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You may see a person with a learning disability as often as once a week or perhaps much more rarely. But whatever the frequency, the question of ‘what should I do differently?’ is an important one to keep in mind. If the answer is to try doing nothing differently, then there is a high chance that the outcome will be unsatisfactory for both patient and clinician. We aim to set out here, based on our clinical experience working in learning disability services, some of the ways you can make the consultation more effective.
Learning disability is a very broad term, requiring only the onset of a significant intellectual impairment (often defined as IQ<70) with limited functional skills before the age of 18 years. Within this category there are highly verbal people living with little support and no associated difficulties, right through to those with multiple, profound physical impairments and very limited communication skills. The skills to interact effectively with this group of people and with those who support them are important to all practising health professionals. The frequent comorbidity of disorders such as epilepsy and cerebral palsy will bring neurologists into frequent contact with people with learning disability.
The range of impairments
In considering the communication techniques which may be useful, it is worth bearing in mind three patients from across the range of learning disabilities.
■ First, Maurice, whose learning disability is mild, but who also has autism. Autism involves impairments in social communication, interaction and imagination, exhibited as a restricted range of interests and repetitive behaviour. He is able to speak clearly and at great length about his particular interests, but can find it difficult to grasp straightforward statements or questions on other topics. He is likely to find social interaction and unpredictable changes to his routines anxiety-provoking.
■ Second, Dawn, who …
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