Transcript Speech and Language Skills Mr C Evans

Speech & Language Skills for
the LD Psychiatrist
Clive Evans
Speech & Language Therapist
PCH Community Learning Disability Team
Westbourne
11th January 2013
Aims and Objectives
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To raise awareness of communication
difficulties faced by people with learning
disabilities
To provide practical communication
strategies.
How do we communicate?
How do we communicate?
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Verbal
Tone and intonation
Gesture / body language
Written
Facial expression
Behaviour
Sign language
Communication aids – high/low tech
Learning Disabilities and Communication
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One in three people with learning disabilities are
likely to have problems with their sight or hearing, or
both.*
50-90% of people with learning disabilities have
communication difficulties.**
About 60% of people with learning disabilities have
some skills in symbolic communication using pictures,
signs or symbols.**
*Taken from Foundation for People with Learning Disabilities www.fpld.org.uk
**Taken from BILD factsheet www.bild.org.uk
Common Communication Difficulties
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Limited vocabulary (Leudar 1997) and difficulty
formulating sentences
Auditory memory difficulties
“Borrowed” expertise by repeating others’ words and
phrases as their own (Kernan & Sabsay 1997)
Difficulty interpreting non-verbal cues and facial
expression
Common Communication Difficulties cont.
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Difficulties with conversational repair
Difficulties with asking for feedback i.e. asking
questions about what you’ve been told
Difficulty understanding abstract concepts
Use of strategies to hide difficulties e.g. feigning
understanding; giving response listener wants (Kernan
& Sabsay 1997)
Difficulties with predicting information and inferring
consequences
Understanding is dependent on:
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Attention and motivation
Memory
Vocabulary
Sentence length
Sentence complexity
Feedback and questioning
Abstraction
Spot the vocabulary problem…
Taken from Eastaway, R & Askew, M (2010) Maths for Mums and Dads. London: Square Peg
ANXIETY
makes
it
very
difficult
to
process
language
Expression
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Language ability
Speech production
Social skills
Experience of failure
Limited opportunities
Pragmatic Language Problems
Difficulties with:
Expressing communicative intent e.g. poor non-verbal
communication; word-finding difficulties; difficulties
initiating communication.
Conversational management e.g. poor turn-taking;
difficulties with staying on topic; difficulties with
changing topic appropriately.
Presupposition (awareness of what others may know) e.g.
tactless; ignores listener’s perspective; too much/not
enough information given; inappropriately familiar.
Difficulty with irony, metaphors etc.
Taking It Literally…
Taken from Eastaway, R & Askew, M (2010) Maths for Mums and Dads. London: Square Peg
How to help - Communication
When you are talking:
 Avoid complex vocabulary and jargon.
 Be consistent- use the same word every time
 Break longer sentences into shorter “chunks”.
 Say what you mean- avoid metaphors.
How to help (2)
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Tell the person the topic you’re going to talk
about, before giving explanations.
Try giving prompts to get more information
e.g. “Where did you go?” “Who did you see?”
Check the person’s understanding of the
words and phrases they use.
How to help (3)
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Don’t ask multiple questions
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Check the person has understood:
a) the main point
b) any important details.
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Repeat the important information.
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Explain the consequences- don’t expect people to
be able to predict them.
How to help (4)
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Give the person TIME- to process what
you’re saying, and time to respond.
Provide repair strategies- ask if they need
you to say it again; have any questions.
Remember, it is easy to overestimate
someone’s level of understanding because
they can talk.
Total Communication
INCLUSIVE COMMUNICATION
touch
speech
facial
expression
gesture
sign
pictures
objects
writing
drawing
Making things easy to read and
understand
The Language
-Vocabulary
-Acronyms
Pictures
-Photos
-Symbols
-Internet Graphics
Layout
-Font font
-Size size
-Bullet points
Word definitions
Mental health issues
Assessment
Psychiatrist
Hallucination
Case Study
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You are prescribing anti-psychotic
medication for a lady with mild-moderate
learning disabilities.
How would you go about explaining what
the medication is for; potential side
effects; how she needs to take it.
Useful websites
Easyhealth www.easyhealth.org.uk
Easyread information (including videos) on a range of health matters.
See A Picture of Health also www.apictureofhealth.southwest.nhs.uk
Talking Mats www.talkingmats.com
Useful pictorial rating scale method which can be used to ascertain
people’s opinions about their likes/dislikes; accommodation; medical
treatment etc
Books Beyond Words www.rcpsych.ac.uk/publications/booksbeyondwords.aspx
Picture books on a range of topics: Epilepsy; Going to the doctor etc. Help
people prepare for an event or deal with an issue. Some free online
copies are available (see website).
The Elfrida Society www.elfrida.com
Easyread leaflets on antipsychotic and antidepressant medication.
More information about Communication
and Learning Disabilities…
NHS Evidence
www.library.nhs.uk/learningdisabilities
Lots of articles in the Communication section, plus comprehensive (!) DoH
guidelines on producing easyread information.
Kelly, A. (2001). Working with adults with a learning disability.
Milton Keynes: Speechmark Publishing Limited.
Useful introduction to communication and learning disability, with lots of
information on communication assessment and communication
strategies. Covers the whole range of learning disability.
Contact…
Speech & Language Therapy Team
PCH Community Learning Disability Team
Westbourne
Scott Business Park
Beacon Park Road
Plymouth
PL2 2PQ
0845 155 8077