The Department of Health and Social Care (DHSC) (2001) defines learning disability as:
“a significantly reduced ability to understand new or complex information,
to learn new skills (impaired intelligence),
with a reduced ability to cope independently (impaired social functioning),
which started before adulthood.”
Learning difficulty is not the same as learning disability. Learning difficulty does not necessarily involve impaired intelligence, but causes specific challenges in certain types of learning:
- Dyslexia involves difficulty in reading, writing and spelling
- Dysgraphia involves difficulty in writing
- Auditory processing disorder involves difficulty in processing auditory information
- Non-verbal learning disability involves difficulty in processing non-verbal information (e.g., body language)
- Dyspraxia (or developmental co-ordination disorder) involves difficulty in physical co-ordination
Classification
The severity of the learning disability is based on the IQ (intelligence quotient):
- 55 – 70: Mild learning disability
- 40 – 55: Moderate learning disability
- 25 – 40: Severe learning disability
- Under 25: Profound learning disability
IQ measures cognitive and problem-solving ability compared with the average score of 100. In isolation, IQ is limited, as it does not account for other aspects of daily life, such as emotional intelligence, practical skills and creativity.
Causes
Often, there is no specific cause for the learning disability. A family history of learning disability increases the risk. Environmental factors, such as abuse, neglect, psychological trauma and toxins, can all increase the risk.
Certain conditions are associated with learning disability:
- Antenatal conditions (e.g., fetal alcohol syndrome and congenital rubella syndrome)
- Perinatal conditions (e.g., prematurity and hypoxic-ischaemic encephalopathy)
- Postnatal conditions (e.g., meningitis and traumatic brain injuries)
- Genetic conditions (e.g., Down’s syndrome and fragile X syndrome)
- Metabolic disorders (e.g., phenylketonuria)
- Autistic spectrum disorder
- Epilepsy
Management
Managing learning disability involves a multidisciplinary approach to support the child and family, including:
- Schools
- Health visitors
- Social workers
- Educational psychologists
- Paediatricians, GPs and nurses
- Occupational therapists
- Speech and language therapists
Specific terms and definitions are used in managing the educational needs of children with learning difficulties:
- Early intervention services aim to identify learning difficulties early and provide additional support
- Special Educational Needs (SEN) means a child requires additional or different support with learning
- Special Educational Needs Coordinators (SENCOs) are teachers responsible for coordinating support in school
- Individual Education Plan (IEP) or Personalised Learning Plan (PLP) details the individual’s needs and plan
- Education, Health and Care (EHC) plans detail individual needs across broader domains
TOM TIP: Examiners may test your communication with someone with a learning disability. Involve the child in any appropriate discussions, regardless of their intellectual ability. When talking to someone with a learning disability, it is essential to make things simple to understand, give only small amounts of information at a time and check understanding. Use tools to assist your communication, such as pictures. For example, a pain scale with a series of faces from happy to sad can help patients communicate their pain.
Capacity
Capacity is decision-specific, meaning a person can make some decisions but not others. Having a learning disability does not prevent patients from making decisions for themselves. They may require more time, effort, and decision aids to fulfil the criteria. It may take several attempts on different days or at various times of day to make a decision. Capacity becomes more critical as they approach adulthood, as most decisions about a child will be made by their parent or guardian.
To have capacity, a patient must demonstrate the ability to:
- Understand the decision that needs to be made
- Retain the information long enough to make the decision
- Weigh up the options and the implications of choosing each option
- Communicate their decision
TOM TIP: Remember the four key words for demonstrating capacity, as these are frequently tested in exams. Remember that capacity is decision-specific, meaning someone may have the capacity to decide what they want for breakfast but not to decide whether to undergo complex surgery.
Last updated November 2025
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