As Buddha pointed out to mankind some time ago (and M. Scott Peck a little more recently) life, by its very nature, is difficult. And that's assuming that you have all 5 physical senses and an average IQ on your side. People who have a learning disability are not always so fortunate, which makes its even more difficult for them to make sense of the world in which they live and to communicate their needs and feelings to others. To further complicate matters, these people often only experience touch in a functional capacity (e.g. when being dressed, washed, etc) yet they are perhaps the most deserving. For some, the frustration proves too much, leading to frequent episodes of negative behaviour, including rocking, hand wringing, aggression, physical violence towards others, and self-abuse (e.g. repeated head banging or hair pulling). Others simply become extreme introverts.

How aromatherapy can help

Whilst intellect, speech, hearing, and sight can often be compromised by a learning disability, a person's sense of smell, taste and touch are much less likely to be affected. Aromatherapy, of course, stimulates two of these three senses through the use of essential oils and massage, thus potentially opening up new avenues by which people with learning difficulties can understand and make contact with their environment and other people.

As well as addressing a number of mental and emotional needs, physical symptoms commonly experienced by people with learning difficulties may also benefit from the use of massage and essential oils. For instance, circulation may be improved in those who are wheelchair bound, and conditions such as constipation, headaches, and insomnia may benefit from carefully selected essential oils.

Choosing the right essential oils

In Aromatherapy for Health Professionals, the authors write: "The range of oils from which selection is made is very important in the case of people with learning difficulties and should not include those containing aldehydes, ketones, oxides, phenols or phenolic ethers as principal constituents."

Ideally, the therapist should select three essential oils that will benefit the client, and then introduce these one at a time. Individual oils can be presented on a tissue (I drop) or ready mixed in a carrier oil on the back of the therapist's hand.

Therapists should note the client's reactions carefully. Did the client: push the tissue/ hand away; avert the head; or move closer? If the client finds more than one oil agreeable, these should not be blended together, as a different aroma will be produced - only use one essential oil at a time.

Treating the client

Treating clients who have a learning disability requires a great deal of patience, as building up a trusting relationship takes time. Very often, the first treatment will last for no longer than one minute, after which time the client will usually make it evident that they have had enough by moving away from the therapist. Treatments may also be quite basic to begin with, e.g. just a simple hand, foot, leg or arm massage, and might not involve any oils or creams at all. However, a number of individual case studies have shown that following a series of 4 treatments or more:

• massage tolerance in clients usually increases (e.g. from I minute to 20)
• there is often a marked improvement in: communication; behaviour patterns; cooperation in daily tasks; circulation
• clients are generally more relaxed and sleep more soundly
• clients smile and laugh more readily
• clients may initiate treatment.

After a number of weeks or even months, the client may work through the following sequence of responses to treatment: resistance, toleration, enjoyment, cooperation (offering or turning the hands for the therapist), imitation (self massage or massaging the therapist) and initiation (fetching the oils).

Essential oils can also be used to help people with learning disabilities recognise different people, or locate different rooms (e.g. pine for a bathroom, lemon for a kitchen, and a selected oil for the client's own room).

Editor's Note:

The statements made about improvements in clients are opinion and contribute to the debate. Of course, the effect of massage on its own may also achieve the same results and in non-scientific studies this may be ignored. GP permission should be obtained if the client is having regular medical treatment or has a condition that is contra-indicated.

What is meant by the term 'learning disabilities'?

According to the Foundation for People with Learning Disabilities', learning disabilities can be defined as "the presence of a significant intellectual impairment and deficits in social functioning or adaptive behaviour which are present from childhood." This means that the person affected will usually have difficulties understanding, learning and remembering new things, and in generalising any learning to new situations. People with learning disabilities may also have one or more physical and/or sensory impairments.

The words mild, moderate, severe and profound are often used to describe the degree of learning disability a person has. To establish the 'degree' of learning disability, an IQ measurement is usually taken. People with an IQ of less than 20 are considered to have a profound disability, those with an IQ of 20-50. a severe learning disability, and those with an IQ between 50-70, a moderate or mild learning disability. There is some debate, however, as to whether this is the most accurate and ethical way to evaluate an individual's level of disability and needs.

How many people have learning disabilities?

It is estimated that there are between 230,000 and 350,000 adults and children with severe learning disabilities within the UK. A further 580,000 to 1,750,000 are believed to have mild or moderate learning disabilities. Males are more likely than females to have both severe and mild learning disabilities. Approximately I in 600 people are born with Down's syndrome, which is the single largest known cause of learning disability.

What are the other causes of learning disability?

Impairments which cause or contribute to learning disability can occur before, during, or after birth. Pre-natal and pre — birth causes include Down's syndrome, Fragile X syndrome, and infections affecting the pregnant mother, such as German measles. Oxygen deprivation during birth can result in cerebral palsy. Postnatal causes of learning disability include illnesses, injury or environmental conditions (e.g. meningitis, brain injury, malnourishment, neglect, or physical abuse).

ISSUES OF CONSENT

It is always vital that a client consents to having treatment, but particularly so when the client is considered to be a potentially 'vulnerable' member of society, e.g. they have a learning disability. For the client's consent to be valid, the client must be:

• capable of taking that particular decision (they are considered 'competent'/ have 'capacity')
• acting voluntarily (not under pressure or duress from anyone)
• provided with enough information to enable them to make the decision.

It should never be assumed that a client is unable to make decisions simply because of a learning disability. Non-verbal communication between a client and therapist, e.g. through pictures or gestures, is just as valid as verbal or written communication, and should be treated as such (and noted on the client's records). If the therapist is unsure what the client is trying to communicate, then specialist staff or a speech therapist who work with the client may be able to help clarify the situation. If the client makes any indication that they do not wish to have, or proceed, with a given treatment, then the treatment should be abandoned immediately (if safe and practicable to do so).

If the client has a severe or profound learning disability, they may not be capable of giving or refusing consent. In such circumstances a procedure or treatment may only be carried out if it is considered to be in the client's "best interests" (e.g. will benefit their health or well-being). However, the issue of whether or not to treat a client who is incapable of giving or refusing consent is a complex one, and therapists should always seek the advice of the client's entire care team, which may include doctors, nurses, social workers, and relatives, in order to reach an agreement as to whether or not treatment would be in the client's best interests.

For further guidance, obtain a free copy of the Department of Health's publication "Seeking consent: working with people with learning disabilities" by calling 08701 555455, or download from: www.dh.gov.uk (type "consent disabilities" in the search option).

References and further reading

• The Foundation for People with Learning Disabilities (www.learningdisabilities.org.uk). Tel. 020 7802 0300.
• British Institute of Learning Disabilities (www.bild.org.uk). Tel. 01562 723010.
• Department of Health. Seeking consent: working with people with learning difficulties. Ref. 25754
• Harrison, J. & Ruddle,). An introduction to aromatherapy for people with learning disabilities. British Journal of Learning Disabilities (1995). Vol 23; p37-41
• Price, S. & Price, L. Aromatherapy for Healthcare Professionals (Chapter II: People with learning difficulties). Churchill Livingstone; 2003. ISBN: 0443062102

Our thanks to International Therapist Magazine for allowing us to share past articles