Medicines in learning disabilities

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.