New Canadian guidelines for primary care of adults with learning disabilities


This Canadian review set out to update guidelines related to primary care of people with learning disabilities. The terms developmental disabilities is used in Canada but is equivalent to the use of the term learning disabilities in the UK.  Estimates of the prevalence of learning disabilities in Canada vary from 1% to 3% of Canadians.

Following a colloquium of health care providers, a working group revised the 2006 guidelines based on a comprehensive review of publications, feedback from users and personal clinical experiences.

The guidelines, 31 in total,  bring together general, physical, behavioural, and mental health issues and present recommendations for screening and management based on current knowledge. They emphasise the involvement of all stakeholders, the adaptation of primary care procedures and the need for input from a multidisciplinary team of health professionals. The guidelines also stress human rights issues such as informed consent and the assessment of health benefits in relation to risks of harm.

Since 2006, new guidelines have been added relating to the detection of pain and distress, as these can manifest in atypical ways in adults with learning disabilities (eg, different physical cues or changes in behaviour); screening and prevention of infectious diseases, cancer  and alcohol or drug abuse. Reviews of literature have shown that adults with learning disabilities are less likely to be included in preventive screening programmes, to do self-examinations, or to report abnormalities or difficulties in these areas.

In relation to behavioural and mental health issues, new categories have been added to address non-pharmaceutical interventions and psychotropic and antipsychotic medications with an important recommendation which rejects the routine use of antipsychotic medications for aggressive challenging behaviour, without a confirmed robust diagnosis of schizophrenia or other psychotic disorder.

Most of the available evidence in the area of primary care for people with learning disabilities is from expert opinion or published consensus statements  and the authors conclude therefore that the guidelines should be regularly updated in light of new findings in practice and more rigorous research.

Primary care of adults with developmental disabilities: Canadian consensus guidelines, Sullivan W.F. et al., in Canadian Family Physician. 2011 May; 57(5): 541-53,

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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