The role of communication partners in conversations with people with learning difficulties

1. The role of communication partners in conversations with people with learning difficulties Dr Celia Todd

2. What I will cover: • Why a Doctorate of Education? • Research questions and methodology • Looking at conversation • Case study – AAC user • Findings from larger study • Implications for practice • Assessment practices • Use of SGDs • Preparing staff and families • What next?

3. Doctorate of Education • Taught modules – to develop thinking, exposure to sociological and educational concepts • Exploration of broad range of research methodologies • Professional focus - practical outcomes

4. Theresearch: Primary questions • What happens in informal conversations between people with learning difficulties and their communication partners? • How can the research findings be used to improve professional practice? • How can people with learning difficulties be involved in research?

5. Methodology • Loan of video camera to 3 “research partners" with learning difficulties to record conversations of their choice • Transcribe and analyse this data using • Conversation Analysis • Systemic Functional Linguistics

6. Conversation Analysis • Sociological/Ethnomethodological perspective • Harvey Sacks, Emanuel Schegloff and Gail Jefferson • Interested in the detail of actual practices of naturally occurring talk-in-interaction, in particular its sequential organisation. • Participants own understanding as revealed in the exchange itself

7. Systemic Functional Linguistics • Discourse analysis with a linguistic perspective • developed by Michael Halliday • Focuses on how people use language and how language is structured for use • Integrated, comprehensive, systematic model of language

8. Annotation Gesture, facial expression, artefacts etc. Overlap Intonation Increased pitch Increased volume Pause Eye gaze

9. Case Study Cate • Aged 24 • Severe cerebral palsy • Wheelchair user with restricted hand function • Uses a DV 4 Communication aid • Lives in her own flat with 24 hour staff support

10. The conversations • Daisy – her main paid carer who had worked with Cate for 2 years, (Mum and dad also present) • Mother (Dad, brother and Daisy also present) • Lisa – new member of staff (Daisy also present)

11. Topic control • Mostly controlled by conversation partner • When Cate tried to introduce new topic, brought back to original topic by partner after 2 or 3 turns • Some attempts at topic change by Cate ignored

12. Turn construction Cate Mostly one Turn construction Unit (TCU) Mostly yes or no response If 2 TCUs usually Yes + additional information Partner Lots of one turn TCUS Frequent use of 2 TCU structure consisting of wh question followed by yes/no question

13. Co-construction • Partners build turns collaboratively • Common in conversations with people with communication impairment • Example D: Do you not like the warm↓ C: /ɜræn/ ((Stretching arm towards L)) L: It won't be too hot↓ ((shaking head))

14. Use of Questions Cate Asked very few questions How can she? Partner Clarification Qs – repeats with rising intonation Yes/no questions to construct message Very few Tag questions Test questions – to which they already knew the answer

15. Breakdown Cate No problems understanding partner Partner Frequent understanding checks Use of familiarity and prior knowledge Sometimes ignored or unresolved

16. Repair Very little self initiated repair by Cate Repair by partner (OIR) • Repeat or partial repeat • Candidate answer • Request for repetition • Do you mean? Open→Wh→Rpt+Wh→Rpt → Direct check WEAKER STRONGER (From Sidnell (2010a) p.118)

17. Pauses Long pauses tolerated Frequently longer than 2 seconds – often if Q to Cate required other than a yes/no answer Pause by partner if repeat or candidate answer

18. Overlap Mostly at end of TCU – yes no or continuer When Cate was asked a question and did not immediately respond – sometimes filled by partner resulting in overlap

19. Intonation Cate Restricted tone patterns Mostly falling tone Very occasional rising tone to ask Q Occasional rise/fall + broad smile when definite about her response after an extended repair sequence Partner Widely varied tone Frequent use of rise/fall tone with increased stress – surprise/ use with children Fall/rise to query accuracy or unclear that they had understood her correctly

20. Eye contact Cate Compromised by her positioning Used to bring people into conversation to aid repair Disrupted by using SGD Partner Tended to maintain constant eye contact

21. Facial expression Cate Limited facial expression Smiling to build answer Broad smile when partner finally successful • Partner • Puzzled look to query what was said • smiling Nodding and shaking Sometimes difficult to distinguish between nod and head shake

22. Gesture and sign • Amount varied between conversations • Very little used by unfamiliar partner • Signing used by Cate and her mother - often prompted by mother • Familiar care staff used mime

23. Use of objects and SGD • Not used spontaneously – always prompted by partner • Performance – showing how it worked • Used for spelling • Disrupted eye contact and excluded Cate from the conversation

24. Evaluative Language Cate Very little use of evaluative language Partner Frequent judgement of speech attempts and use of VOCA High incidence of amplified evaluation “That’s really really good” Restricted phonemic repertoire

25. Association Prompt to use SGD spelling M: What’s the first thing you’re going to have↓↑ ((smile)) That you haven’t been able to have for a long time↑{€→C} C: /ʌ/ (..) /bæ æ↓/ ((smile)) {€→M} M: Butter↑↓ ((smiling, eyes widening)) {€→C} C: /næ æ↓/ ((smile)) {€→M} M: No↓↑ ((shaking head)) {€→C} C: /uː juː aɪ æ↓/ {you like it} ((smile)) {€→M→D} M: (..) You like that↓ what is it↑ {€→D→C} C: /dæ aɪʔ↓/ {€→D→M} M: ((shaking head)) (..)Is it on your Dynavox↓↑= ((Pointing to Dynovox)) {€→C} C: =/nəʊ/↓ {€→M} M: [Is it↑] {€→C} N: [Can you] spell it↑ ((off camera))

26. M: Ye, what letter does it begin with↑ {€→C} C: /nɪː/↓ {€→M→DV} ((D reaches to Dynovox)) M: It begins with B↓↑ {€→C} C: (..) /je↓/ ((smile)) {€→D} D: ((activating Dynavox)) B yes↓↑ what else↑ {€→DV→C→DV} C: (2.3) /æ↓/ ((smile)) {€→D} M: A↓↑ {€→C} C: /je↓/ {€→D→M} M: B A↓↑ {€→C} D: ((Activating Dynavox)) {€→DV→C→DV} M: (3.3) yeh {€→C} C: {€→M} /jæ æ↓/ {€→M} M: [Batter↓↑] {€→C} N: [batter↓↑] Use of SGD by staff to spell Guess work!

27. Shake of head C: ((Slight shake of head)) /jæ ʌ↓/ {€→D} D: (..) B A yeh↓↑ got B A ↓ {€→C→DV→C} C:/ɪ ɒ↓/ (..) /ɒ ɔ↓/ {hot}((moving right arm up and down)) {€→M} M: Hot↓↑ its hot, curry↓↑ Thats not B↓ ((shake of head, frown)) {€→C} C: /bæ ʌ↓/ {€→M} (3.3) ((D shakes head)) M: Again↓ ((shake of head)) {€→C} C: /juː e ʌ æ↓/{you make it}{€→M→D} D: I make it↑(..) I eat it↑ {€→C} C: /en↓/ ((nod of head, smile)) {€→D→DV} D: What the heck↑ {€→C→DV} C: LAUGH (1.2) /jæ æ↓/ ((smile)) {€→M} D: Potatoes↓↑ {€→C} C: ((Slight shake of head)) {€→M} D: Roast potatoes↑↓ {€→C→DV} C: /nuː↓/ {€→M} gesture Prior knowledge

28. No it wouldn't be roast potatoes↓↑ ((shaking head)) {€→C} C: /aʊː↓/ ((indicating “out” with right hand)) {€→M} M: Out↓  {€→C} C: /njeː↓/ ((slight nod)) {€→M} M: (..) burger↑↓ ((eyes widening)) {€→C} C: /naʊː↓/ ((shake of head)) {€→M} M: Oh↓↑ {€→C} D: Battered sausage↑{€→C} C: ((Slight shake of head)) {€→D} N: Bacon↑ C: /naʊ↓/ ((Slight shake of head)) {€→M} N: LAUGH M: Is it, is it in a take away [place↑] {€→C} C: [/iː jə æ↓/]{€→M→D} M: Daddy likes it↑ ((shaking head)) {€→C} C: /ɔːə aɪm↓/ {€→M} M: Allthe time↑↓ {€→C} D: do you mean Pasty↑ {€→C} C: /jeː↓/ ((smile)) {€→D→M}

29. Roles , relationships and identity • Lack of real friendships – limited social networks and reliance on staff and family • Staffs perception of the relationship (Antaki 2007) • Family role – the “eternal” parent (Jingree and Finlay 2012)

30. Competence and evaluation Osburn 2006 • Competence undermined by discourse style – unintelligible speech ignored, or understanding check (Bloch 2005). • Questions adequacy, accuracy or plausibility of what is said

31. Evaluation • Competency judgment – related to performance • Often amplified

32. Recipient design, reasonable adjustments or patronising speech! • What is patronising speech? • Baby talk • Over-accommodation to needs of partner • Use of diminutives • Speaking louder • speaking more slowly • Exaggerated tone – higher pitch • Use of shorter sentences • Inappropriate collective nouns “we” • Eye contact – too much or too little

34. Power and control • Asymmetrical conversations • Topic choice • Longer Turn Construction Units • Amount and type of questions • Yes/no rather than Wh • Wh Q immediately followed by yes/no Q “Where was it? Do you know where it was?” • Parent: child or teacher: child type interactions (Leahy 2004, Jones 2007) Question:Response:Evaluation

35. Implications for practice • What can we learn from detailed listening – does this give us strategies for assessment, therapy and partner training?

36. SLT Assessment – Observational tool

37. Implications for training

38. How can we set up communication aids to be helpful for clients whose use them to support speech? • Topic management • Asking questions • Clarification and repair • How can we give power to the speaker? Blackstone et al (2007) – communication parity: “the extent to which interactants themselves feel that they are • Equal partners in the interaction (as befits the context) • Have equal access to communication time and resources, and • Are comfortable in presenting their authentic selves in context”

39. References • ALDRIDGE, J. 2007. Picture this: the use of participatory photographic research methods with people with learning disabilities. Disability & Society, 22, 1-17. • ANTAKI, C., FINLAY, W. M. L. & WALTON, C. 2007. The staff are your friends: Intellectually disabled identities in official discourse and interactional practice. British Journal of Social Psychology, 46, 1-18. • ARMSTRONG, L. & MCKECHNIE, K. 2003. Intergenerational communication: fundamental but under-exploited theory for speech and language therapy with older people. International Journal of Language and Communication Disorders, 38, 13-29. • BLACKSTONE, S., WILLIAMS, M. & WILKINS, D. 2007. Key principles underlying research and practice in AAC. Augmentative and Alternative Communication, 23, 191-203. • BLOCH, S. 2005. Co-constructing Meaning in Acquired Speech Disorders: Word and Letter Repetition in the Construction of Turns. In: RICHARDS, K. & SEEDHOUSE, P. (eds.) Applying Conversation Analysis. Basingstoke: Palgrave Macmillan. • HUMMERT, M. L. & RYAN, E. B. 1996. Towards understanding variations in patronising talk addressed to older adults: psycholinguistic features of care and control. International Journal of Psycholinguistics, 12, 149-169. • JEFFERSON, G. 1987. On exposed and embedded correction in conversation. In: BUTTON, G. & LEE, J. R. E. (eds.) Talk and Social Organization. Clevedon, Avon: Multilingual Matters. • JEFFERSON, G. 2004. Glossary of transcript symbols with an introduction. In: LERNER, G. H. (ed.) Conversation Analysis: Studies from the first generation. Amsterdam/Philadelphia: John Benjamins. • JINGREE, T. & FINLAY, W. M. L. 2012. 'It's got so politically correct now': parents' talk about empowering individuals with learning disabilities. Sociology of Health and Illness, 34, 412-428. • JONES, D. 2007. Speaking, listening, planning and assessing: the teacher's role in developing metacognitive awareness. Early Child Development and Care, 177, 569-579. • JONES, F., PRING, T. & GROVE, N. 2002. Developing communication in adults with profound and multiple learning difficulties using objects of reference. International Journal of Language and Communication Disorders, 37, 173-184. • LEAHY, M. 2004. Therapy Talk: Analyzing Therapeutic Discourse. Language, Speech and Hearing Services in Schools, 35, 70-81. • MONDADA, L. 2006. Participants' online analysis and multi-modal practices: projecting the end of the turn and the closing of the sequence. Discourse Studies, 8, 117-129. • MURPHY, J. 2006. Perceptions of communication between people with communication disability and general practice staff. Health Expectations, 9, 49-59.

40. OSBURN, J. 2006. An Overview of Social Role Valorisation Theory. The Social Role Valorisation Journal, June. • OWENS, J. 2006. Accessible information for people with complex communication needs. Augmentative and Alternative Communication, 22, 196-208. • POWELL, G. 2000. Current research findings to support the use of signs with adults and children who have intellectual and communication difficulties Available: www.makaton.org [Accessed 26th September 2008]. • PRIOR, S., BLACK, R., WALLER, A. & KROLL, T. Investigation of Narrative use in the care environment. Communication Matters, 2011 Leicester. • RUST, T. B., KWONG SEE, S. & SCHWALFENBERG, A. Caregiver's use of Patronising Speech While Interacting with People with Alzheimer Disease. Psychologie Canadienne, 2010 Winnipeg. • SACKS, H. 1992. Lectures on conversation volume 1. In: JEFFERSON, G. & SCHEGLOFF, E. A. (eds.). Oxford: Basil Blackwell. • SCHEGLOFF, E. 1987. Analyzing Single Episodes of Interaction: An Exercise in Conversation Analysis. Social Psychology Quarterly, 50, 101-114. • SIDNELL, J. 2010 Conversation Analysis, Chichester, Wiley-Blackwell. • THURMAN, S. 2011. Communicating Effectively with People with a Learning Disability, Kidderminster, BILD. Many thanks Celia.todd@cft.cornwall.nhs.uk