Communication Support Needs in Adults with Intellectual Disabilities and Its Relation to Quality of Life

Research suggests that individuals with intellectual disabilities (ID) experience difficulties in communication, ranging from intelligibility issues to more severe problems in the use and comprehension of spoken, written or sign language. Despite the negative effects that the inability to communicate have on quality of life (QoL), not much research has explored the relationship between communicative competence and QoL in the adult population with ID. The aim of this study was to describe the global communication profile of a sample of 281 adults with ID recruited from Grupo AMÁS Social Foundation, who differed in their level of communication support needs (CSN). The relationships between communicative competence and CSN with QoL were further examined. The results showed lower QoL indices for those participants characterized by their limited use of discourse and inability to exhibit certain communicative purposes, with the largest differences in the dimensions of self-determination, social inclusion, interpersonal relationships, emotional wellbeing and personal development. Overall, low levels of QoL were found for all participants, with even lower scores for the group identified as having CSN. A multiple regression model revealed that having speech/discourse competence is a powerful predictor of QoL, along with the level of disability and having the communicative competences to express likes and preferences or to establish new relationships. This clear relationship between communication and QoL is an important argument for disability support services when it comes to setting communication supports as a priority and as an important preventive step towards the protection of those at risk of exclusion.

'It's my home and your work': the views of a filmed vignette describing a challenging everyday situation from the perspective of people with intellectual disabilities

Purpose: Examining everyday challenges in the interactions between people with intellectual disabilities and their staff, as seen from the user’s perspective, is an important perspective in health care research. Involving people with intellectual disabilities as so-called co-researchers is a relatively unexplored research strategy. In this paper, co-researchers participated in all the steps of the research process, from planning to reporting, in addition to the written reporting of the findings. The aim of this study was to explore how people with intellectual disabilities experienced a filmed vignette of an everyday situation. Method: Based on audio-recorded and transcribed individual and focus-group interviews with people with intellectual disabilities, performed by co-researchers with intellectual disabilities together with researchers, qualitative content analysis was used. Results: The analysis reveals three themes: “being emotionally touched”, “being aware of the other”, and “being unclear”. Conclusions: The results are discussed in light of normalization and participation in society with independence and one’s own decision-making. Regarding the care of people with intellectual disabilities, the main finding is the need to focus not only on greater involvement of this population in their own daily lives, but also to teach self-determination skills. Another finding is the importance of involving people with intellectual impairment as co-researchers.

Communication Intervention for Young Children with Severe Neurodevelopmental Disabilities Via Telehealth

Young children with neurodevelopmental disorders such as autism spectrum disorders (ASD) and Rett syndrome often experience severe communication impairments. This study examined the efficacy of parent-implemented communication assessment and intervention with remote coaching via telehealth on the acquisition of early communication skills of three young children with ASD (2) and Rett syndrome (1). Efficacy of the intervention was evaluated using single-case experimental designs. First, functional assessment was used to identify idiosyncratic/potentially communicative responses and contexts for each child. Next, parents implemented functional communication training (FCT). All of the children acquired the targeted communication responses. The findings support the efficacy of telehealth as a service delivery model to coach parents on intervention strategies for their children's early communication skills.

You and me: The structural basis for the interaction of people with severe and profound intellectual disability and others

Interaction between two people may be construed as a continuous process of perception and action within the dyad. A theoretical framework is proposed in this article that explains the concepts and processes which comprise the interaction process. The article explores the transactional nature of interaction, through analysis of narrative data from two dyads, each comprising a person with severe or profound intellectual and multiple disability and a service worker. The novel application of grounded theory to analyse video data of non-verbal communication data in order to develop the theoretical framework is reviewed. Previously, attuning has been identified as the key process that drives interaction. This article explores the other concepts of the theory proposed, namely, setting, being, stimulus, action, attention and engagement. The article concludes by contrasting this theory of the interaction process with other related concepts and suggests how application of the proposed framework may enhance practice.

Triangulated Proxy Reporting: a technique for improving how communication partners come to know people with severe cognitive impairment

PURPOSE

This paper explains and demonstrates the pilot application of Triangulated Proxy Reporting (TPR); a practical technique for enhancing communication around people who have severe cognitive impairment (SCI).

METHODS AND RESULTS

An introduction explains SCI and how this impacts on communication; and consequently on quality of care and quality of life. This is followed by an explanation of TPR and its origins in triangulation research techniques. An illustrative vignette explicates its utility and value in a group home for a resident with profound multiple disabilities. The Discussion and Conclusion sections propose the wider application of TPR for different cohorts of people with SCIs, their communication partners and service providers.

CONCLUSIONS

TPR presents as a practical technique for enhancing communication interactions with people who have SCI. The paper demonstrates the potential of the technique for improving engagement amongst those with profound multiple disabilities, severe acquired brain injury and advanced dementia and their partners in and across different care settings. Implications for Rehabilitation Triangulated Proxy Reporting (TPR) shows potential to improve communications between people with severe cognitive impairments and their communication partners. TPR can lead to improved quality of care and quality of life for people with profound multiple disabilities, very advanced dementia and severe acquired brain injury, who otherwise are very difficult to support. TPR is a relatively simple and inexpensive technique that service providers can incorporate into practice to improving communications between clients with severe cognitive impairments, their carers and other support professionals.

Guidelines for Conducting Socially Valid Systematic Preference Assessments

Systematic preference assessment is the process of presenting sampling trials and observing the person's response. The response to those items is then interpreted as an indicator of preference. The empirical research on systematic preference assessment has greatly advanced the field's understanding of how to identify the preferences of individuals with nonsymbolic and limited symbolic communication skills. The purpose of this paper is to translate this research into guidelines for planning systematic preference assessments that strive to reduce the risk of missing or misinterpreting the person's preferences, as well as increase the social validity of the process and outcomes. We present four guiding questions for practitioners to plan preference assessments: (a) What will be offered? (b) When and where will sampling opportunities take place? (c) Who will present the sampling options? and (d) How will sampling options be presented?

Teaching Communication Book Use to a High School Student Using a Milieu Approach

This study combined communication book training, a milieu approach (Warren & Kaiser, 1986), and systematic vocabulary selection to teach a nonspeaking adolescent to communicate in three settings. Specifically, we conducted a systematic replication of Hamilton and Snell's (1993) instructional procedures to teach a high school student from a Spanish-speaking home to use a communication book to initiate conversation and respond to teachers, peers, and work supervisors. The student had mental retardation and was deaf and nonverbal Results indicated rapid learning of communication book use in two settings (i.e., meal preparation and employment training) and more delayed increases in a third setting (i.e., small group communication). Based on these findings, we make suggestions for future research and practice.

Communication Strategies of Adults with Severe Disabilities

Individuals with significant developmental disabilities are often considered by others to be dependent and incompetent. They are frequently defined by their deficits rather than their abilities. New concepts such as self-determination have challenged researchers and service providers to think differently about the abilities of individuals considered to have severe intellectual disabilities. Analysis of communicative events between individuals with and without severe disabilities provides evidence that individuals who are often considered least able to do indeed communicate, asserting control over their environments and activities. Careful attention to communication reveals that behaviors that on the surface appear to be random, maladaptive, or challenging are purposeful, even useful. The author proposes that embedded in each communicative act, there is a drive toward self-determination, but that in order for self-determination to be actualized, communication partners must learn to apprehend, and respond appropriately to, the messages.

Tailoring communication supports for students with multiple and severe disability using a mentor-model approach: four case studies from classrooms in special schools

OBJECTIVE

This paper describes four case studies of communication support for students with multiple and severe disability (MSD) in special school classrooms that used a mentor-model approach to the professional development of educational staff.

METHODS

A range of observational and report instruments was used to measure student changes in communicative involvement and the views of teaching staff that engaged with them.

RESULTS

Four case studies of the contextual features, student needs and specific support strategies utilized in this study in four special school classrooms highlight the challenges that are faced by teaching staff in improving and maintaining student communication outcomes, and the reasons for these challenges.

CONCLUSIONS

The mentor-model approach to professional development for educators working with students with MSD holds promise as a general framework for intervention. Despite the inherent variability in student outcomes and the practical limitations in practice, educators reported that the approach was helpful.

Self-determination and choice

Promoting self-determination and choice opportunities for people with intellectual and developmental disabilities has become best practice in the field. This article reviews the research and development activities conducted by the authors over the past several decades and provides a synthesis of the knowledge in the field pertaining to efforts to promote self-determination and choice.

Self-reported health of people with intellectual disability

Self-reported health is an important outcome in the evaluation of health care but is largely ignored in favor of proxy-based reporting for people with an intellectual disability. This study briefly reviews the role of self-report in health assessment of people with intellectual disability and the challenges and recommendations that have emerged from the considerable body of research on interviewing and self-report. Limitations in current recommendations are addressed from the perspective of the cognition of self-report. The review describes conceptual directions for the reconciliation of the two contradictory themes in the treatment of self-report: the centrality given to personal perceptions and choices and the methodological concerns over the meaningfulness and validity of the self-reporting process.

"I'm supposed to be in charge": self-advocates' perspectives on their self-determination support needs

In this qualitative interview study, we explored the perceptions of adults with intellectual disability regarding interpersonal or social supports needed to express their own self-determination. Specifically, 10 adults, all members of a self-advocacy group, were asked to discuss their understanding of the term self-determination and ways in which support staff have either supported or inhibited their self-determination. Ten themes characterizing supportive and impeding staff actions were identified. The need for greater exploration of environmental and social influences on self-determination is emphasized.

"I like others to not try to fix me": agency, independence, and autism

This article is based on an interpretevist, qualitative research project conducted with individuals labeled with autism who type to communicate. Researchers engaged in participant observation and conducted open-ended interviews with 9 participants who were working to develop independent typing skills. Three findings emerged from this research. First, participants shaped a notion of independence that included dependence on various supports. Second, researchers recognized the concept of agency in the interactions between participants and their communication facilitators. Third, participants exercised control of their lives through these expressions of agency.

The impact of partner training on the communicative involvement of students with multiple and severe disability in special schools

BACKGROUND

The outcomes of a pilot program of staff development in communication support in the context of observed changes in student behaviour states and interactive abilities are reported. Participant reports about the impact of the program on their professional practices are included.

METHOD

Six teachers and six teacher aides in special (segregated) schools were provided with a short, intensive training program designed to improve their communicative interactions with students with multiple and severe disability (MSD) in their classes. Behaviour state assessment was used for pre- and post-testing of six students. Teachers and aides completed self-report scales related to their communication skills, knowledge and concerns prior to and at the conclusion of the training program.

RESULTS

While staff reported improved skills and knowledge, this was not reflected in improvements in the communicative interactions of the students as observed in their classrooms.

CONCLUSIONS

The training provided may not have been sufficient to change well-established teaching and interaction processes. Further research using in-school collaborative mentors is planned.

A novel method for testing learning and preferences in people with minimal motor movement

Ten individuals with profound multiple impairments were given novel tests for learning and preference with adaptive switches and leisure-oriented devices, such as audio tape players. Typically, tests for learning include a baseline or extinction component in which the adaptive switch and device are not connected as a control for incidental or involuntary switch use. As an alternative, conditions were compared in sets of six sessions each in which switch closure caused (a) Activation of a device, (b) Deactivation of an already operating device, and (c) Deactivation of one of two devices and Activation of the other (Two-Choice). Changes in behavior indicative of learning were observed in eight participants in Activation-Deactivation conditions. The Two-Choice Condition produced indices of learning that also showed a preference for one device over the other with five participants. The preferences observed in the Two-Choice Condition had not been seen in the Activation or Deactivation Condition data. People with profound multiple impairments evinced leisure-device preferences, but such preferences may not lead to differential responding across opportunities with only one device at a time.

“Imagine”: Relaxation and Guided Imagery with People who are Deaf-Blind

This article discusses the acquisition of self-control using relaxation and guided imagery. These methods can be used in conjunction with other effective teaching tools to enable people who are deaf-blind to lead self-determined lives.

Living with support in the community: predictors of choice and self-determination

Ensuring that people with intellectual disability experience typical levels of choice and self-determination has become an essential objective for quality disability services. Three perspectives on self-determination were identified in the literature: psycho-educational, ecological, and socio-political. Personal characteristics, specific self-determination competencies, and environmental variables all were found to be associated with choice and self-determination. Living environments that were smaller and more individualized were linked to greater choice and self-determination. The theoretical perspective investigators applied to the issues influenced approaches to research and intervention, and differences in emphasis were evident regarding the relative importance of self-determination competencies and environmental factors. MRDD Research Reviews 7:91-98, 2001.

A systematic evaluation of preferences identified through person-centered planning for people with profound multiple disabilities

Person-centered planning is becoming a popular means of designing supports for people with disabilities. However, very little research evaluating person-centered planning exists. We evaluated the degree to which items and activities reported to be preferred in person-centered plans represented accurate preferences based on how individuals responded when presented with the items and activities. Person-centered planning meetings were conducted with 4 individuals with profound multiple disabilities to develop preference maps and to identify leisure-related preferences. A sample of the reported preferences in the plans was then systematically assessed by observing each participant's approach and avoidance responses to the items and activities. Of the sampled items and activities reported to be preferred in the plans, 42% represented moderate preferences based on the latter assessment process and 33% represented strong preferences. With 2 participants, several preferences identified in the plans were nonpreferred items and activities based on the preference assessments, and some were frequently avoided. These results suggested that although person-centered plans may identify some accurate preferences for people with profound multiple disabilities, this approach should be used cautiously. Results also suggested that such plans should be supplemented with systematic preference assessments to ensure the accuracy of identified preferences. Future research areas focus on evaluating other aspects of person-centered planning.