Learning disability and communication

Also called Intellectual disability and communication, LD and communication

Most people with a learning disability have a communication need, most services aren't meeting it, and the law says they must: what the differences are and what the duties look like.

What it is

A learning disability is a lifelong reduced ability to understand new or complex information and to learn new skills, with a reduced ability to cope independently, starting before adulthood. The Health A-Z carries it as learning disability. This entry is about communication, which is affected for most people with a learning disability, from a mild difficulty following fast talk to having no speech at all.

Two things make it more than a personal matter. A person's communication need is the single biggest predictor of whether they'll be misunderstood, ignored or have decisions made for them. And services have legal duties: the Accessible Information Standard in the NHS, reasonable adjustments everywhere, and the Mental Capacity Act requirement to help a person make their own decision before anyone decides for them.

Who it can help

Adults with a learning disability, their families and supporters, and the staff of every service that sees them: GPs, hospitals, care providers, day services, housing and benefits. Children too, though schooling has its own entry.

It isn't about a learning difficulty such as dyslexia, which is different, nor about the profound end, which has its own entry at profound and multiple learning disabilities.

How it works

Understanding is usually affected more than people realise, because a person who has learned to nod and say yes hides it well. Long sentences, abstract words, questions with several parts, time words ("next Tuesday", "before") and figures of speech all get lost. Expression may be limited to short sentences, single words, signs, symbols or behaviour. Reading may be minimal, so a letter is not communication.

What works is consistent: short sentences, one idea each, concrete words, pictures or objects alongside, time to answer, and checking understanding by asking the person to tell you rather than asking "do you understand?". Easy read for written information. Makaton where the person uses it. A communication passport so every new person starts with what already works.

Behaviour is often the person's clearest channel, and a service that only reads it as a problem has stopped listening.

Getting started

Write, or update, the person's communication passport this week and take it to every appointment. Ask the GP practice to record the communication need on the record and to flag it, which the Accessible Information Standard requires.

Practise one habit: after you explain something, ask the person to tell you what's going to happen. If they can't, you haven't explained it yet.

Ask for a speech and language therapy assessment through the community learning disability team. Many adults have never had one and never been offered AAC.

Where to get help

Mencap has a helpline and guidance on communication and rights. BILD publishes practice guidance for staff, and CHANGE makes easy read and trains organisations. The community learning disability team, via the GP or social services, is the NHS route to speech and language therapy; the RCSLT explains the profession. Beyond Words publishes wordless picture stories for talking through difficult subjects.