Background There are an estimated 1.5 million people in the UK with a learning disability (LD), of which 351,000 are children (2.5% of total childhood population).¹ It is recognised that for people with LDs to have the best life chance, early diagnosis and appropriate intervention in childhood is key.² However, a formal diagnosis of LD may never be made despite a continuing acknowledgement of a child’s global development delay as they progress towards adulthood.³ Of those that are diagnosed, many do not receive recommended interventions, with only 55% of those registered as having an LD receiving their annual health check in primary care.⁴

Objectives To survey practice regarding diagnosing LD within community paediatrics.

Methods A questionnaire was designed by the authors and distributed amongst community paediatric departments in the West Midlands via a lead trainee. Responses were requested from community paediatric consultants and speciality doctors. It was open for responses between 7th January and 25th February 2020. The questionnaire addressed areas such as confidence in diagnosing LD, methods used in clinical practice to diagnose LD, and other conditions where you would consider giving a diagnosis of LD.

All responses were voluntary and anonymous. Both quantitative and qualitative data were obtained from the responses.

Results 40 responses were obtained, of which 29 (72.5%) were from consultant community paediatricians. Only 2 (5%) were completely confident in diagnosing LD. 13 (32.5%) were fairly confident, 19 (47.5%) somewhat confident, 4 (10%) slightly confident and 2 (5%) lacked confidence in making the diagnosis. Clinicians used a range of tools and methods to assist with making a diagnosis including school reports, educational psychology reports, functional skills histories, IQ/WISC (The Wechsler Intelligence Scale for Children). A lack of access to educational psychology reports was felt to be a barrier to making a diagnosis with 17 clinicians (42.5%) stating access to their reports would help them make a diagnosis.

Conclusions Confidence in diagnosing LD varies amongst clinicians. We call for the development of standardised pathways in diagnosing LDs. We hope that this would empower community paediatricians to confidently diagnose LDs, enable children and young people to access the health care and support services available to them, and subsequently reduce their future physical and mental health complications.

An additional survey of practice following these results is currently being undertaken to explore the diagnosis of LD amongst Educational Psychologists within the region.

References

1. Research and statistics. Mencap. [cited 2021 Jan 21]. Available from: https://www.mencap.org.uk/learning-disability-explained/research-and-statistics

2. Horridge K. Learning disabilities matter. Dev Med Child Neurol. 2020 Oct;62(10):1112.

3. Kenten C, et al. To flag or not to flag: identification of children and young people with learning disabilities in English hospitals. JARID. 2019 May;32(5):1176–1183

4. Health and Care of People with Learning Disabilities, Experimental Statistics: 2017 to 2018 [PAS] - NHS Digital