Associated phenomena

• Physical health problems, including motor disorders, malformations, and impairments of sight and hearing, are present in about 30 per cent of severe cases.

• Epilepsy is seen in about 25 per cent, being more frequent the lower the IQ.

• Psychiatric illness is seen in up to 40 per cent. Patients may not have the linguistic ability to describe psychiatric symptoms, so they present with behaviour disturbance. There is a raised incidence of all common mental health problems, including both affective and psychotic illnesses (Smiley, 2005).

• Behaviour disturbance. Causes include:

- a manifestation of the underlying brain damage

- a manifestation of the underlying genotype (behavioural phenotype)

- psychiatric illness

- physical illness

- excessive, insufficient or inappropriate medication (psychotropics, anticonvulsants)

- frustration with a boring or repressive environment

- communication difficulties

- adjustment reactions following stressful events, such as change of residence or bereavement. People with LD may be just as much affected by such psychological stresses as anyone else, and also may need a longer time to adjust to them.

Behaviour disturbance in the form of aggression, overactivity, or self-mutilation is present in about half of severe cases, and is often the reason for families requesting institutional care for a child with LD. Behaviour disturbance is also found in adults with milder impairments who are living in the community, and often leads to conflict with the law.

Failure to learn desirable behaviour of which the patient is potentially capable, such as speech and self-care, may also be considered as a type of behaviour disturbance.

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