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This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

General Learning Disability (Mental Handicap)

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Mental handicap is characterised by subaverage cognitive functioning and deficits in two or more adaptive behaviours with onset before the age of 18. In England and Wales the Mental Health Act 1983 defines "mental impairment" and "severe mental impairment" as "a state of arrested or incomplete development of mind which includes significant or severe impairment of intelligence and social functioning, associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned.

The term general learning disability has now been recommended in the UK to replace terms such as mental handicap or mental retardation. A child with a general learning disability finds it more difficult to learn, understand and do things compared to other children of the same age. The degree of disability can vary greatly.

General learning disability must be differentiated from specific learning difficulty (e.g. dyslexia) which means that the person has one difficulty such as in reading, writing or understanding, but has no problem with learning in other areas.

Classification
  • Mild learning disability: IQ 50-70, approximately 85% of cases; most can lead normal lives except may need assistance in handling difficult situations.
  • Moderate: IQ 35-49, approximately 10% cases; use simple language when talking but understand speech better. Patient can generally attend to the basic tasks of life after training but more complex activities such as using money usually require support within a special residential environment.
  • Severe: IQ 20-34, approximately 3-4% cases: many able to look after themselves with careful supervision.
  • Profound: IQ less than 20, approximately 1-2% cases: development level of one year old baby across a range of parameters and so require intensive help and supervision in all activities.
Epidemiology
  • Learning disability is common, affecting 1-2.5% of the general population in the Western world.1
  • The number of people with intellectual disabilities increased by 53% over the 35 year period from 1960 to 1995 (as a result of improved socioeconomic conditions, intensive neonatal care and increasing survival).2
Causes
Presentation
  • The presentation will depend on the cause.
  • Generally poor performance on tasks such as learning, short term memory and problem solving.
  • Frequently associated with specific congenital syndromes e.g. Down's syndrome, fragile X syndrome.
  • Assessment needs to consider the possible cause e.g. family history, birth history, functional disability and associated medical, psychological and social difficulties.
Associated problems
Management
  • Management includes multidisciplinary support for both the child and the rest of their family. The person with mental handicap and their carer(s) and family need a great deal of physical and emotional support.
  • Psychological, psychosocial, and educational interventions for deprived children with low IQ have been shown to have positive effects on behaviour, overall adjustment and possibly also on IQ.1
  • Behavioural treatment methods for self-injury in learning disability are probably effective if used systematically by people who are well trained in such methods.1
  • Psychotropic drugs are often used but rarely produce significant benefits.
  • Direct support and coaching of young people with learning disability are efficient ways to improve their integration into employment.1
Complications
  • Behaviour problems: includes distractible, overactive, impulsive, repeated self-injury, stereotyped repetitive and purposeless activities.
  • Sexual problems: curiosity about other people's bodies may be misunderstood as sexual; inappropriate behaviour e.g. masturbation, in public.
  • Physical disorders are more frequent e.g. sensory or motor disabilities, epilepsy.
  • Disorders of vision and hearing are also more frequent.
  • Effects on the family: parental rejection, physical and emotional stress in caring for a child with learning disability, difficulty with family dynamics with other sibs, increasing difficulty as the child gets older with isolation, contraception etc.
Prognosis
  • Most adults with learning disability have very limited economic resources.
  • People with severe learning disability have a particularly poor outlook. Those with mild learning disability and borderline intelligence also do poorly in terms of adaptive functioning.1
  • Life expectancy is reduced in those with learning disability. Non-mobile children and those incapable of feeding themselves may be at particular risk of a short life expectancy.
  • Both the scope and pattern of disease mortality and cause-specific mortality tend to become increasingly similar to those of the general population after the age of 40 years.1
Prevention
  • Early and effective management of problems during the antenatal period and during intrapartum care.
  • Early and effective management of problems in the neonatal period and early childhood.


Document references
  1. Gillberg C, Soderstrom H; Learning disability. Lancet. 2003 Sep 6;362(9386):811-21. [abstract]
  2. Cooper SA, Melville C, Morrison J; People with intellectual disabilities. BMJ. 2004 Aug 21;329(7463):414-5.

Internet and further reading Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article and to Dr Huw Thomas and Dr N Hartree for earlier versions. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 2452
Document Version: 21
DocRef: bgp651
Last Updated: 26 Jun 2008
Review Date: 26 Jun 2010

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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