The five papers in this edition are linked by a common thread. They reflect the universal human need to interact and engage with others – they testify in their separate and diverse ways to the importance of communication for emotional, psychological and social well-being. Communication is central to our lives as social beings. It is how we exchange ideas, share knowledge, pass on information, give advice and a thousand-and-one other day-to-day interactions but, at a more fundamental level, it is how we make our wishes and needs known, and it is how we reach out to and make contact with others But communication for people with learning disabilities may be problematic. For all sorts of reasons it can be difficult for people with learning difficulties to reach out in this way and make contact. This edition of the journal is in two parts. The first three papers look at interventions in people's lives to facilitate and support communication, and thus to improve the overall quality of their lives. The last two papers look at how to enhance communication so that people with learning disabilities have the means to make their wishes and needs known to others. The first three papers, then, look at what happens when there are barriers to communication. The authors identify situations where people's wishes and needs cannot be expressed in ways readily understood by others but, instead, find distorted expression in, for example, violent incidents or other manifestations of challenging behaviour, or in depression, or in potentially self-mutilating and dangerous sexual practices. What interventions have proved beneficial to the people concerned? What lessons can others learn from these results? The first paper, by George Rowland and Simon Treece, on ‘Violent incidents’, looks at the role communication – or lack of it – played in the lives of four men with severe learning disabilities, and ‘severely challenging behaviour’. The authors' retrospective evaluation of the purpose-built specialist unit where the men were placed on their discharge from a long-stay hospital, found that the emphasis there was on promoting communication, in its widest possible sense. This had the effect, over a six-year period, of reducing the number of violent incidents and the need therefore for reliance on antipsychotic medication to control them. The second paper, by Karen Long, Harry Wood and Nan Holmes, looks at assessing and treating depression in a young woman, Ms X, ‘with learning disability and autism’. Ms X, aged 19, had ‘extremely limited communication skills’ that prevented her from expressing her wishes and needs effectively and that found expression instead in challenging behaviour. The picture was further complicated by an underlying depression that was difficult to detect but, once diagnosed, could be treated not only by medication but by enhanced opportunities to develop activities, networks and family contacts. At the heart of this programme was the detailed and personalised work of the speech and language therapist in working with Ms X on developing her means of effective communication with others. The third paper, by Alison Williams, Linda Phillips, and Zed Ahmed, focuses on their work with Joe, aged 20, who had a history of engaging in auto-erotic practices. They reduced his sexual behaviour through ‘environmental strategies’. This entailed strict monitoring and control of Joe's sexual behaviour whilst at the same time a male support worker worked with him to develop his social life and activities, and to extend his relationships. The last two papers in this edition focus on how communication can be improved or enhanced. One way is to look at how people with learning disabilities in a local area actually use words and phrases, what vocabulary they draw on, and which topics of conversation they cover, in order to extend the range and quality of their communication with others. This is what Judy Graves set out to do, and in her paper on ‘Vocabulary needs’ she describes how she involved staff and service users in local residential and day settings in holding conversations, and recording in diaries the main topics covered. She found that the major talking points were interests, leisure, day activities, food and drink. Very few conversations were about feelings. Emotional needs can find expression, but perhaps they require a vocabulary which allows or encourages them to be expressed. The work of Isabel Hernadez-Halton and her colleagues at the Tavistock Clinic in London, reported in their paper ‘A psychotherapy service’, demonstrates with examples that people with learning disabilities can be supported in learning to convey their feelings and thoughts in order to understand them better.
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May 1, 2002
Cathy Aymer 
Open Access