Difficulties with speech and communication are common for many people with intellectual disability. Some people might experience difficulties with speech itself, have problems with language (including how to use and understand spoken language), or both.
There are many reasons why a person with intellectual disability might experience speech difficulties, and these reasons may or may not be related to their disability. Some of the factors that can contribute to difficulties with speech include (CYWHS, 2011):
- Physical factors and physical disability – such as low muscle tone; structural problems in the mouth, nose and throat; and conditions that affect nerve and muscle control (it is important that physical difficulty with speech does not lead to assumptions about a person’s level of comprehension or language ability)
- Ear infections that can cause hearing difficulties and hearing impairment
- Intellectual disability, which slows the development of speech and language
- Acquired brain injury, which may temporarily or permanently damage the parts of the brain that deal with speech and communication
- Lack of stimulation or experience in communicating verbally
- Traumatic experiences, which can change the chemical structure in the brain and affect the ability to recognise, accurately describe or sequence even concrete concepts (discussed in Shauer, Neuner & Elbert, 2005).
Some of the particular difficulties that people can experience with speech include (CYWHS, 2011):
- Difficulty with making sounds – including saying words clearly or correctly
- Speaking fluently – without hesitating too much or stuttering
- Using words and grammar – knowing and applying the rules of word order and word use
- Choosing the right words and putting them in the right order to convey the intended meaning.
It is vitally important not to make assumptions about why a person experiences difficulties with speech. For example, people who have verbal communication difficulties due to their physical disability are often assumed to have an intellectual disability, due to the association between intellectual disability and problems with communication. This may not be the case.
People with intellectual disability might present as having much higher levels of communication ability than they actually do. Many people with intellectual disability have numerous strategies for masking their disability, and can appear to understand and participate in conversation when their genuine level of comprehension is limited. Mimicking and copying others’ language use is common, and can be convincing.
These strategies can be useful for supporting counselling practice with people who experience speech difficulties:
- Build rapport and safety in the counselling relationship. This is vital in developing the client’s trust in you as someone who will help them to express themselves and their story, regardless of their speech or language problems
- Show the person that what they have to say is valued, and that there is time to be with them and hear their story
- Never pretend to understand a person’s speech. Simply say ‘I’m sorry, could you please say that again?’. You may need to explicitly state that you really want to understand the client, and will get better at understanding them as you get to know each other better
- If the client has little or no verbal speech, find other languages. Talk to caregivers and others who know the client about how they communicate. Do they use particular signs? Symbols? Facial gestures? Body movements or signals? Music? Dancing? Drawing? Photographs and/or other picture languages? Perhaps caregivers or family could support you to learn the best approaches
- Take time to work slowly and with respect – show interest in getting to know the client and their story, and find ways to communicate this
- Regularly check for meaning. Do not make assumptions about what the client is saying or meaning. Use examples and comparisons with other words or scenarios to check meaning.