EDITORIAL

Dorothy Atkinson and Jan Walmsley

The ®ve papers in this edition are linked by a common

thread. They re¯ect the universal human need to interact

and engage with others ± they testify in their separate and

diverse ways to the importance of communication for emo-

tional, 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 interac-

tions 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 dif®-

cult for people with learning dif®culties to reach out in this

way and make contact. This edition of the journal is in two

parts. The ®rst three papers look at interventions in peo-

ple'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 ®rst 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, ®nd distorted expression in, for example, violent

incidents or other manifestations of challenging behaviour,

or in depression, or in potentially self-mutilating and dan-

gerous sexual practices. What interventions have proved

bene®cial to the people concerned? What lessons can others

learn from these results?

The ®rst 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 dis-

charge from a long-stay hospital, found that the emphasis

there was on promoting communication, in its widest possi-

ble 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 chal-

lenging behaviour. The picture was further complicated by

an underlying depression that was dif®cult to detect but,

once diagnosed, could be treated not only by medication

but by enhanced opportunities to develop activities, net-

works 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 stra-

tegies'. 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 commu-

nication can be improved or enhanced. One way is to look

at how people with learning disabilities in a local area actu-

ally 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 ®nd 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 sup-

ported in learning to convey their feelings and thoughts in

order to understand them better.

= 2000 British Institute of Learning Disabilities, British Journal of Learning Disabilities, 28, 89 89