Life course
Section: Life course | LD Toolkit template | RCGP Learning
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Life course
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The definition of learning disability is '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'. The presence of a learning disability persists throughout a person’s life. People experience many transitions during their lives that have an impact on their well-being.
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Many children with a learning disability will need extra help to become toilet trained. Parents need support during this time.There are some resources available which can be helpful for parents.
ERIC: potty training children with additional needs
Down Syndrome UK: toilet training children with Down syndrome
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Many children with a learning disability find it difficult to exercise or keep active. This may be due to additional physical disabilities but can also be due to difficult finding inclusive sports clubs and activities.
SCOPE: sport and exercise for disabled children and young people
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Children and young people may face additional challenges understanding the changes in their bodies and feelings, as well as some of the practicalities such as dealing with periods.
NSPCC Learning: navigating puberty and sexual development
Sexual Health Sheffield: puberty and your body
NHS Sheffield Children's NHS Foundation Trust: puberty in girls with learning disabilities
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Transition to adult services normally occurs at age 18 and should be done directly; paediatric services should not discharge with a request for the GP to refer to adult services. Difficulties can arise when equivalent adult services do not exist on the NHS. Preparation for transition should start several years before the transfer is made The annual health check for people with a learning disability in England and Northern Ireland should start at age 14 (16 in Wales and 18 in Scotland) and is an ideal opportunity to discuss transition of healthcare services. There are many transitions of importance including the law around capacity and consent.
Mencap: transition into adult services
National Confidential Enquiry into Patient Outcome and Death: the inbetweeners
Together for short lives: transition to adult services pathway
RCGP: Better transitions - improving young people’s transfer from paediatric to adult services
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Many young people with a learning disability are vulnerable and it can be important to understand consent.
Somerset & Avon Rape and Sexual Abuse Support: what is sexual consent (Easy Read)
Twinkl: teaching about consent and healthy boundaries with learners with SEND
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People with a learning disability have the right to inform themselves about gender and sexuality and to receive support to express themselves.
Choice Support: supported loving
Mencap: relationship and sex resources
Brandon Trust: relationships, sex and trust (Easy Read)
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Local sexual health clinics may be able to provide additional support but some may struggle with reasonable adjustments. Often it is assumed that people with a learning disability are not sexually active, hence adding a barrier.
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People with a learning disability are less likely to receive appropriate sexual health education.This is one of the factors contributing to the higher risk of sexually transmitted infections (STIs), pregnancy and sexual abuse amongst people with learning disabilities. Studies have shown that people with a learning disability may have incomplete knowledge of sexually transmitted infections so there is a higher risk of undetected infection.
SH24: what is chlamydia (Easy Read)
InnovAiT: sexual health in people with learning or intellectual disabilities
NHS Lanarkshire: easy read guides on sexual health
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Periods may not be easy for young women with a learning disability, particularly those who depend on others for their care. It is important to document menarche and also support any issues around periods like heavy or painful periods. Printed and online information does not always include period underwear/swimwear, as they have only become mainstream in the last few years, and it may be useful to tell patients or their parents/carers about this option.
Mencap: menstruation (Easy Read)
NHS Southwest: help, I've started my periods
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Women with a learning disability may reach the menopause earlier than the general population particularly women with Down syndrome or Fragile X. Symptoms such as hot flushes or disturbed sleep may not be understood, especially during the perimenopause phase; treating the menopause may improve behaviour which is perceived as challenging.
Selby Town PCN: menopause patches (Easy Read)
Selby Town PCN: menopause in learning disabilities
Penine Care NHS Foundation Trust: menopause (accessible resource)
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The uptake of breast screening for women with a learning disability is much lower than the general population. If women do get breast cancer they also present at a more advanced stage, so screening needs to be accessible and women need to know what to look for. Pre-visits to the screening centre and longer appointments can increase uptake.
Thera Trust: breast cancer resources - know your chest
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Women with a learning disability are signficantly much less likely to have cervical screening than the general population but may be at greaater risk as they have lower rates of HPV vaccination. There is also an assumption of 'asexuality' but all women should be offerred screening and reasonable adjustments offered. Results must also be provided in an accessible format.
NHS England: cervical screening - supporting people with learning disabilities
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