Speech & Language Skills for the LD Psychiatrist

1. Speech & Language Skills for the LD Psychiatrist Clive Evans Speech & Language Therapist PCH Community Learning Disability Team Westbourne 11th January 2013

2. Aims and Objectives • To raise awareness of communication difficulties faced by people with learning disabilities • To provide practical communication strategies.

3. How do we communicate?

4. How do we communicate? • Verbal • Tone and intonation • Gesture / body language • Written • Facial expression • Behaviour • Sign language • Communication aids – high/low tech

5. Learning Disabilities and Communication • 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

6. Common Communication Difficulties • 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

7. Common Communication Difficulties cont. • 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

8. Understanding is dependent on: • Attention and motivation • Memory • Vocabulary • Sentence length • Sentence complexity • Feedback and questioning • Abstraction

9. Spot the vocabulary problem… Taken from Eastaway, R & Askew, M (2010) Maths for Mums and Dads. London: Square Peg

10. ANXIETY makes it very difficult to process language

11. Expression • Language ability • Speech production • Social skills • Experience of failure • Limited opportunities

12. 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.

13. Taking It Literally… Taken from Eastaway, R & Askew, M (2010) Maths for Mums and Dads. London: Square Peg

14. 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.

15. How to help (2) • 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.

16. How to help (3) • Don’t ask multiple questions • Check the person has understood: a) the main point b) any important details. • Repeat the important information. • Explain the consequences- don’t expect people to be able to predict them.

17. How to help (4) • 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.

18. Total Communication

19. Making things easy to read and understand • The Language • -Vocabulary • -Acronyms • Pictures • -Photos • -Symbols • -Internet Graphics • Layout • -Font font • -Size size • -Bullet points

21. Word definitions Mental health issues Assessment Psychiatrist Hallucination

22. Case Study • 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.

23. 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.

24. 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.

25. Contact… Speech & Language Therapy Team PCH Community Learning Disability Team Westbourne Scott Business Park Beacon Park Road Plymouth PL2 2PQ 0845 155 8077