School-based speech-language therapists play a significant role in terms of education and rehabilitation in the lives of learners with multiple disabilities. Assessment forms a critical part of a speech-language therapist’s post description and is the cornerstone of any type of intervention. The assessment of learners with multiple disabilities poses as a great challenge to speech-language therapists. These challenges include a lack of guidelines, resources, appropriate standardized tests and the heterogeneity of the group of learners labelled as multiply disabled. This research project aimed at describing the methods of assessment that school-based speech-language therapists use when assessing learners with multiple disabilities. Additionally, these methods were compared to international best practice. The first phase of the study consisted of compiling a set of guidelines with the purpose of providing a framework for a proposed set of guidelines for the assessment of learners. These guidelines were based on the principles as recommended by the literature regarding best practice. Because a qualitative approach was adopted for this research project, the second phases consisted of data collection, utilising eight focus groups as well as document reviews. On average, each focus group consisted of two to four participants. The data was then analysed thematically and compared to a checklist. The results indicated that speech-language therapists encountered many obstacles when assessing learners with multiple disabilities. It was evident that the participating speech-language therapists assessed within a multidisciplinary team and that they used formal as well as informal methods of assessment with learners with multiple disabilities. Discrepancies were found between the collected data and the guidelines. The guidelines were then used to propose a way forward for speechlanguage therapists when assessing learners with multiple disabilities in schools in Gauteng.

Children who have multiple disabilities often have complex communicational needs (Crickmay 1966; Orelove & Sobsey, 1996; Van Riper & Erickson, 1996; Workinger 2005). To augment or supplement these children’s communication skills some form of alternative and augmentative communication (AAC) may be provided (Beukleman & Mirenda, 2005; Downing, 1996; Orelove & Sobsey, 1996; Stephenson & Dowrick, 2005). However it has been found that parents fear AAC will prevent focus on verbal output which is the preferred way of communication (Allaire et al 1991; Beukelman & Mirenda, 2005; Schlosser, 2003; Stephenson & Dowrick, 2005). This study investigated the impact of a combined therapy approach on the phonetic repertoire of children with multiple disabilities. In addition, changes in communication intent were also explored. Each child received intervention across four, 20-30 minute sessions per week for six weeks. Results show that all of the children made improvements, however not all changes were significant. Clinical implications of the study include the notion that working on traditional therapy techniques can improve the speech and language of children who have multiple disabilities and there is a need to look further at traditional therapies and incorporate AAC into these

Children who have multiple disabilities often have complex communicational needs (Crickmay 1966; Orelove & Sobsey, 1996; Van Riper & Erickson, 1996; Workinger 2005). To augment or supplement these children’s communication skills some form of alternative and augmentative communication (AAC) may be provided (Beukleman & Mirenda, 2005; Downing, 1996; Orelove & Sobsey, 1996; Stephenson & Dowrick, 2005). However it has been found that parents fear AAC will prevent focus on verbal output which is the preferred way of communication (Allaire et al 1991; Beukelman & Mirenda, 2005; Schlosser, 2003; Stephenson & Dowrick, 2005). This study investigated the impact of a combined therapy approach on the phonetic repertoire of children with multiple disabilities. In addition, changes in communication intent were also explored. Each child received intervention across four, 20-30 minute sessions per week for six weeks. Results show that all of the children made improvements, however not all changes were significant. Clinical implications of the study include the notion that working on traditional therapy techniques can improve the speech and language of children who have multiple disabilities and there is a need to look further at traditional therapies and incorporate AAC into these

The Picture Exchange Communication System (PECS) is an augmentative and alternative communication program (Frost & Bondy, 2002). Although PECS has been effectively used to teach functional requesting skills for children with autism, mental retardation, visual impairment, and physical disabilities (e.g., Anderson, Moore, & Bourne, 2007; Chambers & Rehfeldt, 2003), there are limited studies examining the effectiveness of PECS to teach requesting skills for children with multiple disabilities including visual impairment (Lund & Troha, 2008).This study explored the effectiveness of combining tangible symbols and other adaptations with PECS to teach requesting skills to students with multiple disabilities. Specifically, the participants were four students with multiple disabilities including visual impairment who also had many challenges in communication skills. The research design was the multiple probe design across subjects, a variation of a multiple baseline design. A notable benefit to this design is that there was no need to collect continuous recordings of baseline measures, because a strong a priori assumption of stability and the possibility of causing strong participant reactions existed before introducing the intervention. Instead, the researcher made periodic recordings of baseline levels to insure no significant changes have occurred before introducing the intervention.The study included four parts: (a) the assessment of reinforcers, (b) baseline, (c) the implementation of the intervention, which was teaching the three PECS phases and conducting generalization sessions, and (d) the maintenance condition. Three important research questions were posed:1. Can students with multiple disabilities including visual impairment learn to make requests for preferred items using adapted PECS materials and procedures?2. Can students with multiple disabilities including visual impairment generalize requesting skills for preferred items using adapted PECS from training rooms to classrooms?3. Can students with multiple disabilities including visual impairment maintain requesting skills after training?The results indicated that all four participants learned requesting skills using adapted PECS, generalized the newly acquired skills to their classrooms, and maintained the requesting skills after training. Results of this study provided preliminary evidence that PECS with adaptations could be used effectively to teach requesting skills for students with multiple disabilities including visual impairment.

I denna systematiska litteraturstudie ville vi undersöka modern forskning kring kommunikation och delaktighet för elever med flerfunktionsnedsättningar och intellektuella funktionshinder. Ämnet delaktighet för elever med flerfunktionsnedsättningar som ingår i grundsärskolans inriktning träningsskola är ett komplicerat ämne att bearbeta. Elevernas olika förmågor, förutsättningar och svårigheter att uttrycka sig gör det svårt att få insikt i elevernas egna uppfattningar. Konsekvensen av detta blir att personer med flera funktionsnedsättningar ofta blir exkluderade från forskningen. Syftet med studien är att sammanställa forskning som handlar om kommunikation och samspel med elever med flera funktionsnedsättningar på tidig utvecklingsnivå. För att samla in data till vår litteraturstudie gjorde vi vår artikelsökning i Stockholms universitetsbiblioteks (SUB) databas-samling och denna studie omfattar 12 artiklar som berörde vårt ämne. Våra urvalskriterier var att artiklarna skulle handla om elever med flera funktionsnedsättningar och kommunikationssvårigheter samt vara kopplade till lärande och skolmiljö. Kvalitetsgranskning och metodanalys samt resultatanalys av dessa kvantitativa artiklar har dels redovisats i tabellform, som bilaga och ett mer omfattande resultat återfinns i löpande text. Det sammanfattande resultatet visar att omgivningens värdegrund och attityder samt pedagogers förhållningssätt är avgörande för elevernas utveckling och lärande. Undervisningen måste individanpassas utifrån elevernas förmågor och förutsättningar med tillgänglig AKK samt med stöd av partners och mentorer för att skapa de bästa premisserna för samspel och kommunikation.

Thesis advisor: Susan Bruce / The prevalence of children with severe and multiple disabilities who come from culturally and linguistically diverse backgrounds increased considerably with the rise of immigration to the U.S. However, there is very little research about the way that children with disabilities who come from a culturally and linguistically diverse background communicate and develop communication skills (Mueller, Singer, & Carranza, 2006). Furthermore, there is no established term for describing this group of children. That is why this study uses the term Prelinguistic bilinguals to define individuals who use one or more languages at a nonverbal level in their everyday lives. This definition of prelinguistic bilinguals was built upon Grosjean’s (2010) definition of bilingualism. Knowing how prelinguistic bilingual children communicate and develop communication skills is fundamental for their educational team in order to effectively interact and support the children’s communication, which in turn would have a positive effect on their learning outcomes. The main goals of this study were to describe the communication of prelinguistic bilingual children and to learn more about what teachers, teacher assistants, speech language pathologists, and parents do to support their communication in English and Spanish. This qualitative study uses a constructivist theory approach to make in-case and across-case analyses of three case studies. Findings for the study indicated that prelinguistic bilingual children were not only aware of a difference between the two languages, but could also express a preference for one of their languages. Most of the communication supports that the participating adults provided for prelinguistic bilingual children were the same communication supports used for monolingual children developing language, which did not consider the children’s bilingual needs. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Lynch School of Education. / Discipline: Teacher Education, Special Education, Curriculum and Instruction.

This study aims to develop an understanding of the lived experience of family carers of people with PIMD and dysphagia, in relation to mealtimes and food. Policy in recent years has begun to address the inequalities faced by people with learning disabilities and it is striving to improve their lives and the services offered to them. People with profound intellectual and multiple disabilities (PIMD) often have additional eating and drinking difficulties (dysphagia). People with dysphagia require ongoing support and guidance, to maximize their health, specifically their nutrition and hydration. In order to ensure that this support is appropriate, useful and sensitive to the needs of individuals and their families, it is important to try and view mealtimes through the eyes of these individuals and their families. The aims of this study emerged from observations made during my clinical work as a Speech & Language Therapist (SLT) and from engaging in discussion with family carers. In particular it has become increasingly clear from clinical practice that family carers often have different points of view about their son or daughter with profound intellectual and multiple disabilities, than those of professionals. These different points of view are often not clearly articulated by carers or professionals, and clinical interventions may become marked with conflict. This study is sited within a mental health and learning disability NHS trust in the north east of England. It utilises a phenomenological methodology and employs mixed methods to obtain data. Data collection took place between June 2013 and August 2014. Medical descriptions do not capture how it feels to live with impairment and resulting disability. Only when we examine this and allow individuals to tell their stories, as experts in their experiences, can we understand and offer support accordingly and ensure more functional and beneficial interactions and interventions. Findings are presented around four themes – the meaning of food and mealtimes, relationships, roles within the family and challenges. Findings are discussed in relation to the existing literature and recommendations are made for practice and for future research. During this study the adult child is mainly referred to as the ‘child’. For clarity, this is not in any way meant to convey the individual’s presentation as having PIMD as akin to being a child. The term is used to represent the relationship between the parents and the child. Despite the fact that the individuals are adults, they are still the children of the parents, and the relationship is a parent-son/daughter relationship. For brevity the term ‘child’ is used in preference to ‘adult child’. The use of the term has been agreed with the parents participating in the study. All names are assumed and have been chosen by the participants. In the course of this thesis the direct giving of food to the individuals with disabilities is termed ‘feeding’. I acknowledge this term may be associated with potentially negative connotations. The term ‘feeding’ has been used because it is the term used widely in the literature, because it was used by the family carers in their narratives and because there is no other suitable substitute which adequately describes the direct provision of food from one person in to the mouth of another.

Individualised needs based approaches are increasingly being utilised to fund disability support services. Frequently, standardised assessments such as adaptive behaviour scales and, more recently, measures of support needs are used for determining level of need. The aim of this thesis is to understand the relationship between adaptive behaviours and support needs and to investigate factors that impact functional capacity and need for supports for individuals with an intellectual disability. Although a conceptually attractive approach to assessment, concern exists regarding the adequacy of the theoretical framework for guiding the development of support needs instruments. Though possessing theoretical similarities, adaptive behaviour and support needs scales are considered to measure different, albeit related constructs, prompting investigation into the nature of the relationship and the structure of the support needs construct. Accordingly, in Study 1 the Supports Intensity Scale (SIS), the Adaptive Behaviour Scale–Residential and Community (ABS-RC:2), and the Inventory for Client and Agency Planning (ICAP) were used to examine this relationship (N = 80). Dimensionality of the SIS (Section 1) was examined in reference to the three areas of conceptual, social, and practical skills, considered as comprising the adaptive behaviour construct. Factor analysis offered support for measurement of a common underlying construct. When considered in terms of the three adaptive behaviour skill areas, the support needs construct related predominantly to conceptual skills. Unlike adaptive behaviour scales, little is reported about the properties of support needs measures or factors that impact on an individual’s need for supports. Study 2 examined factors likely to influence adaptive behaviours and need for supports; in particular, the presence of coexisting disabilities. Using a measure of adaptive behaviour (i.e., ICAP) and two support needs scales (i.e., SIS and the Service Need Assessment Profile, SNAP), the extent to which adaptive and challenging behaviours and support needs (including medical) were impacted by the number and severity of disabilities was examined (N = 83). Results showed adaptive behaviours and support needs (including medical) were meaningfully related to the number and severity of disabilities present, whereas this was not so for challenging behaviours. Profiles for challenging behaviour measures did not support a linear association with number and severity of additional disabilities, raising the possibility that the profiles were influenced more by the nature of the additional disabilities present. Study 3 investigated the impact of the nature of the additional disabilities present on adaptive and challenging behaviours, support and medical needs using the same instruments utilised in Study 2. Each scale discriminated skills and needs associated with the presence of additional physical and speech disabilities. The support needs subscales of SNAP and SIS were more sensitive to the needs of individuals with coexisting neurological and sensory disabilities. SNAP was the only instrument to identify unique needs associated with the presence of a psychiatric disability but SIS was the only instrument to discriminate needs associated with the presence of a vision disability. Underlying this finding may be the importance of the person-environment interaction intrinsic to contemporary models of disability and support approach to assessment. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1349602 / Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2009

Individualised needs based approaches are increasingly being utilised to fund disability support services. Frequently, standardised assessments such as adaptive behaviour scales and, more recently, measures of support needs are used for determining level of need. The aim of this thesis is to understand the relationship between adaptive behaviours and support needs and to investigate factors that impact functional capacity and need for supports for individuals with an intellectual disability. Although a conceptually attractive approach to assessment, concern exists regarding the adequacy of the theoretical framework for guiding the development of support needs instruments. Though possessing theoretical similarities, adaptive behaviour and support needs scales are considered to measure different, albeit related constructs, prompting investigation into the nature of the relationship and the structure of the support needs construct. Accordingly, in Study 1 the Supports Intensity Scale (SIS), the Adaptive Behaviour Scale–Residential and Community (ABS-RC:2), and the Inventory for Client and Agency Planning (ICAP) were used to examine this relationship (N = 80). Dimensionality of the SIS (Section 1) was examined in reference to the three areas of conceptual, social, and practical skills, considered as comprising the adaptive behaviour construct. Factor analysis offered support for measurement of a common underlying construct. When considered in terms of the three adaptive behaviour skill areas, the support needs construct related predominantly to conceptual skills. Unlike adaptive behaviour scales, little is reported about the properties of support needs measures or factors that impact on an individual’s need for supports. Study 2 examined factors likely to influence adaptive behaviours and need for supports; in particular, the presence of coexisting disabilities. Using a measure of adaptive behaviour (i.e., ICAP) and two support needs scales (i.e., SIS and the Service Need Assessment Profile, SNAP), the extent to which adaptive and challenging behaviours and support needs (including medical) were impacted by the number and severity of disabilities was examined (N = 83). Results showed adaptive behaviours and support needs (including medical) were meaningfully related to the number and severity of disabilities present, whereas this was not so for challenging behaviours. Profiles for challenging behaviour measures did not support a linear association with number and severity of additional disabilities, raising the possibility that the profiles were influenced more by the nature of the additional disabilities present. Study 3 investigated the impact of the nature of the additional disabilities present on adaptive and challenging behaviours, support and medical needs using the same instruments utilised in Study 2. Each scale discriminated skills and needs associated with the presence of additional physical and speech disabilities. The support needs subscales of SNAP and SIS were more sensitive to the needs of individuals with coexisting neurological and sensory disabilities. SNAP was the only instrument to identify unique needs associated with the presence of a psychiatric disability but SIS was the only instrument to discriminate needs associated with the presence of a vision disability. Underlying this finding may be the importance of the person-environment interaction intrinsic to contemporary models of disability and support approach to assessment. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1349602 / Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2009

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