Adults with Special Needs and Learning Disabilities
Adults with with special needs and learning disabilities (also called adult learning difficulties or intellectual difficulties in some countries) often have difficulties with communication which can be related to speech and language, social skills and/or behaviour. However, there are a number of programs and strategies that can help adults with learning disabilities communicate and express their needs. Even for adults with profound communication difficulties, there are ways to give them the tools to initiate, respond and make choices (often using a Total Communication approach.
Adult Learning Disabilities
An unpleasant history
Until recently most adults with learning disabilities were institutionalized. Unfortunately, some individuals in these institutions were probably quite capable of looking after themselves or living in the community with some minimal support. In many countries around the world, individuals with learning disabilties are still institutionalized.
Thankfully this is slowly changing and many adults in the western world are now living in the community and leading active lives. There is a new principle of inclusion both in the community and in schools and this is a very positive move forward. For the much older individuals however, lifelong institutionalization has meant they will likely require on-going care and support. For the younger generation there is new hope. They have been given more opportunities at school and will have more opportunities to be involved in paid employment when they reach adulthood. Adults with learning disabilities now have the opportunity to play a part in the community and make a positive contribution to society in many countries.
Communication difficulties
Many adults with learning disabilities have a range of difficulties with communication. These difficulties include:
Comprehension – not understanding what others are saying and / or understanding more abstract language.
Expression – not being able to express thoughts and feelings, or not being verbal at all.
Social skills – not understanding social norms, and how to respond appropriately in social situations.
These difficulties may be made more difficult by a sensory difficulty such as hearing or visual impairment. Often individuals may have several of the above difficulties and have a global communication delay.
Another aspect that is closely linked with communication is behaviour. Often a problem with communication leads to inappropriate or challenging behaviour. This may occur because the individual becomes frustrated at not being understood, or has difficulties understanding what others expect of him.
Strategies and therapy to improve communication
Before we look at the communication difficulties of others, we must first be aware of our own communication skills and how we communicate. We probably perceive ourselves to be skilled communicators, and that being said, we are in a better position to adapt our own communication to help others. This means being aware of the language we use and providing the listener with other cues to help them. When it comes to communicating with adults with learning disabilities, it is important to have strategies to help the communication process. For instance, if an individual has autism you may use visuals strategies, if an individual has hearing impairment you may use sign and be more aware of the environment (lighting, background noise etc), and if an individual has a profound learning disability you may use objects of reference. Every adult is different and if you work with a number of adults with learning disabilities it is important to have strategies to communicate with all of them individually.
If we have a “Total Communication” approach we can greatly enhance our communication, the communication potential of the individual with learning disabilities, and the communication environment as a whole. See our Key Guidelines to creating a Total Communication environment.
Total Communication
What is total communication?
This is a holistic view of communication, often using a range of modalities or even thinking “outside the box” to create a system of communication that works for an individual. Other definitions of Total Communication include:
- Using any means and every means to communicate and / or receive a message.
- Creating a best fit to help an individual to communicate, optimizing his skills and reducing his impairments.
- A “catch-all” that ensures that an individual has access to some means of communication.
- Facilitating and assisting each person by providing supports and opportunities to become involved and to actualise their potential.
Here are some examples of strategies that may be used in a total communication approach. This is not a complete list but covers many aspects of communication. Every individual is different and some may use a range of these modalities.
1. Touch cues
Touch cues are a way of giving blind / deaf individuals information about what is going to happen or who is there.
2. Texture cues / Objects of reference
Through the use of objects or tactile symbols, individuals can build up a wide range of communication options.
3. Braille
This system was devised by Louis Braille in 1821 and is a method widely used by blind people to read and write.
4. Environmental cues
This is a general description for many cues that are around us. They can include pictures, logos, colours, noise and texture.
5. Facial expression, gesture and body language
These are some of the more obvious examples of non-verbal communication but are important because they carry so much meaning and can be used very successfully by people with communication difficulties.
6. Signing Systems
There are a number of different signing systems which vary greatly in complexity.
7. Pictures / Visual Strategies
Visuals and pictures can work for many individuals with communication difficulties and they can be used to help support them with their understanding.
8. Print and symbol systems
Using a printed word or recognisable symbol system can be used when other forms of communication fail.
9. Assistive Technology / Assistive Communication
Assistive technology, Assistive Communication or Alternative and Augmentative Communication (AAC) devices are generic terms that include assistive, adaptive, and rehabilitative devices (both lo-tech and hi-tech) with a focus on facilitating communication. Visit our Assistive Communication section for more information relating to devices that facilitate communication.
10. Speech, Voice and Language
Many people with communication impairment are still able to use their voice and speech.
11. Eye-gaze and partner assisted scanning
Using your eyes to control a device, or using eye-gaze to communicate with a partner is another way many individuals successfully express their thoughts and needs.
Total Communication encompasses a host of different ways to communicate, many of which we already use every day without thinking (eye-gaze, gesture, intonation, facial expression, environmental cues). The important thing to note here is that by using a combination of different communication modalities you can greatly increase the strength and effectiveness of a message.
Assistive technology / assistive communication / AAC
Assistive technology, Assistive Communication or Alternative and Augmentative Communication (AAC) devices are generic terms that include assistive, adaptive, and rehabilitative devices (both lo-tech and hi-tech) with a focus on facilitating communication. Modern new electronic machines (hi-tech) have become the new way for many individuals to communicate. However, assistive devices do not have to be expensive or electronic, they can be lo-tech – picture cards or an E-Tran frame for instance, and often the simpler lo-tech option is the better more functional option depending on the individual and their disability. Whatever assistive device is used, the end goal is to facilitate communication and independence.
Assistive technology can be a huge help to adults with learning difficulties, helping them to communicate and share information across environments. Assistive technology can be broken into 2 sub-categories – hi-tech and lo-tech:
Hi-tech generally refers to electronic devices. These tend to be a more expensive option, and can be very sophisticated machines which provide voice output and environmental control. Hi-tech options can also have additional software which helps with typing, word prediction and scanning.
Lo-tech refers to less technical options such as picture communication cards, communication books or an E-Tran frame. Although often overlooked, these options can actually be more effective than a hi-tech option.
An important point to note here is that when looking at assistive communication devices, it is crucial that you do a thorough trial of several different options to really find the best fit. The higher tech, most expensive option is not always the best. You have to take account of many variables including portability, functionality and speed of use.
See our section on Assistive Communication for more detailed information relating to hi- and lo-tech assistive communication devices.
High and complex needs, and severe communication difficulties
Adults with severe communication difficulties or high and complex needs, pose a real challenge when it comes to communication. However, there are often ways that these individuals can access communication and there are many ways that you can help them understand.
It is really important to observe an adult with severe communication delay before trying to introduce a system of communication. Often there are many subtle attempts at communication that go unnoticed. If these attempts at communication go unnoticed for too long, the individual may give up trying to communicate at all. We must therefore, pay attention to every movement and vocalisation and see them all as possible attempts at communication. Video the individual and watch it back, often you will see new things you had not noticed before. Look at the triggers of movement and vocalization e.g. what made John wave his hand and shout, or Jane clap and smile? By keeping a running record you may begin to see that certain events elicit certain responses e.g. what did the individual do when he was upset, or what did he do when he wanted more? This can be your starting point for communication. By learning the individual’s responses you can learn his system of communication.
Intensive Interaction
Non-verbal individuals who have major learning difficulties or “severe” autism are often very difficult to interact with. Not only do they have major difficulties understanding, but may also be unable to express their own needs or feelings. By “severely” autistic, I refer to those individuals that are non-verbal, non-communicative, and often described as “in their own world”. These individuals have difficulty following instructions and may also display challenging behaviour if approached or encouraged to do something.
Intensive interaction tries to create a communication environment that is enjoyable and non-threatening to the individual with autism, or severe learning disabilties. In some respects the model of the approach is taken from the way we first start to communicate with naturally developing infants, where interactions are short, and involve noises, touch and eye contact. Interactions are brief but can grow over time. Ultimately we are looking for the individual to:
- Accept our presence
- Allow some presence in personal space
- Attend to another person (even fleetingly at first)
- Allow and use some touch
- Engage in eye contact
- Use facial expression
- Focus on body language and facial expression
- Take turns in communicative behaviour
- Take turns using vocalization which may start to have meaning
- Experiment with communication
- Learn cause and effect
The individual is an active participant who is motivated to communicate and who will take the lead and feel a sense of control over the communicative situation.
Through this approach carers can make a connection with an individual, create an enjoyable exchange, reduce challenging behaviour, and develop communication skills. To begin with, sessions may be very short, but expand over time and vary in activity. Sessions should take place several times daily on a one-to-one basis.
To read more about Intensive Interaction see our Download Centre.
Visuals
Visuals are great and can be used in many ways to facilitate communication with individuals that have difficulty understanding. Non-verbal individuals can also use visuals as a way to communicate their needs, initiate communication, or respond. Visuals are especially useful with adults who have severe learning difficulties, autism or communication delay. Visuals are often easier to understand for some adults than spoken words. Pictures can be line drawings or even photographs. Pictures can be used in social stories, timetables and schedules. An individual may not be able to say the word toilet, but if he shows you a picture of a toilet you know where he wants to go.
Behaviour and Communication
Some adults with learning difficulties often display inappropriate or challenging behaviour. Although there are many reasons for this type of behaviour, it can often be linked to a breakdown in communication. When someone is unable to express themselves, or does not understand what they are xpected to do, this is when behaviours may occur.
There are many ways to adapt your communication to help individuals understand. It is also important to get an individuals receptive language skills assessed by a qualified speech and language therapist / pathologist.
Ideally, having the skills of a psychologist to help with assessment and behavioural programs is the ideal, but this is not always possible. However, there are many things we can do to try and change or replace inappropriate or challenging behaviour. See our Section on Behaviour and Communication for more information on strategies relating to behaviour and communication.
Professional involvement
It is important to have a team approach around some adults as their needs are often complex. Psychologists, Dieticians, Occupational Therapists and Physiotherapists may all be involved in helping the individual with their needs and creating the opportunity for greater inclusion.
For more information about communication difficulties, and ideas and strategies to help communication, see our Resources, or for specific fact-sheets about adult special needs and learning disabilties and information and strategies for improving communication go to the Downloads Section.
Recommended Reading
For a wider range of books, click here to see our Bookshop.