Communications between staff and adults with intellectual disabilities in naturally occurring settings.
Staff in residential/day services talk too much and too complexly—switch to shorter sentences, more gestures, and open questions to boost client participation.
01Research in Context
What this study did
McConkey et al. (1999) watched staff talk with adults who have intellectual disabilities during normal day and evening routines. They wrote down every word and gesture to see how staff used language.
The team wanted to know if staff matched their words to clients who could not speak or who spoke very little.
What they found
Staff talked a lot and asked many questions. They rarely used simple signs, pictures, or waited for clients to start a turn.
Most clients got few chances to lead the conversation or show what they wanted.
How this fits with other research
Delprato (2001) saw the same mismatch: about half of staff sentences were too hard for the listener’s skill level. Both studies show staff talk too complexly.
Wetterneck et al. (2006) moved the lens to residents’ meetings. Staff still steered talk away from clients, proving the problem repeats in formal and casual settings.
Koenig et al. (2025) widened the view to hospitals and clinics nationwide. Adults with IDD still get poorer explanations and lower satisfaction, showing the gap lasts across places and decades.
Why it matters
You can fix this today. Cut your sentence length in half. Add a gesture, photo, or object cue. Ask open questions like “What do you want?” then wait five full seconds. These tiny swaps give clients more control and practice with real communication.
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02At a glance
03Original abstract
Videotapes were made of 43 staff-client dyads in small-scale residential and day service settings. Frequency counts were made of carers' communicative acts, and two experienced speech and language therapists rated these for appropriateness. Recommendations for enhancing communication were also noted. The results showed that clients were presented with few opportunities to engage as equal partners in the conversational interchanges: staff overly relied on verbal acts, even when they were communicating with predominantly non-verbal clients; they tended to favour the use of directives and questions, and the majority of staff failed to adjust their language to the client's level of understanding. The most commonly recommended changes for staff were to use simpler sentences and words, to increase their use of non-verbal signals and open questions, to provide more opportunities for clients to initiate topics, and to increase their responsiveness to client's non-verbal signals. The explanations for staff behaviour are reviewed and the implications for changing practice are discussed.
Journal of intellectual disability research : JIDR, 1999 · doi:10.1046/j.1365-2788.1999.00191.x