Communication & People with Learning Disabilities

René RelphSpecialist Speech and Language Therapist

November 2015

Introduction

• René Relph BA hons – Specialist SLT Camden Learning Disabilities Service

• rene.relph@camden.gov.uk

Learning outcomes

• Understand what is communication• Have an overview of what impacts on our

communication• Understand the various communication

difficulties a person may have• Have an overview of the tools we may use with

people who have learning disabilities • Know the difficulties with expressive and

receptive language

What is Communication?

“Communication is a two way process, involving at

least two people sending and receiving messages”

Alex Kelly (2001)

….via any means possible.

…..via any means possible

REMEMBER…

• Communication is two way….

• We need to send a message (express ourselves)

• Receive a message (understand what’s been said)

Gaag 1998“It is the communication environment, the quality of personal relationships, the opportunities a person has to use his/her communication skills and the knowledge and experience of the ‘communication partner’ which will have major influence on whether or not an individual is or becomes a successful communicator”

( Leudar & Fraser, 1985; van der Gaag 1989; Leudar 1989; McConkey et al, 1995 – Cited in Gaag 1998)

MEANSREASONSOPPORTUNITIES

Means

Opportunity

Reasons

Talk About Teaching

Package (Money & Thurman 1994: 1996)

Talk About Teaching

Package

(Money & Thurman 1994: 1996)

What influences our communication?

• Mental Health• Physical Health• Level of alertness• Level of attention• Life experiences• Sensory impairment• Social communication

difficulties

10

Ian is sick so he can’t come today, but it okay

Jon is coming to support you, but he won’t be here until;

after lunch

Buuuzzzzzzz

Non Verbal Communication

• body language• facial

expression• eye contact• posture & gait• gesture• sign language• distance• touch• personal

appearance• body

movements• behaviour

Prosody – how we sound

• tone of voice• volume• rate of speech• clarity of speech

• fluency

Classification of LD•Mild learning disability - IQ 50-70, approximately 85% of people

•Moderate - IQ 35-49, approximately 10% of people

•Severe - IQ 20-34, approximately 3-4% of people

•Profound - IQ less than 20, approximately 1-2% of people

http://www.patient.co.uk/doctor/General-Learning-Disability.htm link directed from NHS Evidence https://www.evidence.nhs.uk/search?q=learning%20disabilities&om=%5B%7B%22ain%22%3A%5B%22%20clinical%20%22%5D%7D%5D

significant impairment of overall cognitive functioning as measured on a specific IQ test of 70 or below

Plus

Significant Impairment of Adaptive Skills Function

How do people get diagnosed?

difficulties with communication for people with

learning disabilities

difficulties with communication for people with

learning disabilities

hearing & eyesight

hearing & eyesight

Concentration &attention

Concentration &attention

understandingof speech & language

understandingof speech & language

MemoryMemory

opportunities for cultural and social experiences

opportunities for cultural and social experiences

physical & mental healthphysical & mental health

SpeechSpeech

Social skillsSocial skills

Difficulties withExpression

Delayed speech; unclear, slurred

Limited vocabulary

Errors in grammar/concepts

Non verbal communication; eye contact

Repeat words/phrases/questions

Behaviour may be used to get their message across

Idiosyncratic sign/gestures

Social skills; turn taking, initiation. proximity etc

Social Rules

Difficulties with Comprehension

Delayed language development

Processing information/memory

Tenses and complex sentences

Time; yesterday/tomorrow/next week

Missing negatives in sentence e.g. not, don’t

Vocabulary limitations

Poor interpretation of social cues/situations

Routine supports understanding of the world

Intensive Interaction•Used with people who can be difficult to reach; non verbal

•Based on principles of mother child interaction

•Communicate at the persons level, allowing them to lead

•Mimicking, copying sounds, movement, facial expression etc

•Measure progress e.g. increased eye contact,/shared attention, reduced rocking, tolerance of touch, seeking out interaction

•Needs to be timetabled in to a persons day

•DEMENTIA – new research area

Objects of ReferenceObjects like words signs and symbols can represent an:

• Activity

• Event

• Person

• Place

Objects of Reference

• Symbolic• Motivating• Meaningful• Frequent•Routine•Opportunity

Communication Passport

• Information Sharing•Booklet•Easy to read at a glance•Photos and Pictures•How to bring out the best in a person•Accessible •Anyone can make them

•Also Communication Profiles – 1 page

Photos and Symbols

• photo’s can be easier than symbols• concrete visual support• support the word• can be pointed to or looked at• consider size, colour, how many, when where

to use• should not be tokenistic• Is it meaningful?

Visual Timetable

• tailored for person• size, number of symbols, times of day• structure/routine• reduce anxiety• sets boundaries• can be used to reflect on day• gives control•Opportunity for choice

Scrap Book• Like a daily or weekly diary

• Visual way to reflect and share

• Cut and stick

• Draw and print from computer

• Can share with others

Visual staff rota

Talking Mats - A low-tech framework to help people with severe communication difficulties express their views.

Talking Mats• Talking Mats is used by clinical practitioners, carers and

support workers in a wide range of health, social work, residential and education settings.

• Provide a ‘thinking tool’ to enable people to explore issues and help them to structure and verbalise their thoughts.

• Help people with a learning disability to both understand what is involved in a decision and to then give their opinion

• http://www.talkingmats.com

Signing• Makaton – language system

•Supports speech

•Multi-modal

•Doesn’t disappear

• used in schools often lost when adult

Social time• Often forgotten• Need to create opportunities• Time to reflect• Time to share info

Communication Book• need to have adequate skills

• simple or complex

• pointing to pictures/symbols

• need to know where things are in book

• build up number of symbols

• can move onto high tech aids (computers)

Social Stories Carol GrayTaking my

Tablets

“A Social Story accurately describes a context,skill, achievement or concept according to 10defining criteria. These criteria guide Storyresearch, development, and implementation toensure an overall patient and supportive quality,and a format, ‘voice’, content, and learningexperience that is descriptive, meaningful, andphysically, socially, and emotionally safe for thechild, adolescent, or adult with autism.”

Turnaround DVDStrategy 1Situational: no understanding of words needed; understands through context and routines, tone of voice, etc.

Strategy 2: Words as guides only for things present i.e. you do what you normally do when you hear the word or see that sign.

Strategy 3:Words as guides for things that do not need to be present i.e. you do what you normally do when you hear the word

Strategy 4:Familiar words are understood and linked together but words are ignored that are not understood

Strategy 5: Understanding sentences using some rules and grammar

Strategy 6:Full understanding of all parts of sentence

Changing how WE interact

• How fast do you talk?

• How much jargon do you use?

• How much information do you put in a sentence?

• How do you know if someone is listening and taking on board what you are saying?

“Keep It Simple for Safety”

https://www.youtube.com/watch?v=XiBZjpy3ibs

What are the barriers to communication?

Barriers to positive interactions

• Sensory Impairment• No shared language• Lack insight into partners level of understanding• Time – not enough• Assumptions made e.g. physical disability• Issues with personal hygiene • Unmet health needs

Welcome to Holland

http://www.our-kids.org/Archives/Holland.html

Health & Learning Disabilities

• http://www.bild.org.uk/information/factsheets/

• http://www.improvinghealthandlives.org.uk/

• https://www.mencap.org.uk/about-learning-disability

Communication – useful links

http://www.communicationpassports.org.uk/Home/

http://www.makaton.org/

https://www.mencap.org.uk/Communication_complex_needs

http://www.photosymbols.org.uk/index.html#bench

http://www.talkingmats.com

ReferencesBradshaw, J. (1998) Assessing and Intervening in the Communication Environment. British Journal of Learning Disabilities Vol. 26Gaag, A. (1998) Communication Skills and Adults with Learning Disabilities: Eliminating Professional Myopia. British Journal of Learning Disabilities Vol. 26 Gray, C. (2010) The New Social Story Book. Future HorizonsJones, J. (2000) A total communication approach towards meeting the communication need of people with learning disabilities. Tizard Learning Disability Review. Vol 5:1. p20- 26Kelly, A. (2000) Working with adults with have Learning Disabilities. Winslow PressMoney, D. & Thurman, S. (1994) Talkabout Communication, Bulletin of the College of Speech and Language Therapists, 504, 12 13.‐Nind, M. & Hewett, D. (2001) A Practical Guide to Intensive Interaction. BILD.Smith, C. (2003) Writing and Developing Social Stories – Practical Interventions in Autism. Speechmark Publishing Ltd.