SHANK2 gene linked to learning disabilities and autism

Variations in a gene called SHANK2 could be linked to both learning disabilities and autism. Researchers from Heidelberg University Hospital studied 396 people with autism and 184 with learning disabilities. They found more variations in the gene in people with learning disabilities and autism none of which were present in an unaffected control group. The gene is partially responsible for linking nerve cells together via synapses.

You can find out more about this research at

http://www.sciencedaily.com/releases/2010/05/100525103933.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

CBT and learning disabilities

People with learning disabilities suffer from mental-health problems as much as, if not more than, other people. Cognitive behaviour therapy has been found to be effective for a number of different mental-health problems but it is unclear whether people with learning disabilities are able to grasp the links between thoughts, feelings and behaviour that they need to understand in order for the therapy to be effective. Researchers from the University of East Anglia and Norfolk Primary Care NHS Trust looked into this issue in a study of 34 adults with learning disabilities. 18 of them were given training in distinguishing between thoughts, feelings and behaviours and in linking thoughts and feelings while the rest of the participants went to a relaxation class. The study found that the training led to significant improvements in the particpants' abilities to link thoughts and feelings, skills that could then be applied to new situations. However, the training had no effect on the participants' ability to distinguish between thoughts, feelings and behaviour.

Bruce, Melanie ... [et al] - Does training improve understanding of core concepts in cognitive behaviour therapy by people with intellectual disabilities? A randomized experiment British Journal of Clinical Psychology March 2010, 49(1), 1-13

Genes, violence and learning disabilities

Between fifteen and twenty per cent of people with learning disabilities have behaviour problems. Researchers from Vanderbilt University in Tennesee have been looking at how genetics might play a part in this. They looked at a gene linked to a substance called monoamine oxidize A (MAOA) which in turn regulates the neurotransmitters serotonin (linked to appetite and mood) and norepinephrine (linked to the 'fight-or-flight' response). Previous studies have linked a variation in this gene to violent behaviour. The researchers studied 105 men between the ages of 18 and 50. Some had learning disabilities and a history of violent behaviour, others had learning disabilities but no history of violent behaviour while the remainder formed a control group of men with no learning disabilities and no history of violence. The researchers found that 43% of those with learning disabilities and a violent past had the gene variation compared to only 20% of the other two groups.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/07/090721122855.htm

Behavioural problems, developmental difficulties and mothers' stress

Researchers at the University of Washington's Autism Center compared stress levels in the mothers of children with autism to those in the mothers of children with developmental delay. They studied 73 mothers and their children. 51 of the children had autism and 22 had developmental delays. The mothers filled out questionnaires about their stress levels and their children's developmental progress. They found that the mothers of children with autism had higher levels of stress. Problem behaviour was associated with higher levels of stress among both sets of mothers but this relationship was stronger in the mothers of autistic children. There was no link between children's levels of daily-living skills and maternal stress suggesting that it was the children's behaviour problems not their developmental difficulties which were stressing the mothers.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/07/090708153233.htm

The Ombudsman (a U.K. body which deals with complaints against public services) has published its report into the death of six people with learning disabilities who were being 'looked after' by health and local-authority services at the time.

You can download the Ombudsman's report here

http://www.ombudsman.org.uk/improving_services/special_reports/hsc/six_lives/index.html

The report follows a similar one from the learning-disability charity Mencap - Death by Indifference - which highlighted an 'appalling catalogue of neglect of people with a learning disability.'

You can download the Death by Indifference report here

http://www.mencap.org.uk/document.asp?id=284&audGroup=&subjectLevel2=&subjectId=&sorter=1&origin=pageType&pageType=112&pageno=&searchPhrase=

Learning disabilities and dementia

People with learning disabilities are at a greater risk of developing dementia than other people. People with Down's syndrome have a genetic predisposition for dementia, related to the APP gene on chromosome 21 but not all people with learning disabilities have Down's syndrome. The cognitive-reserve theory holds that everyone starts out with different levels of brain power. Dementia reduces this but only when the brain's capacity falls below a certain level do the symptoms of dementia appear. This would explain why people with higher IQs have a smaller risk of dementia; the same processes of decline are going on but they have enough spare capacity to cope without symptoms developing. According to this theory people with learning disabilities should develop dementia symptoms earlier as they have less capacity to begin with. 281 adults over 60, and with learning disabilities, took part in a study organised by researchers at University College Medical School. The study found that the rate of dementia was 2.77 times as high in this group as among the general population but that there was little difference in the rates of dementia between those with mild, moderate and severe learning disabilities. Younger people with learning disabilities were also at a higher risk of developing Alzheimer's disease than people of the same age without learning disabilities.

Strydom, A. ... [et al] - The relationship of dementia prevalence in older adults with intellectual disability (ID) to age and severity of ID Psychological Medicine January 2009, 39(1), 13-21

Learning disability and health

The British learning disability charity Mencap has launched a new initiative aimed at improving physical health care for people with learning disabilities. The project called Getting it Right follows the publication of Mencap's report into inequalities in health care experienced by people with a learning disability 'Death by Indifference'.

You can find out more about Mencap's campaign and download a copy of Death by Indifference by clicking on the link in the title of this post.

Helping sex offenders with learning disabilities

The Sex Offender Treatment Services Collaborative

www.sotsec.org

is a group of professionals who provide treatment for men with intellectual disabilities who are at risk of sexual offending. The group provides a forum for the discussion of treatment issues as well as training and support for clinicians who are delivering group cognitive behavioural treatments for men with intellectual disabilities who sexually abuse. One of the modules in the programme uses a four-stage model - motivation to abuse, overcoming internal and external inhibitions and overcoming victim resistance - to help offenders understand their steps to offending. An article in this month's British Journal of Learning Disabilities looks at the progress of four men going through this programme and discusses some of the issues around this work.

Goodman, Wendy ... [et al] - Group treatment for men with learning disabilities who are at risk of sexually offending: themes arising from the four-stage model to offending British Journal of Learning Disabilities December 2008, 36(4), 249-255

Learning disabilities and mental-health problems

The term learning disability covers a variety of clinical presentations, syndromes and underlying pathologies. About 1% of the population have a learning disability and most studies have found that the risk of mental-health problems is higher in people with a learning disability. However, identifying mental health problems in people with a learning disability is difficult. An Australian study used a register of people with learning disabilities and a register of people with mental-health problems to look at people with a 'dual diagnosis' of learning disability and mental illness. The study showed that 31.7% of people with an intellectual disability had a psychiatric disorder, while 1.1% of people with a psychiatric illness had an intellectual disability. Schizophrenia was most closely linked to learning disabilities and 3.7-5.2% of those with intellectual disabilities had co-occuring schizophrenia. Pervasive developmental disorder was much more common among people with 'dual diagnosis' while Down Syndrome was much less common. Individuals with a learning disability and mental health problems were more disabled than those with psychiatric illness alone.

Morgan, Vera A. ... [et al] - Intellectual disability co-occuring with schizophrenia and other psychiatric illness: population-based study British Journal of Psychiatry November 2008, 193(5), 364-372

Ethnicity and learning difficulties

It has long been recognised that people from different ethnic groups receive different levels of care from mental-health services. People from ethnic minorities have higher rates of compulsory admission, longer average lengths of stay and are more likely to be prescribed drugs or ECT rather than psychotherapy or counselling. They are also less likely to use mental-health services in the first place. Ethnicity and learning disability is an under-researched area although what research there is suggests that services often offer a 'tokenistic' approach in meeting individual needs, resulting in under usage of service and creating a general environment of 'lack of engagement'.

You can read more about the existing research on this topic and plans for future research at

http://www.library.nhs.uk/ethnicity/viewResource.aspx?resid=296479&code=13e349d0c83a1a920e3672f92df146f0

Specialist learning disability units

In the past people with learning disabilities often spent long periods of time as hospital inpatients. This is no longer considered to be acceptable and the current UK policy is for long-stay hospitals for people with learning disabilities to be reduced in size and, eventually, closed. However, there is still a need for people with learning disabilities to receive assessment and treatments that may still involve a period of admission to a specialist facility. A study of such a facility by researchers in Northern Ireland found that the main reasons for admission were challenging behaviour and mental-health problems. The study found that there were significant reductions in these problems following admission to the unit, which was staffed by a multidisciplinary team, mostly made up of nurses.

Slevin, E. ... [et al] - People with learning disabilities admitted to an assessment and treatment unit: impact on challenging behaviours and mental health problems Journal of Psychiatric and Mental Health Nursing September 2008, 15(7), 537-546

Intellectual disabilities and mental health problems in children

A study of 18,415 children and adolescents in the U.K. compared the rate of mental-health problems among those with intellectual disabilities to that in other children. The researchers found that the prevalence of psychiatric disorders was 36% among children with intellectual disabilities compared to 8% among children without. Children with intellectual disabilities accounted for 14% of all British children with a diagnosable psychiatric disorder. Children with intellectual disabilities were 33.4 times more likely to suffer from autism, 8.4 times more likely to be hyperkinetic and 5.7 times more likely to have conduct disorders. The cumulative risk of exposure to social disadvantage was associated with increased prevalence of mental health problems.

Emerson, Eric and Hatton, Chris - Mental health of children and adolescents with intellectual disabilities in Britain British Journal of Psychiatry December 2007, 191, 493-499