Behaviour and Communication
Some adults with learning difficulties often display inappropriate or challenging behaviour. Although there are many reasons for this type of behaviour, it can often be linked to a breakdown in communication. When someone is unable to express themselves, or does not understand what they have to do, this is when behaviours may occur.
Be Aware of your Language level
The receptive language level of an individual with challenging behaviour is an important issue to consider. Often an individuals lack of understanding is overlooked because he appears to understand what is going on around him. This is very true of some autistic adults who may use a lot of expressive language (not necessarily functionally) which gives the impression that their receptive language is better than it actually is.
When an individual has expressive language difficulties, behavioural problems can occur just as easily, for instance, if Bob cannot tell you he has a toothache, he is liable to get a little “ratty” when you keep telling him he has to go and play basketball.
There are many ways to adapt your communication to help individuals understand, pitching your language at the right level and reducing the complexity of your sentences where appropriate. You must have an awareness that the individual’s receptive language may be more delayed than you realize. It is important to get these areas assessed by a qualified speech and language therapist / pathologist.
Minimal Speech Approach
The minimal speech approach focuses on using one or two key words rather than a sentence when communicating with adults who have difficulties with understanding. For instance, a carer could say to an individual with autism, “Right, get your coat and boots and let’s go out to the beach”. The individual may not understand any of the command and completely ignore the carer, or may just follow what others are doing. Alternatively the carer could take the individual to their coat, hand it to them and say, “coat” and then “beach”. The individual may realise when he is handed his coat that he is going out, and when he hears “beach”, he may be able to understand this single word and realise he is going to the beach. By using single words to describe a focus of attention, it is easier for an individual to make the link between the word and the object or situation.
When using language it is also important to avoid using abstract language and terms. Initially it is probably best to stick with nouns (coat, cup) and verbs (run, swim), rather than use adjectives (big, old), prepositions (in, behind), pronouns (he, mine), or time concepts (tomorrow, this afternoon).
The minimal speech approach can be used with adults or children with a severe communication delay. Just using single words can often be much more effective than sentences. There is now evidence to show that simplifying language not only helps individuals with autism have a better understanding of language, but also has positive effects on behaviour and encourages more interaction and responses. Behavioural difficulties often occur because individuals do not understand what is happening or what other people are expecting. By simplifying language, inappropriate or challenging behaviour may be avoided.
Adding further cues alongside single word commands can also facilitate understanding. Using visuals, a sign or gesture, or objects alongside the speech can give the individual further cues. It is also worth noting, that if you use visuals etc, still use single words, as a longer sentence can distract from the other cue.
Non-verbal individuals who have major learning difficulties or “severe” autism are often very difficult to interact with. Not only do they have major difficulties understanding, but may also be unable to express their own needs or feelings. By “severely” autistic, I refer to those individuals that are non-verbal, non-communicative, and often described as “in their own world”. These individuals have difficulty following instructions and may also display challenging behaviour if approached or encouraged to do something.
Intensive interaction tries to create a communication environment that is enjoyable and non-threatening to the individual with autism, or severe learning difficulties. In some respects the model of the approach is taken from the way we first start to communicate with naturally developing infants, where interactions are short, and involve noises, touch and eye contact. Interactions are brief but can grow over time. Ultimately we are looking for the individual to:
- Accept our presence
- Allow some presence in personal space
- Attend to another person (even fleetingly at first)
- Allow and use some touch
- Engage in eye contact
- Use facial expression
- Focus on body language and facial expression
- Take turns in communicative behaviour
- Take turns using vocalization which may start to have meaning
- Experiment with communication
- Learn cause and effect
The individual is an active participant who is motivated to communicate and who will take the lead and feel a sense of control over the communicative situation.
Through this approach carers can make a connection with an individual, create an enjoyable exchange, reduce challenging behaviour, and develop communication skills. To begin with, sessions may be very short, but expanded over time and varied in activity. Sessions should take place several times daily on a one-to-one basis.
Applied Behaviour Analysis
Using Applied Behaviour Analysis (ABA) new skills are taught by breaking tasks into small steps and working through these steps. Prompting, Shaping and Rewarding are used to motivate the individual to complete the steps. ABA can be part of a comprehensive program, or used to attempt to teach individual tasks new behaviours and replace inappropriate or challenging behaviour.
Ideally, having the skills of a psychologist to help with assessment and programs is the ideal, but this is not always possible. However, there are many things we can do to try and change or replace challenging or inappropriate behaviour. To replace behaviour we need to find the cause of the behaviour (antecedent), what behaviour occurs, and the consequences and function of that behaviour. We need to observe and assess, and define the behaviour and measure it. When we know the causes and consequences of the behaviour, we can look at how to replace it.
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