Learning disability, mental health and challenging behaviour

What is a learning disability?

It is not rare for people to have problems with learning. When these problems do not impact on a person’s intellect or their daily life, it is known as a learning difficulty.

However, under some circumstances when a person’s problems with intellect are more severe it may be considered a learning disability. For example, if the problem started before the age of 18, or it impacts on their ability to take part in day-to-day activities, or if they have an IQ below 70.

There are many possible causes of learning disability. These can range from common, well-recognised conditions such as Down syndrome to less well-known genetic causes, trauma during birth or severe infection. Many people are never able to pinpoint a single cause for their learning disability. It is also frequently associated with other conditions such as autism.

Learning disability is quite common, affecting about two people in every hundred. Many people with a more mild learning disability may not have their disability recognised or receive any support. The severity of the learning disability, and the amount it affects a person’s intellect and function, is important. Those with a more severe learning disability often have greatly increased care needs. They may also have associated psychological and physical health problems.

Having a learning disability itself is not a medical condition, and much of the help people need relates to social and other support. However, when health needs are present these need to be addressed. For some conditions, such as mental health problems or challenging behaviour, general health services may not have the expertise to address these issues. In these cases, specialist services are needed.

Mental health and learning disability

Children and adults with a learning disability can experience the same range of mental health problems as the general population.

In fact, research shows that mental health problems are more common in people with a learning disability.

We do not fully understand the cause of these mental health problems, but as in the general population, a range of factors can play a part including:

  • genetics
  • physical ill health
  • psychological stress
  • poor social relationships
  • lack of employment
  • poverty

Recognising and diagnosing mental health problems can be very difficult. The way an individual is able to express their needs, either by themselves or with help from others, influences diagnosis.

A person with a mild learning disability may be able to express the symptoms of mental health problems such as low mood in some detail. However, a person with a more severe learning disability may have very limited language abilities, and the only clue to the presence of mental health problems may be changes in behaviour such as poor sleep, decreased appetite or challenging behaviours.

Challenging behaviour and learning disability

A proportion of people with a learning disability will present behaviour that may be considered challenging. In adults this is around 10-15%. What we think of as challenging behaviours can vary, but this often includes aggression, self-injury and destructiveness.

These behaviours can have serious effects on the person’s life, making it harder for them to get an education or socialise. It can also make it difficult for them to live independently.

Challenging behaviour can be influenced by lots of different personal and environmental factors, including the quality of the care environment. Associated physical and psychological ill health can also play a part.

Challenging behaviour is most common in males, people with autism and those with more severe learning disability. For many people with a learning disability, these behaviours are a form of communication. This could be communicating underlying distress or anxiety, a need for help and attention, or a need to leave a particular situation or source of stress.

Getting help

If you feel you have a mental health problem or challenging behaviour, or if you are a carer of a person with a learning disability and feel that they may have these problems, it is important that you seek help.

The first step is to talk about it with your GP, or a specialist learning disability service if you are in contact with one. They will then need to make sure that a physical health problem such as excess acid from the stomach or a dental problem is not causing the issues that are concerning you. If this is not the case, then an assessment will be needed. This will usually be provided by either child and adolescent mental health services (CAMHS) or, in adults, by learning disability psychiatric services.

When a mental health problem is diagnosed, health professionals may recommend talking therapies, medication or a combination of the two. A thorough assessment of the quality of an individual’s social care and social experience should also be carried out.

In cases of challenging behaviour, a psychologist or learning disability nurse will often carry out a functional assessment to try and better understand the causes. People with more severe challenging behaviour may be referred to specialist behavioural teams who can offer detailed assessment, and often long-term support.

Tips for people with a learning disability
  • It can be hard to understand your emotions. Sometimes problems with your mental health can make you feel pain or like you are physically ill. If you are worried about any change in how you feel, tell your doctor
  • Talk to friends and carers, or just to your doctor – it’s important to talk about how you feel. Talk about the things that make you feel good as well as the things that stress you out
  • Being active and healthy can make a big difference with conditions like depression. Try to get more exercise and eat healthy foods
  • Don’t feel bad about seeing a doctor, nurse or psychiatrist – that’s what they’re there for. Anyone can get a mental health problem, the important thing is to get help
  • If you are given tablets ask about side effects. If you feel you have side effects don’t stop taking the medicine, go to your doctor first and tell them about it
Tips for carers and families
  • Keep an open mind when someone’s behaviour changes, and go to see the doctor. Most changes won’t be related to a mental health problem at all, and will probably be the same short-term reactions that we all get
  • Remember that a person with a learning disability may not show symptoms in a “typical” way. For example, if they are depressed, instead of saying so they may be angry, or withdrawn
  • Always allow time for the person to communicate how they feel. If you visit a health professional, let them know how best to communicate with the person too
  • If a person is displaying challenging behaviours and you are worried for your safety or theirs, let the professionals know as soon as possible
  • Remember to look after your own health – being a carer can be very stressful, and many develop mental health problems themselves. If you think you may be unwell, speak to your doctor

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National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ

+44 (0)29 2068 8401
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