Associated Impairments

Mild learning disability is often an isolated disability; severe learning disability is often associated with other impairments that increase the level of disability. The frequency of these impairments increases as the level of learning disability increases. Associated impairments include -:

Physical

• Cerebral palsy is a general term used to refer to a set of neurological conditions, which affect a child's movement and coordination. Affected children have loss of voluntary movement, motor difficulties affecting walking and muscular tension/rigidity. They may have feeding problems and failure to thrive. Cerebral palsy is caused by damage to the brain, which normally occurs before, during, or soon after birth. It affects approximately 1 in 400 children, of whom 60% have an associated learning disability.
• Sensory impairments, of which visual impairments, especially squint and refractive errors are the most common, occur in more than half of children with severe learning disability and twenty five percent of children with mild learning disability. Hearing impairment is also common.
• Epilepsy occurs in about 20% of children with learning disability. Children 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. Some specific medical syndromes, known to be associated with learning disability, have particular types of seizure disorders within some of these syndromes.
• Motor impairments include spasticity, ataxia (unsteadiness) and abnormal movements.
• Abnormal movements including head banging and rocking are common in children with severe learning disability. Although they may be due to motor pathology, in the majority they are due to behavioural problems.
• Continence difficulties may well be experienced.

Psychiatric / Psychological / Behavioural

• The prevalence of mental health disorders in children with learning disability is 30 – 40%.
• The prevalence of challenging behaviour in people with learning disability varies across the range of severity of learning disability from 7% in mild learning disability to 33% in profound learning disability. The causes are multi-factorial and include difficulties in communication, side effects of medication and psychiatric disorders. It often impairs the physical safety of the child or others or makes participation in the community difficult. See ADHD / ADD guidance.
• Symptoms vary depending on the children and young person’s level of learning disability and ability to communicate. Children and young people with more significant learning disability may not be able to clearly communicate their experiences and therefore more emphasis has to be given to the behavioural effects of the disorder.
• The following behaviours are likely to be associated with more severe disabilities -:
• Threatening and violent behaviour including assault and verbal abuse;
• Self injury, for example biting and head banging;
• Disinhibition (being unable to control or suppress impulses to speak, act or show emotions), 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.
• Children and young people with learning disability often exhibit poor judgment and are more vulnerable to influence by others. They therefore need greater levels of supervision as they may be vulnerable to involvement in criminal activities.

Please refer to relevant guidance if these are present.