Working with Adults with a Learning Disability

Alex Kelly

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351698115
• Edition: 1
• Topic: Didattica
• Subtopic: Didattica generale

A comprehensive and practical resource for all speech and language therapists and students, this book covers all aspects of working with this client group. Written by the author of the hugely successful "Talkabout", each section gives the reader a theoretical background of the subject under discussion, practical suggestions and formats for assessment, a guide to intervention as well as a clear and worked-out example. In addition, the author addresses staff training, group therapy, accessing the criminal justice system and working with a multi-disciplinary team.

Chapter 1: Assessment

♦ Introduction

♦ Communication and the Adult with a Learning Disability

♦ Communication and the Environment

♦ Additional Factors to be Considered

♦ Assessment

♦ Following Assessment

♦ Worked Example

INTRODUCTION

This chapter will address the area of assessment of communication and the adult with a learning disability. The communication needs of this client group will be considered first, including an overview of the most common difficulties experienced and how these can have a profound effect on their ability to communicate successfully. Secondly, assessment of the adult with a learning disability will be considered, and in particular, assessment of expression, comprehension and the environment. This chapter will not describe areas of assessment that are covered in detail in other chapters, ie, assessment of the client who has challenging behaviour, a profound learning disability, social skills needs, or who needs an augmentative and/or alternative communication system. Finally, this chapter will consider how to use the assessment material to plan intervention and set appropriate goals.

The revised Personal Communication Plan (PCP) is included at the end of Working with Adults with a Learning Disability and it is intended that the reader will refer to the relevant sections of the assessment while reading this chapter.

COMMUNICATION AND THE ADULT WITH A LEARNING DISABILITY

Communication is an important part of our everyday life and central to many of the things we do. Crystal (1992, cited by Ferris-Taylor, 1997) summarises the main functions of communication as ‘the exchange of ideas and information, emotional expression, social interaction, control of reality, recording facts, thinking and expressing identity’. In order to communicate these, a variety of verbal and nonverbal behaviours are used. Communication is also a two-way process, involving at least two people sending and receiving messages and information.

When working with people with learning disabilities, however, it is necessary to recognise a wide range of behaviours as potential communication, and to adopt a generous definition of communication. As Bell (1984) states, ‘Behaviours not intended as communicative by the handicapped person can be regarded as such if they are interpreted in that way by the receiver’. This means that all behaviour has the potential to communicate a message, but it is often up to the carers to recognise and respond to it and in doing so, to give it a purpose.

The incidence of communication difficulties among people with learning disabilities is high. Depending on definitions and the population involved (eg, hospital or community), it has been estimated as 40–50 per cent (Mansell 1992, cited by Ferris-Taylor, 1997). This would suggest that there is an almost open-ended need for speech and language clinicians, and that communication is certainly a key consideration for all those who come into contact with people with learning disabilities.

So, what are the communication problems that face the adult with a learning disability? Adults who have a learning disability may have a huge range of communication difficulties and one person’s needs will vary considerably from another’s. However, it is possible to outline the most common difficulties experienced by this client group, and thus give the reader an overview of the range of communication needs that will be encountered in working with adults with learning disabilities.

Comprehension

Most people with learning disabilities have some difficulty in comprehending at some level, and it is therefore important to try to assess how much the person understands. Carers and other professionals often find it difficult to work out how much a person with a learning disability can understand, and are more likely to overestimate their ability than underestimate it. As Clarke-Kehoe and Harris (1992) state, ‘our experience suggests that the ability of people with learning difficulties to understand verbal information is often overestimated by staff. How many times have we heard or used the expression; “she understands everything you say”?’ This may happen for a variety of different reasons:

First, it is often assumed that a person’s understanding and expression are on roughly equivalent levels, and yet this is not always the case. Some people with learning disabilities have developed effective social speech and learnt phrases which reap benefits in terms of social contact, but which are sometimes meaningless in terms of their content. They may also have good use of non-verbal skills which make them seem to be understanding even when they are not. It is not difficult to think of clients who eagerly approach people and say ‘Hello … how are you today? … have you come to see me? … the weather’s been good recently, hasn’t it? …’, etc. It must not be assumed that this person understands at the same level as they are expressing themselves as some, or all, of these phrases could be learnt social phrases. Conversely, a person may have relatively good understanding, but little or no speech, and this may lead to staff underestimating their understanding.

Second, for many people, non-verbal information such as gestures, routine, and peer behaviour often gives them enough information to respond to a verbal command correctly. It is not what was said that was understood, but the total situation. A complicated request such as ‘Go and get your coat on now, the bus is here and it’s time to go home’ may be understood purely because of the routine and through peer behaviour. In addition there may be other cues, such as gesturing towards the coats, and sensory information, such as that it is getting dark outside. In this instance, people are receiving a variety of cues – time-related, visual and olfactory – and the verbal message is only one part of the situation. If someone is therefore reliant on additional cues to enable them to understand, and there is a lack of awareness of how much language is actually understood by that person, it can lead to unrealistic expectations and instructions later on. For example, the instruction ‘Go and get your coat on, your mum is here and you’re going to the dentist’ may seem to be of similar complexity to the previous example, but is far more difficult for the person to understand because it is not home time and other clients are remaining seated.

There are some common factors which can be identified as often affecting someone’s ability to understand and therefore making language difficult to follow for the adult with a learning disability:

Vocabulary

There are several reasons why people may have difficulties in this area:

♦ Many different words are used to describe the same thing – for example, the same drink may be referred to by different people as squash, pop, juice, a brand name or a name of a fruit. Everyday activities such as going out for a walk could be referred to as going for a stroll, a wander, a tramp, etc. Confusing at the best of times!

♦ Some words have lots of different meanings, such as ‘hand’ – for example, my hand, give me a hand, hand me that cup, etc.

♦ Words are often used metaphorically and are liable to be either confusing or taken literally by someone with a learning disability – for example, ‘pull your socks up’, ‘blowing a fuse’ or ‘skating on thin ice’.

♦ Understanding of words may be linked to particular contexts and experiences, and may not be correctly understood in other situations. An example of this, cited by Ferris-Taylor (1997) is of the disabled child who was asked if she would like to go to the theatre...