Specialist skills and learning disabilities | Letters

Sally Cheseldine and Bill Hughes contribute to the ongoing debate about the role of learning disability specialists

There are many paediatricians who bring specialist skills to children and adolescents with intellectual disabilities and/or autism spectrum disorders (We need learning disability doctors, Letters, 6 August; A case for learning disability doctors, Letters, 27 July), but few psychiatrists, clinical psychologists and learning disability nurses for this young group, so behaviours that are labelled “challenging” are often neglected.

When children become adults they lose the input from paediatrics and drop over a cliff edge of healthcare services. GPs often haven’t developed the skills because their colleagues in paediatrics have been holding the safety net. Health issues are missed due to “diagnostic overshadowing”, where signs and symptoms are attributed to the disability and the “challenging behaviour”.

The system does need an overhaul, but I would be careful what we wish for. I’m old enough to remember the days when there were specialist doctors – usually found in those “specialist” hospitals that many of us spent our time trying to close. Let’s not go back to those days, please.
Dr Sally Cheseldine
Edinburgh

• My late wife, Valerie, was passionate about learning disability. In mid-career she took a reduction in status and salary, from senior doctor to senior house officer, in order to undertake a three-year traineeship in psychiatry and, after passing the exam to become a member of the Royal College of Psychiatrists, was appointed consultant in Cambridge.

She was especially keen on the diagnosis of physical illness in patients with learning disabilities. She was able to give 10 years in post until retirement. This at a time when in, some areas, the prevailing ethos was “It’s good enough for the likes of them”.
Bill Hughes
Witham, Essex

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