The Link Between Learning Disabilities and Behavior - Dissertation Example

RESEARCH PROPOSAL Introduction And Research Question To explore the link between obsessed episodes of agitated behavior and hyperactivity in people with learning disabilities. The main aim of this research is finding a connection between hyperactivity and obsessed interests in people with learning disabilities. There are higher chances of occurrence of epilepsy, in people with a learning disability. In people with severe learning disability, 50% of them have epilepsy. There must definitely be a link between hyperactivity and agitated behavior in people with learning disabilities, because people with both epilepsy and learning disabilities show symptoms of underlying brain dysfunction in a person. If I can show that there is a link between all these symptoms, it would be very helpful to people having these symptoms. Finding the link can also be very helpful to, all people who are dealing with these learning disabilities, like doctors, nurses, parents and teachers. It will help them to give better and innovative treatment to the patients, and teachers will be more aware of a student's behavior in class, parents can also prepare the students better by building their self-esteem. The above symptoms may also found in people suffering with autism. Autism is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs). Autism is characterized by impaired social interaction, problems with verbal and nonverbal communication, and unusual, repetitive, or severely limited activities and interests. Finding a link between all this symptoms, would be helpful to may people suffering from different types of diseases. Literature Review And Related Research: Many people are not aware of the difficulties faced by the patient undergoing these symptoms. Many people don't have any knowledge regarding these characteristics in a patient; they don't know anything about the condition of patients with learning disabilities and hyperactivity, leave alone the link between these disorders. The present scenario is such that people are researching on individual topics be it autism, autism spectrum disorder epilepsy, Attention Deficit hyperactivity disorder, learning disabilities, phobias etc., but nobody is trying to find the link between all these disorders. Therefore I strongly recommend that more and more people take up such topics for their research, which will be very helpful to people with all these disorders. The main basis for my study would be to help people, taking this case for eg. A particular person has a moderate learning disability and has tuberous sclerosis. His health needs are as follows: He has epilepsy and his seizures over the last six months have become more frequent. The type of seizures he has is complex partial and he is prescribed sodium valproate by his G.P. He has been diagnosed of autistic spectrum disorder. He has frequent paranoid episodes and associated agitated behaviour with hyperactivity. If I can show that there is a link between all the above characteristics, it would be helpful to people like him, nurses and other professionals dealing with learning disabilities. According to the literature review done by National institutes of health, a service of the national library of medicine, a marked prevalence of mental health dysfunction in childhood epilepsy has been documented in the literature. While several individual risk factors have been identified, which are statistically associated with an impaired mental health outcome, there is a lack of knowledge on the pathways taken by these risk factors on development of the disease and treatment. Thus, the appearance of mental health dysfunction in childhood epilepsy is analyzed under three levels. Pathogenetic causes: These involve both the underlying CNS pathology and the associated epilepsy disorder characterized by specific time of onset duration type and severity. Mediators and moderators connecting causes to outcomes. This encompasses three major domains: risks for learning disability, for impairments of health-related quality of life, and for psychopathology. The proposed framework serves the development and validation of hypotheses and can be applied to testing procedures aimed at investigating the emergence of mental health dysfunction in childhood epilepsy. On the scientific level, it provides an appropriate tool to approach childhood epilepsy in general, whereas on the clinical level, it facilitates the assessment and management of individual patients. Taking into context different literature reviews done by, Leicestershire Child and Adolescent Mental Health Service, Leicester, UK., autism as a concept has developed over the past 50 years. It also appears that the prevalence of autism is increasing. Fombonne (1999), in his meta-analysis, showed an overall median rate for autism of 5.2/10 000 but studies over the past 10 years have shown a median rate of 7.2/10 000. It is not known if this increased rate is due to a true increase in incidence or to an increased awareness. A previous study by the authors showed a rate of 7.7/10 000 (Morgan et al, 2002). The link between learning disability and autism was recognized in the early descriptions of the condition; more recent studies have quantified this relationship, suggesting that four out of five individuals with autism have a learning disability (Wing and Gould 1997), Individuals with autism can also be diagnosed with other psychiatric conditions: DeLong & Nohria (1994) have suggested that autistic spectrum disorders may be related etiologically to bipolar affective disorder, and Bolton et al (1998) suggested a possible link to affective disorders. Research on people with both learning disabilities and autism are challenging because it is difficult to separate the deficits caused by autism from those due to a learning disability. The other consideration is that the presentation of psychiatric symptoms is changed by the presence of autism and learning disabilities. Recognition of the impact of learning disabilities in changing the symptoms of psychiatric illness has led to the development of specific psychiatric diagnostic criteria for those with a learning disability (DC-LD; Royal College of Psychiatrists, 2001). Taking into view the association between learning disabilities and autism, and autism and affective disorders, my aim was to study the link between agitated behavior and hyperactivity in people with learning disabilities. The study population was identified in a two-stage method. Firstly, adults with learning disability attending any social, voluntary sector, private sector or National Health Service (NHS) service within an urban NHS Trust area, were screened for pervasive developmental disorders using the Pervasive Developmental Disorder Mental Retardation Scale. The screening tool devised by Kraijer (1997) has 12 items and looks at behavior in the past 2-6 months, as rated by a parent or corer. It is designed to be used in all levels of learning disability and from 2 to 55 years of age. The PDD-MRS identified 153 positively tested individuals. All were found, on clinical examination by a learning disability consultant psychiatrist, to meet the ICD-10 (World Health Organization, 1992) criteria for autistic spectrum disorder. Of the 27 people identified as borderline with the PDD-MRS, 18 were clinically confirmed to have an autistic spectrum disorder by meeting the ICD-10 criteria. Thus, 171 clients with autistic spectrum disorders were identified from 571 adults screened. Because the initial screening took 2 years, seven clients were lost to follow-up, leaving 164 clients. The 400 adults without a diagnosis of autism were used as a control group for prevalence rates of major psychiatric illness. Additional data were collected from psychiatric case notes. As well as basic demographic data, information was collected on recorded medical and psychiatric co morbidity and current medication on a set day, the psychiatric diagnoses in the medical notes being based upon ICD-10 criteria. The level of learning disability was based on the information recorded in the clinical summary sheet contained in individual clinical notes. A total of 164 adults were identified with a diagnosis of autistic spectrum disorder. The overall female: male ratio was 1:1.25, which is similar to other studies on the gender ratio of autism, although gender ratios for autism vary widely. Of the study group identified, 57% had severe, 31% had moderate and 12% had mild learning disability. Most of the sample with autistic spectrum disorder did not have a definitive cause for their learning disability recorded, but of those whose diagnoses were known, 11 had Down's syndrome, two had tuberous sclerosis and one each had metachromatic leucodystrophy, fragile-X syndrome, Cornelia de Lange syndrome and phenylketonuria. The prevalence rates for psychiatric morbidity were: 41% within the whole sample; 65% in people with mild learning disability; 35% in those with moderate learning disability; and 40% in those with severe learning disability. People with severe learning disability accounted for 53% of all the psychiatric morbidity within the total sample Using the screened individuals who did not have autism as a control group, significantly larger than expected lifetime prevalence rates of depression (20% v. 2.75%) and bipolar affective disorder (11% v. 1.75%) were found. Schizophrenia (5% v. 5.25%) did not show a significant difference, even when compared with the higher published population rates in people with learning disabilities. A rate of 2% for Tourette syndrome appeared high, but no comparison prevalence rates in learning disability were identified in a literature search. As would be expected in this sample, with a large number of people with severe and moderate learning disability, there was a high prevalence of epilepsy (34%). In the sample, 50% of the individuals were on at least one psychotropic medication and were on more than one. Of the 87 individuals on neuroleptics, 35 did not have an additional psychiatric diagnosis. This study shows a high rate of psychiatric disorder among those with a diagnosis of autistic spectrum disorder, the largest rate being in the group with mild learning disabilities. A possible explanation is that this group has higher abilities that are proportionately more disabled by their autistic features and they are therefore more likely to develop psychiatric illnesses. Alternatively, psychopathology in those with more severe learning disabilities could be more likely to be attributed to the learning disability than to a psychiatric illness. A surprising finding was the 10% prevalence of hypothyroidism, which is statistically significant compared with a general adult population rate of 1% or less. Overall, 52% of autistic individuals were on psychotropic and 40% of those had autistic disorder as the sole psychiatric diagnosis. Clarke et al found that 36% of learning disabled individuals who did not have a diagnosis of psychiatric illness received psychotropic medication, suggesting that the main indication for the use of psychotropic medication in these people was behavioral disorder. It is therefore assumed in our study that the medication was used to reduce behavior associated with autism, such as stereotypy and aggression. Because neuroleptic medications appear to be used extensively for the treatment of behavioral difficulties with autism, there is clearly a need to study this further. Significance of the Proposal After the literature review and all other studies, it is a necessity for people with learning disabilities to use medications for further improvement. These people also need enough love, care and assurance from others, to seem them through this. By using proper psychotropic medication we can reduce a patients stereotypy and aggression, which are the main symptoms of autism. And using neuroleptic medications could be affectively used for behavioral difficulties in autism. People will have a better understanding regarding. Patients can be forewarned about the effects of, anti-epileptic medication in epilepsy. Epilepsy may also impair a persons cognitive functioning (mental process of learning, thinking and knowing). Difficulties encountered by people with learning disabilities are mostly due to the brain damage that caused the epilepsy, than the epilepsy itself. If the seizures are properly controlled, and the drug regime is simple, further cognitive difficulties are lesser. Proper therapies and behavioral interventions can be designed to remedy specific symptoms, which can bring about substantial improvement. The ideal treatment plan should coordinate therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better. Therapists can use highly structured and intensive skill-oriented training sessions to help patients develop social and language skills. Family counseling for the immediate family of the patient with autism often helps families cope with the particular challenges of living with an autistic person. People will be more sensitized about this issue. Patients may be given anti-psychotic medications treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity. Research Methodology Study Population My main strategy will be to create awareness among the public regarding these disorders. Conducting surveys, interviews, going to various schools and colleges, advertising in the print and online media, group discussions and online surveys. We can reach out to people through any of these channels and get them more sensitized to such situations. Type Of Data Collected Autism, attention deficit disorder with hyperactivity and without it (ADHD/ADD), dyspraxia, dyslexia, various behavioral and learning problems in children and adults, allergies, asthma, eczema - all have reached outbreak proportions. We can hardly meet a child who presented with just one of the above conditions. Every child has two, three or more of these health problems at once. A large percent of allergic and asthmatic children are dyspraxic and hyperactive to various degrees. Many of them have problems with concentration and attention span, which affect their learning ability. There is an approximate 50% overlap between dyslexia and dyspraxia and a 30 - 50% overlap between ADHD and dyslexia. Children who suffer severe eczema in infancy quite often develop autistic features later in life. Data Analysis After the above analysis, we are surer that there is definite link between behavioral problems, hyperactivity, learning disabilities and all other types of ailments. We should ask ourselves what underlying problem are we missing in our children which makes them susceptible to asthma, eczema, allergies, dyspraxia, dyslexia, behavioral problems, ADHD and autism in different combinations We will be surprised to know that every other child or an adult with autism, ADHD/ADD, asthma, eczema, allergies, dyspraxia or dyslexia, have certain digestive abnormalities. In many cases they are so severe, that the patients or their parents to start talking about them first. In some cases the parents may not mention their child's digestive system, yet when asked direct questions would describe a plethora of gut problems. One may ask, what have digestive abnormalities got to do with autism, hyperactivity, inability to learn, and mood and behavior problems But according to recent research and clinical experience, in fact it appears that the patient's digestive system holds the key to the patient's mental state. Gut And Psychology Syndrome (GAP Syndrome) establishes the connection between the gut and the brain. Apart from childhood learning disabilities: autism, ADHD/ADD, dyslexia, dyspraxia and various learning and behavioral problems, there are a group of other conditions which fit into the GAP Syndrome. These conditions are schizophrenia, depression, manic depression or bipolar disorder and obsessive-compulsive disorder. Patients can be treated by using a sound nutritional program. Research Designed The National Institute of Neurological Disorders and Stroke (NINDS) is one of the federal government's leading supporters of biomedical research on brain and nervous system disorders. As part of the Children's Health Act of 2000, the NINDS and three sister institutes have formed the NIH Autism Coordinating Committee to expand, intensify, and coordinate NIH's autism research. Eight dedicated research centers across the country have been established as "Centers of Excellence in Autism Research" to bring together researchers and the resources they need. The Centers are conducting basic and clinical research, including investigations into causes, diagnosis, early detection, prevention, and treatment, such as the studies highlighted below: Investigators are using animal models to study how the neurotransmitter serotonin, establishes connections between neurons in hopes of discovering why these connections are impaired in autism Researchers are testing a computer-assisted program that would help autistic children interpret facial expressions A brain imaging study is investigating areas of the brain that are active during obsessive/repetitive behaviors in adults and very young children with autism Other imaging studies are searching for brain abnormalities that could cause impaired social communication and learning disabilities in children with autism Clinical studies are testing the effectiveness of a program that combines parent training and medication to reduce the disruptive behavior of children with autism and other ASDs Study Setting Studies are needed to identify and define learning disabilities and their subtypes. Teachers need pre-service and in-service instructions to recognize children at risk and to appropriately respond to their needs. Parents should be provided with or directed to instruction and education that will enable them to effectively respond to their child's needs. Parents must meaningfully participate in development of their child's individualized education program, and must be part of a comprehensive home-school service delivery package. The program should address risk and prognosis as well as diagnosis and current status. The program should also address the need for intervention strategies and should evaluate household and peer relationships in terms of service delivery potential. Successful educational policies require the commitment of administrative personnel. Top-down support is necessary for successful implementation of innovative service delivery strategies. Interventions must redirect dysfunctional patterns in the home and in peer groups and avoid problematic social situations. Interventions should represent, in the home and at school, ethics, problem solving, decision-making, conflict resolution, social skills, and nonverbal competency. Conclusion Most of the treatments like behavioral techniques help in education and medication might be very effective. But certain other treatments like psychological treatment and use of some particular medicines are being used amidst controversies. Such treatments should have the necessary approval of the concerned authorities. This might seem to be a very small problem, to a person seeing from the outside, but one should respect the feelings and the turmoil a person suffering with these symptoms is undergoing. Patients with such disabilities will have very complex needs and will require specialized treatment packages to enable them to develop their full potential. There are a number of controversial therapies or interventions available for autistic children, but many few, are supported by scientific studies. Parents should use caution before adopting any of these treatments. Children with such symptoms can be high achievers and can be taught different ways to get around the learning disability. With the right help, children with a learning disability can and do learn successfully. Most Doctors agree that the earlier the involvement, the better it will be for patients with these symptoms. References Psychiatric co morbidity and medication use in autism: a community survey, viewed on 30 November 2006. http://pb.rcpsych.org/cgi/content/full/27/10/378. National Institute of Neurological Disorders and stroke, viewed on 30 November, 2006. http://www.ninds.nih.gov/. The Link Between Learning Disabilities And Behavior, viewed on 30 November, 2006. http://www.emersondickman.org/ReadRoom/Articles/LinkBetLrn.htm. Foundation for people with learning disabilities, viewed on 30 November 2006. http://www.learningdisabilities.org.uk/page.cfmpagecode=ISCSEP. Learning Disabilities association of America, viewed on 30 November 2006. http://www.ldaamerica.org/aboutld/professionals/epilepsy_ld.asp. Gut and Psychology Syndrome, viewed on 30 November 2006. http://www.kiki-health.co.uk/products/supplements/gut_psychology.asp. Viewed 29 November 2006. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi Read More