Student and professional attitudes and interests in working with people with complex communication needs

Speech-language pathology interest in working with people with complex communication needs was investigated in this study. Participants were third year speech-language pathology undergraduates and recent graduates who had participated in a unit on AAC. Undergraduates (n = 85) completed an Interaction with Disabled Persons attitudinal scale and a questionnaire about interest in various client groups before and after the unit. Some undergraduates (n = 34) repeated the attitudinal scale and completed another questionnaire 2 years after graduation. Recent graduates (n = 56) completed a questionnaire about working with people with complex communication needs and factors influencing work choices; 10 also participated in interviews or focus groups. We found a small but positive attitudinal shift for the undergraduates, but, along with previous disability experience, this was a weak predictor of working with this group. Working in developmental disability ranked low amongst undergraduate preferences. Most graduates were influenced in their job choices by a desire to work on a particular team and previous clinical placements. Questionnaires and interview/focus group data indicated the strong influence of clinical placements on later work choices. Participants who worked in disability appeared passionate about the work involved and offered suggestions for engaging more professionals with this group. Implications for speech-language pathology services in disability are discussed.

Perceptions of communication before and after a speech pathology intervention for an adult with intellectual disability

BACKGROUND

The aim of this study was to explore, from the perspective of key communication partners, the meaning of a communication intervention and associated changes for an adult with severe intellectual disability (ID).

METHOD

The parents and key support workers of Mark, a 22-year-old man with ID and complex communication needs, were interviewed. The interviews were conducted prior to and following a speech pathology intervention and were guided by a communication inventory based on the concept of social networks. Interview transcripts were analysed qualitatively, with a focus on the subjective meaning of communication changes. These changes were explored according to both the specific information sought through the inventory and additional information provided.

RESULTS

The findings were organised into three key themes relating to Mark, his familiar communication partners (i.e., parents and disability support workers), and the community. Information obtained from the interviews indicated that Mark's reported communication level remained stable across the intervention. However, an in-depth analysis of the interview transcripts revealed some gains in his communication skills. From the perspective of Mark's familiar communication partners, key sub-themes emerged which were related to changes in ascription of responsibility for developing skills and strategies to enhance Mark's communication. Furthermore, greater participation by Mark in his home community was evident.

CONCLUSIONS

The findings are discussed in terms of the assessment of an individual's communication through interactions with communication partners, and how changes associated with an intervention can be best understood from analysis of rich data.

Further examination of relationships between life events and psychiatric symptoms in adults with intellectual disability

BACKGROUND

It has been proposed that people with intellectual disability (ID) might be similar to the general population in the way they respond to significant life events. Some preliminary findings have demonstrated that adults with ID who have experienced recent life events have an increased probability of having psychiatric problems. The aims of the present study were to determine whether previous findings can be replicated, and to examine the influence of additional diagnoses associated with ID on the strength of relationships between life event frequency and psychiatric problems.

METHODS

Adults with ID (n = 624), living either in staffed community accommodation or in family or foster homes, were assessed on the Developmental Behaviour Checklist for Adults (DBC-A) and a 37-item life events checklist. Carers who knew the person well acted as proxy informants.

RESULTS

People living in staffed accommodation experienced more life events than people living with natural or foster families. Life event frequency predicted DBC-A total score, five of six sub-scale scores, and caseness status, after significant demographic factors were taken into account. However, the strength of correlations between life event frequency and DBC-A total score varied among sub-groups identified by type of developmental disability and level of ID.

CONCLUSIONS

Weak but significant associations between emotional and behavioural problems and life events experienced by adults with ID were demonstrated, but it was also shown that the strength of such associations varies among sub-groups of this heterogeneous population. Future research needs to take account of the circumstances surrounding the life changes, the period of time over which changes might have taken place, and the meaning that the person might attach to the changes. Research into the causal relationship between exposure to life events and the onset of psychiatric problems is also warranted.

Patients with disabilities and complex communication needs. The GP consultation

BACKGROUND

People with complex communication needs vary in terms of their underlying disability and the methods and strategies they use to communicate.

OBJECTIVE

This article describes the varied communication profiles that a general practitioner is likely to encounter in patients with disabilities, and the various types of augmentative and alternative forms of communication that might be used in such consultations.

DISCUSSION

This article provides strategies to facilitate doctor-patient communication involving patients with complex communication needs, some of which are illustrated in a case study of a young woman with an intellectual disability.

Health care service provision for country people with developmental disability: an Australian perspective

Priorities in the delivery of health care to Australian country people with developmental disability were explored through focus groups and interviews of key stakeholder groups from four rural/regional towns. Data were analysed for themes, which converged on lack of access to primary health care providers who lacked knowledge about and had poor attitudes towards developmental disability, discriminatory practices, the burden on support people, and communication difficulties between GPs and people with developmental disability. Potential strategies to address the apparent dissatisfaction with primary health care and GP concerns about working with this group were also evident in the data. In particular, open communication between stakeholders as a mechanism for collaborative problem solving and a strategy to avoid burn out for both support people and GPs is recommended. Facilitation of such communication can best occur through undergraduate training and participation of disability workers in activities of organisations that support GPs.

Assessment of phonemic awareness and word reading skills of people with complex communication needs

A series of phonemic awareness (PA) and single-word reading tasks, which did not require spoken responses, was developed for administration to people with complex communication needs. The aims of the study were to (a) determine the construct validity of the PA tasks and (b) investigate the relationship between PA and single-word reading in adults with complex communication needs. Forty adults with physical and/or intellectual disability were administered these tasks and a standardized measure of receptive spoken vocabulary. In assessing construct validity, data from all participants, including those who used speech, were included in a factor analysis, which indicated that the PA tasks loaded onto a single factor. This factor was interpreted to be PA. The relationship between PA and single-word reading in adults with complex communication needs was determined using correlational and multiple regression analyses of data from 34 of the original participants who did not have functional speech skills. These analyses indicated that receptive spoken vocabulary accounted for a significant amount of variance on most tasks. Additional significant variance in performance on the single-word reading tasks was accounted for by performance on the PA tasks, in particular, Nonword Blending and Phoneme Analysis. These results indicate that the tasks developed provide a valid means of assessing PA and single-word reading skills. In addition, the results indicate that adults with complex communication needs demonstrate the same positive association between PA and reading as has been found in other groups of individuals with and without disability.

The experiences of people with developmental disability in Emergency Departments and hospital wards

The aim of this study was to determine whether needs of people with developmental disability were met during visits to Emergency Departments and stays in hospital. Responses to a questionnaire were obtained from 328 clients of three Victorian organizations. Of 119 respondents who had attended a hospital within a year of completing the questionnaire, most indicated that their needs were met in the areas of hydration and nutrition, medication, mobility and discharge. There were significant associations between getting enough to drink and being able to move from a bed, and having a support person stay with the patient. These results suggested a great reliance on support people during hospitalizations. Issues raised in the questionnaire were explored in follow-up interviews with 11 respondents or their support people. Reliance on support people emerged as a strong theme in interview transcripts, as did hospital staff's negative attitudes, and lack of skills and knowledge in developmental disability. These results are discussed in light of recent literature and the need to address issues in the larger context of the needs of support people and hospital staff.

Health issues for adults with developmental disability

The aim of this paper is to review recent literature on health issues for adults with developmental disability and reflect on how this research informs service provision, future research work, and social and health policy. Studies based on mortality data are most likely to aim at identifying individuals most at risk of premature death, and some researchers argue that health-oriented service systems appear ill-equipped to address the needs of the at risk groups. Morbidity studies highlight specific health concerns found in this population and commonly report high rates of untreated, yet treatable, conditions. The emerging literature on the behavioral determinants of health suggests risk of preventable morbidity and mortality because of the lack of health-promoting behaviors, particularly in relation to diet and physical activity. Of particular interest in this literature is the affect of living arrangements on health promoting activities. This paper concludes that future directions in health research for adults with developmental disability will be concerned with the complexity of the interactions between biology, pathology, and behavioral and environmental determinants. More use of self-reported health studies is suggested, as well as further exploration of effective strategies of health promotion and health promoting decision-making and self-determination among this population.

Phonological awareness and oral reading skill in children with Down syndrome

The existence of a necessary association between phonological awareness (PA) and oral reading development has been questioned using evidence from children with Down syndrome. In this study, 22 children with Down syndrome (between the ages of 6;7 and 10;3) initially completed tests of receptive language, cognitive function, oral reading, and PA. Reading and PA were reassessed approximately 9 months later. Better oral reading was associated with superior phoneme segmentation skills on reassessment. Furthermore, there was some evidence that early segmentation ability predicted later nonword reading, but not the reverse. The results indicate an association between PA and early oral reading ability in children with Down syndrome and are interpreted within a theoretical view of reading development in which PA plays a central role.