GANJI Pamphlet Series on Guardianship Issues

No. 1, January 2004

Enhancing Communication with Non-Verbal or

 Communication Impaired People

 Helpful Hints for Judges, Attorneys, Psychiatrists, Psychologists,

Social Workers, Elder Care Managers, and Family

Presented at the 8^th Annual GANJI Conference, October 2003

By Donna-Marie Whelan, MA

Speech/Hearing Specialist I

NJ Division of Developmental Disabilities

Private Practice, Bergen, Hudson and Passaic Counties

Just because someone does not speak does not mean he can’t communicate.  When a person cannot speak, it is the responsibility of the person seeking information to find out how the non-speaking person communicates.  Legal and clinical professionals may have to assume this responsibility when meeting with a non-speaking client.  The clients may include people with:

 ·       Developmental disabilities

·       Physical disabilities

·       Head injury

·       Elderly who have diminished speech

The following are some basic questions along with general strategies and insight for communicating with non-speaking clients.  Foreign languages will not be addressed.

What is Communication?

Communication is an interchange of information between two or more individuals.  Communication can be verbal, non-verbal or a combination of the two.  When we discuss verbal communication, we are generally referring to the words, phrases, and sentences that the person is able to produce.  Non-verbal communication is communicating without spoken words.

What are the purposes of communication: Verbal and non-verbal?

All communication styles serve many purposes:

·       Request an object, action, permission, etc.

·       Refusal, rejection, protesting, avoidance, etc.

·       Decision making

·       Seeking information

·       Giving information

·       Giving directions/options/guidance

·       Socializing

What do I do if someone cannot talk or speak clearly?

If a person cannot talk or is difficult to understand, he may have formal alternate modes of communication.  Examples of these include:

·       Written communication

·       Pointing to letters to form words

·       Communication (picture) book

·       American Sign Language

·       Formal/informal gesture system

Informal non-verbal communication includes the following:

·       Facial expression

·       Directed eye gaze (looking at something and waiting for someone to comment)

·       Vocalizations (squeals or laughing to indicate pleasure, agreement, consent, etc.  Screaming or grunting can indicate anger, displeasure, negation, etc.)

·       Actions (self-injurious behavior, spitting, hitting, etc., can all indicate anger, displeasure, frustration, etc.  Actions are also used to indicate more positive emotions, but it is usually the negative attempts to communicate that are the most obvious and get the most attention)

So where do I start?

Before you deal with the communication aspects of working with or providing an assessment of a person in this population, you must understand that you will need to allocate more time than you usually might.  You will need to visit the individual in a location that is comfortable and non-threatening to him such as his day program, group home, nursing home, supervised apartment, etc.   Typically, it is easier to assess a client in his own environment than in a strange office.   Multiple visits may be necessary for the assessment to establish trust, to gain mutual understanding, and to obtain a valid assessment.  It is important to develop a rapport with the individual before getting to the assessment.  If this is difficult, sometimes a stranger (you) in a person’s environment can gain the person’s trust by socializing with familiar family, staff or caregivers.   Including caregivers at the interview is, at times, important for clarification and for interpretation of words or other communication attempts.  Family members or caregivers can also be invaluable in explaining to you how the client communicates. 

A Useful Inventory

Ask a caregiver who is familiar with the client to fill out the attached Communication Inventory.  The results of the Inventory will give you insight to how the person communicates, who would be able to give you more information, what are the things that the person might like to talk about—these things could help you in establishing a rapport with the individual.  The Communication Inventory could prompt the caregiver to tell you more about the client’s ability than is obvious.  For example, the client is able to use sign language.  If this is the case, it is beneficial to use an interpreter, particularly a CODA (Child Of Deaf Adults) Sign Language Interpreter, because that type of interpreter is more able to read the subtlest of signs/gestures and interpret them appropriately.  Interpreters are available through state registries.

          Written Communication.     You may find out that while the individual speaks and is difficult to understand sometimes, he is able to write some words. (Don’t expect him to spell very well.)  Some individuals have a communication board with an alphabet for spelling out words.  Have paper and pen available!

          Picture Book.     If the client is able to point to pictures to communicate, see if his communication book or board is available.  If it is, take a look at what pictures are there to see if what you will be talking to the client about has appropriate responses available on the board.     If you can, observe someone who knows the client communicating with him using the communication book.  It is important to know what options he has to choose from in the book or he won’t have a picture to answer your question!  If the client has an augmentative communication device, this usually indicates that he is able to communicate effectively using pictures, but, depending on the device, you might want to ask a caregiver for some assistance in using it to communicate with the client.  The best way to do this is to ask to watch them do it, then ask any questions you might have for clarification.  If you have difficulties, it may be a good idea to ask the caregiver to assist you in doing the assessment.  Sometime a client may have a special relationship with a particular caregiver and will pay attention to things that individual asks when he ignores anyone else. 

           Yes/No Response.     But what if you have abstract questions that cannot be depicted by pictures and the client cannot read or write and doesn’t know sign language?    If the client has a consistent, reliable, and appropriate yes/no response to questions, there is almost no limit to what you can ask him.  YOU must figure out how to state the question in a way that can be answered by a “yes” or a “no.”  Once again, caregivers should be able to tell you how the client indicates “yes” and “no”--- if he is unable to verbalize it or nod his head for “yes” and shake his head for “no.”  It might be a thumb up for “yes”, thumb down for “no”, a smile for “yes” and a frown for “no”, or, as one woman I know does—moves her right foot up and down for “yes” and side to side for “no”.  Once you know how someone indicates “yes” and “no”, it’s important to see if they are consistent and appropriate. If a client does not know you, he may respond “yes” to any and all of your questions.  He’s just trying to make you happy, so you might ask a few questions that have “no” as an obvious answer.  If he still responds “yes”, you can tell him that it’s ok to say “no” and try some more.  If he still only responds “yes” to questions, it may be fair to assume that he is unable to use a yes/no answer as an effective communication strategy.

CONCLUSION

The following strategies will assist you in assessing a person with communication-impairments.

1.     Know the communication style.

2.     Include caregivers for clarification and interpretation.

3.     Develop a rapport with the person you are assessing by socializing with him.

4.     Have a familiarity with the setting in day program, group home, nursing home, supervised apartment, etc.  Communication is typically easier in the person’s own environment rather than in a strange office.

5.     Sometimes a stranger in the client’s environment can gain the client’s trust by socializing in a positive, friendly way with familiar family, staff, or caregivers.  The client sees the stranger interact with someone he trusts and, if it appears that the stranger is liked by the caregiver, the client will be more open to interacting with the stranger.  If there is still a problem, the caregiver can stay and assist.

6.     Multiple visits may be necessary for the assessment to establish trust, gain mutual understanding and to get a valid assessment. 

COMMUNICATION INVENTORY

Name of Client_______________________      Date__________

1.     Which symbols seem to be processed by the client?

2.     How do you know when the client wishes to communicate?

3.     Does the client communicate with the intent to influence his/her environment?

4.     Present attempts at communication:

5.     Is the client currently using or has he ever used an augmentative communication system?  Describe.

6.     List the client’s favorite activities, people, objects, food, interests, TV shows, music etc.

7.  List the primary people in the client’s life (staff members, family members, special friends, etc.)   Are they available to speak with or could they make themselves available with ample notice?

8.  List ten things that the client is able to communicate about. 

Prepared By___________________________

Title_________________________________