Verbal and non-verbal communication

In the previous step, we have seen the ways in which language can either act as an aid to understanding or can become a confusing barrier for the person with an intellectual disability. Language is not the only way, however, that we communicate.

In Step 1.5, we defined intellectual disability in terms of lower than average IQ (Intelligence Quotient). This, however, does not measure a person’s emotional intelligence.

Emotional intelligence is the capability of individuals to recognize their own emotions and those of others, discern between different feelings and label them appropriately, use emotional information to guide thinking and behavior, and manage and/or adjust emotions to adapt to environments or achieve one’s goal(s).

EQ (Emotional Quotient), is a phrase popularised by writer Daniel Goleman. Many individuals with intellectual disabilities may be very emotionally intelligent and be very skilled at reading others’ emotions and finding ways to be pleasing or agreeable to other people.

Simply because someone has an intellectual disability, it is a mistake to think that you cannot hurt their feelings or that they cannot tell when you are ignoring or patronising them. In a previous step, you have already learned about building rapport with the person. This goes beyond just the words that you use.

Non-verbal communication

It has been understood since the 1960s that the majority of our communication can be non-verbal, thanks to the work of Albert Mehrabian.

During health assessments, it is a useful reminder to us that we need to consider:

• Whether we make eye contact,
• The place where and position in which we sit,
• Whether we stand to greet the person,
• The gestures that we use during the consultation,
• The level of appropriate physical contact we make with the person.

All of these, and more, are being ‘read’ by the person with an intellectual disability and, as mentioned above, may be scrutinised in a way that others might miss.

As a health professional, you will also be trying to read the body language of the person with an intellectual disability. This may be very difficult to begin with as the person may have physical behaviours and tics that might give a wrong impression. They may be reluctant to make eye contact, for example, or they may make non-language vocalisations. They may also have behaviours that show their frustration or annoyance but which, without prior knowledge, you would not know.

Being aware of our communication

How we say what we say, such as the speed, tone and volume of our voice will all have an effect on the way in which our communication is received and responded to by the person with an intellectual disability. The same words, but spoken in a brusque or patronising tone can have the opposite effect of what was intended.

Communication is also cultural. The culture in which the person has grown up can affect what they think is appropriate behaviour. They may not wish to shake your hand if they are of a different gender to you, for example. They may challenge your opinion in a way that other patients do not. This does not relate to their disability; it is a reminder that all patients have a cultural history that you need to remember.

Not everyone can get non-verbal communication right all of the time. We can all misinterpret each other and fail to communicate over misunderstandings. This is also true for people with an intellectual disability.

Tips for non-verbal communication during health assessments

Consider these questions when you are communicating with a person with an intellectual disability.

• Are you focusing on the person? Are you making eye contact with them? Are you facing in their direction?
• Are you sitting or standing in a position that can be intimidating, e.g. behind a desk, on a raised platform?
• Are you assuring them, by your behaviour, that you are interested in what they have to say and that you have time for this consultation?
• If they have difficulty speaking, do you look uncomfortable or strained when trying to understand them?
• Do you adopt a sing-song tone of voice, like when you are speaking to a young child?
• If you are someone who gets exasperated easily, how do you express this, e.g. sighing, eye-rolling? How can you keep that behaviour in check?
• Can you pick up tension or anxiety from the person’s behaviour? Are their eyes darting about? Are they wringing their hands?

In your experience

• Think about a person you have met who displayed anxiety. What non-verbal body language did they show?
• What steps could you take to make them feel more at ease?