Interactions involving people with severe intellectual disabilities

People with severe intellectual disabilities usually have few formal language skills, may not be able to produce or understand speech because of their developmental level and, as they communicate in idiosyncratic ways, carers may have difficulty recognising and interpreting communication. There is currently little known about what interactions involving people with severe intellectual disabilities actually look like. Because of the lack of previous research, an exploratory approach was used to examine this over-arching research aim. Approximately 40 hours of video data of everyday interactions between care staff and people with severe intellectual disabilities were collected from one residential centre and one day centre in the South of England. The main analytic approach used is conversation analysis although ethnographic notes were also made and are drawn upon throughout. At times, other methods are also used. Themes emerged from the data and are 1. Vulnerability 2. Relationships 3. Resistance and 4. Meal-time interactions. It is suggested that: 1. People with severe intellectual disabilities are vulnerable but are often viewed as only vulnerable. A holistic view should be taken when considering risks in the lives of people with severe intellectual disabilities. 2. Close interpersonal relationships can exist between care staff members and people with severe intellectual disabilities and these are demonstrated through their actions. Such relationships should be acknowledged. 3. People with severe intellectual disabilities may resist activities in a number of ways. Ideally staff should acknowledge and respect signs of resistance. Making people as mobile as possible may help to promote independence. 4. Meal-time interactions require co-operation between people with severe intellectual disabilities and care staff. People with severe intellectual disabilities can be active players within these interactions and this should be encouraged. It is also suggested that people with severe intellectual disabilities may be capable of making some decisions which affect their wellbeing. This is in contrast to a current specifier in the DSM-5 (APA, 2013). Practical suggestions for care staff are also provided.