Communication with service users living with an intellectual disability

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Communication with service users living with an
intellectual disability

• Karen Bloomberg
• Consultant Speech Pathologist
• Communication resource Centre
• kbloomberg.crc_at_scopevic.org.au

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How do we communicate?
environment
INTERACTIVE BEHAVIOUR
Laughing
posture
ignoring
vocalisation
SPOKEN
touch
WRITTEN
grunting
INTERACTIVE BEHAVIOUR
crying
LANGUAGE
intonation
smiling
SIGNED
gesture
SYMBOL
Body language
gaze
Facial expression
winking
Eye contact
environment
Margaret Walker 1987
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Communication

• A communication disability does not just belong
  to the individual .
• It belongs to the entire environment of which the
  individual is the focal point
• Sandwell Communication Aids Centre, UK

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Getting a message across

• Speech conveys 35 (Birdwhistle,1955)
• Other forms of communication supplement
• We communicate
• to express needs wants,
• for social closeness
• To exchange information
• for social etiquette (Light 1988)
• and Self-talk (Light 2003)

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• DEMOGRAPHICS
• People with Complex Communication Needs (CCN)
  have communication problems associated with a
  wide range of physical, sensory and environmental
  causes which restrict/limit their ability to
  participate independently in society. They and
  their communication partners may benefit from
  using augmentative and alternative communication
  (AAC) methods either temporarily or permanently
  (Balandin, 2002)

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Who might have a Complex Communication
Need?????
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What Is AAC?

• Augmentative and alternative Communication uses
  all forms of communication (e.g. pictures,
  gestures, signing)
• For people whos speech is not adequate

Insert photo here
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Why is AAC used?

• To increase comprehension eg. partners use
• As a temporary means of communication eg.
  intensive care
• As a supplement to speech eg. dysarthria
• As an alternative to speech eg. CP, ASD
• Until speech develops eg. developmental delay

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AAC types

• No tech - natural gestures, eye pointing, facial
  expression, signing
• Low-tech - objects, communication boards, books
• High tech - single message, multiple message,
  computer based

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Service users with an ID

• Communicating with an advocate acting on behalf
  of a person who communicates unintentionally
• Communicating with a context dependent
  communicator
• Communicating- incorporating reading material

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Basic principles

• Include the person at their level
• Use clear simple language /natural gesture
• Take time ( double what you need)
• Understanding exceeds expression
• Get their attention
• Leave opportunities for response
• Check acquiescence

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Augmentative Options

• Unaided
• facial expression/body language
• gesture (AmerInd)
• mime
• key word signing (Makaton)
• signed english, PGSS
• AUSLAN
• finger spelling
• CUED ARTICULATION (Passy, 1990)

• Aided
• objects
• (logos)
• photographs
• line drawings
• pictographs
• symbols
• sight vocabulary
• orthography
• speech / vocalisations

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Working with people with Complex Communication
Needs

• Interview an advocate acting on behalf of a
  person who is nonsymbolic or an Early informal
  communicator

Insert photo of michael here
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Communication Development

• Nonsymbolic or Unintentional communicators
• Need support of communication partner
• Early Symbolic Communicators
• Context dependent
• Established symbolic communicators
• With or without literacy skills

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How Nonsymbolic Communicators Communicate

• Partners interpret needs preferences based on
• Facial expression/Body language/Vocalisations
• Eye movement/eye gaze
• Level of alertness
• Do not have yes/no
• Do not understand photos/ pictures
• Do not understand speech
• Do not have speech

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Strategies to assist with making decisions and
choice (nonsymbolic communicators)

• Use an advocate
• Use key people
• Check affect
• See (PCD) Personal Communication Dictionary or
  Moira Cards
• See Book About Me

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Early Symbolic Communicators

• Understand yes/no qs in the here now
• Do not have literacy skills
• Understand simple directions
• Recognise
• photos of familiar people, objects, activities
• some logos eg. McDonalds
• pictures of familiar objects, activities
• May recognise name
• Can choose between preferred activities, objects

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Insert photo of different levels of comm. Object,
obj symbol and line drawing here
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How early symbolic communicators communicate

• Uses facial expression, body language
  vocalising
• Has a yes/no response - not always reliable
• May have up to 4 or 5 functional words, gestures,
  signs
• Has a point or indicating response

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Quality of life communication aids

• Personal communication dictionary
• Book about me
• Personal history
• Commercially available - Moira cards

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Personal Communication Dictionary ( for Mary)
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Insert photo of book about me here
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Symbolic Communicators

• May recognise some print
• Understand yes/no questions related to their
  experience
• Can follow multi-step directions
• Easily recognise photos/ pictures
• Has concept of a signature

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How symbolic communicators communicate

• Able to use at least 50 signs, words, line
  drawings
• Has a clear yes/no response
• Able to communicate needs, choices and
  preferences
• Has an indicating response - may use indirect
  access.

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Strategies to assist with making decisions
choice (symbolic communicators)

• Use communication assistant
• Present information in symbolic format e.g.
  pictures, photos, written word
• Make information accessible (easy English)
• Use Talking Matse.g. likes dislikes

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Strategies to help comprehension

• Use short simple sentences
• Give one piece of information at a time
• Give time for information to be processed
• Do not use slang e.g. hop out of bed
• Use facial expression and actions along with the
  speech
• Keep information in the here and now
• Repeat information say it again the same way
• Show the person what you want from them as you
  speak.

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Making written materials accessible

• In a format the person can understand
• written in plain English
• use of line drawings print
• Questions read person needs a way to respond
• reliable yes/no
• communication aid with relevant vocabulary
• competent use of signing

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Making written materials accessible (cont.)

• Pictograph documents using 3 principles
• Pictograph key words ie. the words that carry the
  info.
• Pictographs must make visual sense with the word
• Be consistent with use of pictographs - if there
  is no picture for the word, do not use the same
  picture for different words in the same document

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From www. enabledlondon.info
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Resources and Contacts.

• Communication Resource Centre
• 830 Whitehorse Road,Box Hill, VIC. 3128.
  Ph [phone] Toll Free 1800 888 824
  Email crc_at_scopevic.org.au
• Provides information, advice, resources and
  services in the areas of CCN, saliva control and
  swallowing.
• Team of Speech Pathologists, Occupational
  Therapist and Community Development Workers.

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COMTEC

• 705 Geelong Road Brooklyn VIC 30259362 6111
• OT Speech Pathologists
• Assessment information on augmentative
  communication, switches, computer equipment
  electronic communication devices. Includes Loan
  service and training on equipment