Self injury, for example biting and head banging
- Disinhibition, for example self - exposure
- Damage to property
- Putting oneself at risk, for example running into the road without warning
- Refusal to comply with person assisting with activities of daily living
- Forensic problems - People with learning disability have a higher rate of criminal behaviour than the general population. The causes are multi-factorial and include family influences, environment, impulsivity, suggestibility and exploitability. Among the more serious offences, arson and sexual offences (usually exhibitionism) are said to be particularly common.
- Sleep disorders - Serious sleep disorders are common among people with learning disability. They are associated with subsequent behavioural disorder and a worsening of cognitive function and can cause considerable distress to the person and their carers
Amended April 2008
