as both a pre-registration nursing student and a future post-registration staff nurse, is very likely to encounter and work with those who have a learning disability in his day-to-day work, regardless of whether he works in a general hospital, in the community or in a GP practice or health centre. As such, Marcel’s sister, Ziva, would like to act as Hanif’s guide in the following pages.
DEFINITION
Hanif: So, Ziva, what does this term ‘learning disability’ actually mean?
Ziva: Thanks for asking, Hanif. Barber (2011) suggested that the term ‘learning disability’ cannot be defined easily. Learning disability can act as a category for a variety of conditions with different causes. Some forms of learning disability are:
As a result of ‘genetic abnormalities’. Down’s syndrome, phenylketonuria, Marfan’s syndrome and tuberous sclerosis (epiloia) are all examples of genetic causes
As a result of major difficulties during or immediately after childbirth
As a result of alcohol or ‘recreational drug’ use during pregnancy
As a result of environmental factors such as environmental or industrial toxins
Whilst other forms of learning disability just are (otherwise known as ‘idiopathic’)! An idiopathic (from the Greek idios (‘one’s own’) and pathos (‘suffering’)) disease or condition is one whose cause is not known or one that arises spontaneously.
Hanif: Thanks for that, Ziva. However, what you have just presented is some of the causes of learning disability, rather than what learning disability actually is (and is not).
Ziva: Yes, you are quite right about that, Hanif. Sorry. There are a number of ways of looking at the term ‘learning disability’ and hence those with a learning disability. The first of these is to focus on learning disability as a ‘dictionary definition’. Again, there are a number of such definitions that can be looked at. The first of these definitions is taken from the Valuing People White Paper (DH, 2001: 14). According to Valuing People, a person is described as having a learning disability if they have:
A significantly reduced ability to understand new or complex information (impaired intelligence and cognitive functioning)
A significantly reduced ability to learn new skills (impaired intelligence and cognitive functioning), with
A reduced ability to cope independently (impaired social functioning) and
Which started before adulthood and with a lasting effect on development.
Alternatively, learning disability can be seen as:
An arrested or incomplete development of mind (Mental Health Act 1983, Section 1)
That impacts upon most if not all areas of human life: intellectual, spiritual, physical, educational and social
And ranges in severity and impact from borderline to profound
With the likelihood of multiple neurological and physical disabilities increasing with serious and profound learning disabilities
And that often requires additional supportive resources in order to facilitate optimum physical, mental, spiritual, social and emotional health and engagement within society.
Hanif: I think I understand these two meanings, Ziva.
Ziva: However, both of these definitions could be argued to pose a number of questions or problems. First: the Department of Health definition. ‘Valuing People’ was the first learning disability White Paper for nearly a quarter of a century.
Hanif: What is a White Paper, Ziva?
Ziva: A White Paper is formal Government policy on a given subject such as learning disability, as opposed to a Green Paper which is a discussion or consultation document and a Bill or Act of Parliament. A White Paper has no force of law behind it and cannot, therefore, be enforced in the same way as an Act of Parliament such as the Autism Act 2009. The definition given in the White Paper is apparently the ‘definition of choice’ and can be found as such in many learning disability textbooks and is both concise and accurate. However, it lacks in its apparent objectivity and simplicity the possibility that learning disability is not a single condition, but a series of conditions. These conditions range from ‘Borderline’ learning disability through to ‘Profound’ learning disabilities via ‘Mild’, ‘Moderate’ and ‘Severe’ learning disabilities.
Hanif: Would I be right in thinking that the more severe the learning disability is, the more likely that such learning disability will include increasing physical disabilities such as cerebral palsy, musculoskeletal issues such as scoliosis, neurological conditions such as epilepsy and medical conditions such as respiratory and cardiac problems?
Ziva: Yes, you would. Again, although succinct and relatively easy to understand, it could be argued that this definition runs the risk of locating the disability within rather than outside the person. My brother Marcel is disabled and must learn to adapt to society, rather than Marcel having a disability imposed by societal attitudes and practices – attitudes and practices which prevent Marcel from fully engaging with society.
Hanif: OK. But where would one place those with Asperger’s syndrome or high-functioning autism in this learning disability range?
Ziva: Interesting question, Hanif. I must declare a personal interest here as I am Asperger’s. Few people would argue that ‘classic autism’ is not a form of learning disability, as it shares many of the cognitive issues and impairments of learning disability. However, do people such as Bill Gates (founder of Microsoft), Keith Joseph (British politician), Ludwig Wittgenstein (Austrian philosopher), Peter Sellers (British comedian) and Gary Numan (British electronic musician), all of whom are suggested to have Asperger’s syndrome, fit comfortably within a traditional learning disability framework? Probably not!
Hanif: Since those with Asperger’s tend to have higher than average IQs, given the names mentioned above (some of whom I know of), is Asperger’s an aspect of learning disability?
Ziva: Another interesting question and the jury is still out on this one! Anyway, the second definition is based on the opening section of the 1983 Mental Health Act and probably comes closest to providing a ‘legal definition’ of learning disability. However, this definition also applies to those with mental health issues and is not specific to learning disability. Again, the concept of ‘mind’ is introduced but, sadly, is not defined or developed. Having said that, this definition appears to be more ‘holistic’ in tone and acknowledges that learning disability is a spectrum of conditions.
Hanif: I mentioned a moment ago the idea of IQ and learning disability. Could you talk me through this connection?
Ziva: Although this definition is now seen as outmoded, learning disability has been defined in terms of intelligence quotient (IQ), a scale which was used to measure intellectual or mental ability. In general, IQ levels indicated that (Newcastle University, 2011):
| People with an IQ level of: | Were classified as: |
| 75 and above | ‘Normal’ |
| 70 to 75 | ‘Borderline’ learning disability |
