1. Causes and manifestation of learning disability

2. Demographics “A lack of consensus of definition and understanding of what is meant by ‘multiple and complex needs’, which makes quantifying the prevalence of multiple and complex needs difficult” Varies in studies from 4-16% Office of Population Censuses and Surveys 1985 -1989 Approximately 1-3% of pop. 1980 476 000 2005 770 000 Family Resource Survey Disability Discrimination act 2004/05 estimate 7.3% (952 741)

3. Presentation of disability Post head injury/infection RTA, NAI or meningitis In early years Developmental delay Antenatally or at birth Scan or bloods

4. Antenatally or at birth Genetic Inborn errors of metabolism Fragile X syndrome Muscular dystrophy http://www.cafamily.org.uk/index.html Birth defects Prematurity 1980 43/1000 2004 48/1000 Cerebral palsy

5. What is affected by delay Gross/fine motor skills Speech and language development Cognition Social/personal activities of daily living Adaptive Behaviour

6. Development is predictable Sequential trends Developmental pace Sensitive periods Relatively slow !!!

7. Development is global Physical Brain Height and weight Physiological changes Fine and gross motor Language Intellectual and social Personality Cognitive Personality Temperament

8. Best web site SIX MONTHS (approximately) Able to lift the head. Handles large objects by banging them, bringing them to the mouth. Can balance the head. Can sit supported in a chair. Splashes with his hands and feet in the bath. Enjoys being bounced on the knee. ONE YEAR (approximately) Can walk unaided (mostly unstable). Is able to stand balanced on both feet. Is able to turn around while standing. Enjoys climbing. Can sit unaided. Can roll a ball back and forwards. Likes to throw things. Enjoys waving “goodbye”. Beginning to enjoy rhythmic movements. http://www.sabceducation.co.za/portal/site/menuitem.7eafe07f2449143351de adb25401aeb9/

9. Brain Short bursts of growth At birth 20% of body weight adult 2% When do you think most rapid growth is ? Synaptogenesis Neural pathways Repetition of action or behaviour Myelination Maturation of nerve supply

10. Hearing Babies can hear in the womb More attuned to high pitch Loudness Localise sound

11. Language Physical and neurological structures language comprehension, language expression and speech Linked to neurological and cognitive development Broca’s and Wernicke’s area

12. Language Speech development varies Environmental circumstances Critical period 18/12 to 4 years http://www.childrenshospital.org/az/Site1626/mainpageS1626P0.html

13. Assessment Multiprofessional assessment Doctor Physiotherapist Psychologist Nurse Global assessment of physical and psychological development Dysmorphic features Family history GDD epilepsy autism seizures Investigations Genetics and metabolic testing EEG MRI Hearing and sight test

14. Impact on parent Diagnosis Very important to families Attachment Depending on age and relationship of parent and child Resolution To be discussed in more depth

15. Impact on communication The commonest and least treated disability' amongst people with learning disabilities is communication disorders (Hallas et al., 1982) 89% had communication difficulties which 'required speech therapy‘ (Noble, 1990). Parents and youth with learning disabilities: perceptions of relationships and communication. Journal of Learning Disabilities. (Heiman T. Zinck LC. Heath NL. 2008. 41(6):524-34.) Analogical problem solving in children with verbal and nonverbal learning disabilities. Journal of Learning Disabilities. (Schiff R. Bauminger N. Toledo I. 2009. 42(1):3-13.)

16. Conclusion Complex process of development Diagnosis can be difficult to obtain Communication affected

17. References Blackburn C et al 2010. Prevelence of childhood disability and the characteristics and circumstances of disabled children in the UK: secondary analysis of the Family Resources Survey. BMC Pediatrics 10:21 Fink et al 2008. A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication. Journal of Clinical Nursing 17, 2102–2115 Gordon, D., Parker, R., Loughran, F. and Heslop, P. 2000 Disabled children in Britain: a reanalysis of the OPCS disability surveys. London: Stationery Office Norman J et al 2009. The Effect of Changing Patterns of Obstetric Care in Scotland (1980–2004) on Rates of Preterm Birth and Its Neonatal Consequences: Perinatal Database Study public library of science Shevell M et al. 2003. Practice parameter: Evaluation of the child with global developmental delay Report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. American Academy of Neurology. 60;367- 380. Williams J. 2006. Learning from mothers: how myths, policies and practices affect the detection of subtle developmental problems in children. Child: care, health and development,33, 3, 282–290. www.cafamily.org.uk/index.html About families with disabled children - UKwww.cafamily.org.uk/index.html