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Communication in Practice
- A presentation for Allied Health
Professionals 2013
Gerry Coulson, Speech and
Language Therapist
AHPs and communication
• Good people skills and excellent
communication skills
• Committed to working as part of a team
• Be able to 'teach'
• Have empathy
• (from NHS Careers website 2013)
• ‘Communication and sociability are the
human abilities which make the
greatest contribution to emotional well
being and they are also the basic tools
by which all else is achieved’
(Nind, M. and Hewett, D., 2005)
Communication goes wrong for
• Question from wife “What is wrong with
this computer?!!!”
• Reply from husband “I don’t know!! Have
you tried turning it off and back on again?”
• Wife: “That’s no good. It’s always doing
this to me!”
• Husband “Have you told your IT
• Wife “Aaaahhh!!!!!!”
Effective Communication – Kelly, A. (2001)
Effective use of
the skills
The Skills
What are the underlying skills?
• Social awareness and interest
• Social understanding – why people do
things and other people’s perspectives
• Ability to use communication skills socially
and functionally
Functional communication
(Money, D. & Thurman, S. 1994)
Basic Communication
• Shared focus or joint attention
• Turn-taking (Cooperation)
• Maintaining and repairing
Typical development of communication
Eye gaze and facial expression
Coordinating eye contact with reaching
or touching
Engaging in turn-taking sequences
Use of conventional gestures
Linked to the development of social cognitive skills eg discrimination of self
and others and perception of others as agents of action and contemplation
(8-12 months)
Theory of mind develops at about the age of 4 – being able to attribute
mental states in others which may be different from ones own
Attentional demands of social interaction are dydactic (self and other)
Additional attentional demands of joint attention and behaviour regulation triadic (self, other, object/event/consequence)
From lecture: Communication in Autism – Dr Rhea Paul, Yale University (2010)
Intentionality and meaning
• A lifeless human form
- What does this image communicate to
- Is it intentional?
- Context and conventionality
Impact of Learning Disability,
Cognitive decline, Autism or Mental
Illness on communication
• Achieving shared focus – What is the
individual attending to?
• Recognition and recall and processing
• Echolalia
• Ideosyncratic language
• Literal understanding
Views of individuals with ASD –
impact on life
Affects relationships at work, developing and
maintaining personal relationships, appropriate
behaviours around members of the opposite sex
– (Sperry, L. & Mesibov, G. 2005)
“Sometimes I don’t talk to people because I’m
worried about not understanding or they
might not understand me until I get used to
“You said you don’t know what it’s like for us
to talk to people for the first time because
you don’t have Asperger’s but we don’t know
because we do have Asperger’s”
Triad of impairments in Autism
and restricted
• social interaction, communication,
imagination, and behaviour (narrow, and
repetitive pattern of behaviour) (Wing, L.
• impaired social interaction, impaired
communication and restricted and
repetitive interests and activities (Happé,
F. Ronald, A. & Plomin, R 2006)
Theory of Mind
• The ability to take another’s perspective or
“put yourself in their shoes”
(Baron-Cohen, S. 1995)
(Frith, U. 2003)
• Sally Anne dolls test
• “ I used to get into trouble because I didn’t
understand that teachers and students
don’t apparently have an equal status”
Practical techniques
• Observation and awareness of the individual’s
level of understanding and level of engagement
• Intensive interaction
• Environment, and visual (or tactual) supports
• Personalised Accessible information
-Level of content
A special mention….
• Social stories™
- a way of describing and explaining social
behaviour and situations in writing or pictures.
This can help people to understand better, learn
useful ways of behaving and be less anxious
about those things
• Comic-strip conversations™ and Thought
To do list……..
• Prioritise and simplify information
• Personalise
• Practice
Drivers – why must we get this
• Positive outcomes, well-being and satisfaction –
commissioning and the thorny issue of measurement
• Professional standards and HCPC standards of conduct,
performance and ethics (2012) –”communicate properly
and effectively with service users and other practitioners”
“best interests of service users” , “informed consent”,
“accurate records”
• Mental Capacity Act (2005), Mental Health Acts (1983 &
2007) - consent
• Equality Act (2010) – respect, dignity and reasonable
• What do NHS, AHP, OT, SLT, Physio etc
mean to people?
Barnlund, D. C. (2008). A transactional model of communication. In. C. D. Mortensen (Eds.),
Communication theory (2nd ed., pp47-57). New Brunswick, New Jersey: Transaction
Baron-Cohen, S. (1995) Mindblindness: an essay on autism and theory of mind
Equality Act (2010) UK government
Frith, U. (2003) Autism: Explaining the enigma. Cambridge MA: Blackwell
Happé, F. Ronald, A. & Plomin, R (2006) Time to give up on a single explanation for autism.
Nature Neuroscience, 9, 1218-1220
Health and Care Professionals Council Standards of conduct, performance and ethics (2012)
Kelly, A. (2001) Working with Adults with Learning Disabilities. Speechmark. Oxon
Littlejohn, S.W. and Fosse, K.A. (2008) Theories of Human Communication. 9th edition. Belmont,
C.A.: Thomson Wadsworth
Money, D. and Thurman, S. (1994) Talkabout Communication. Bulletin of the College of Speech
and Language Therapists, 504, 12-13
Nind, M. and Hewett, D. 2nd Edition (2005) Access to communication. David Fulton Publishers
Paul, R (2010) Lecture on Communication in Autism, Yale University. Youtube
Shannon, C.E. and Weaver, W. (1949) The mathematical theory of communication. Urbana,
Illinois: University of Illinois Press
Sperry, L. and Mesibov, G. (2005) Autism: The International Journal of Research & Practice, 01
October 2005, vol./is.9/4(362-376), 13623613
Wing, L. (1997) The autistic spectrum. Lancet 350, 1761-66