Communication & People with Learning

Disabilities
Ren Relph
Specialist Speech and Language Therapist
November 2015

Introduction
Ren 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 whats 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)

Means

Reasons

Opportunity
MEANS
REASONS
OPPORTUNITIES

Talk About Teaching

Package
Talk About Teaching
(Money & Thurman
Package
(Money
1994:
1996) &
Thurman 1994: 1996)

What influences our communication?

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

Buu
uzz
zz

Ian is sick so he cant

come today, but it okay
Jon is coming to
support you, but he
wont be here until;
after lunch

10
zzz

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

How do people get diagnosed?

significant impairment of
overall cognitive functioning as
measured on a specific IQ test
of 70 or below
Plus
Significant Impairment of
Adaptive Skills Function

physical &
mental health

Concentration
&
attention

Social skills

hearing &
eyesight

difficulties with
communication
for people with
learning
disabilities

understanding
of speech &
language

Memory

Speech

opportunities for
cultural and social
experiences

Difficulties with
Expression
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, dont

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 Reference
Objects 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

photos 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
Doesnt 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
Taking my
Tablets

Carol Gray

A Social Story accurately describes a context,

skill, achievement or concept according to 10
defining criteria. These criteria guide Story
research, development, and implementation to
ensure an overall patient and supportive quality,
and a format, voice, content, and learning
experience that is descriptive, meaningful, and
physically, socially, and emotionally safe for the
child, adolescent, or adult with autism.

Turnaround DVD
Strategy 1
Situational: 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

References
Bradshaw, J. (1998) Assessing and Intervening in the Communication
Environment. British Journal of Learning Disabilities Vol. 26
Gaag, 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 Horizons
Jones, J. (2000) A total communication approach towards meeting the
communication need of people with learning disabilities. Tizard Learning
Disability Review. Vol 5:1. p20- 26
Kelly, A. (2000) Working with adults with have Learning Disabilities. Winslow
Press
Money, 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.