Speech and language therapists’ approaches to communication intervention with children and adults with profound and multiple learning disability? (summary)

Speech and language


Impaired communication skills are one of the defining characteristics of people with profound and multiple learning disabilities (PMLD).

The communication skills of this group might include idiosyncratic behaviours which are interpreted by their communication partners. These interactions with other people are very important for quality of life.

There is a limited evidence base for speech and language therapists (SLT) intervention with people with PMLD, though Royal College of Speech & Language Therapists (RCSLT) clinical guidelines indicate that it should be available to them.

There are several intervention approaches for which there is some evidence available. These are; intensive interaction, objects of reference (OoR), creative arts therapies, micro-switch technology, symbolic approaches and environmental support and modification or staff training.

What did the authors do?

This study aimed to provide information through a survey of SLTs looking at:

  • What communication approaches are most commonly used by SLTs working with the PMLD population.
  • What rationales SLTs give for their choices of intervention approaches.
  • To what extent the rationales relate to the evidence based practice framework.

Fifty five SLTs who worked for all or part of their time with people with PMLD completed the survey.

What did they find?

The most commonly used approaches were intensive interaction and OoR. Communication passports were used more often with adults than children and symbolic interventions more commonly with children. Creative arts i.e. sensory stories and music were used exclusively with children.

The rationales for selection of intervention approach were divided into four main categories:

  • Research evidence
  • Clinical expertise
  • Individual development needs and client/carer views
  • Practical and organisational issues

The most commonly given rationale across all of the intervention approaches was related to the empowerment, needs development and behavioural preferences of the people with PMLD.

Developing communication partner’s skills and the communicative environment were also commonly mentioned.

The use of published research evidence was given as a rationale in only a limited number of interventions.

The authors found that SLTs rationales were largely based on client factors, mainly the benefits to the person with PMLD rather than on clinical expertise or research evidence. However more evidence is needed as to whether the perceived benefits can be attributed to the interventions.


There are a number of limitations identified in the paper including whether sufficient information was sought regarding indirect as opposed to direct interventions, particularly in relation to staff training.

Further research is also needed about the combinations of communication interventions used for people with PMLD.

The participants in the survey were self-selecting and there is no information about the representativeness of the sample.

Each of the intervention methods needs further evaluation to develop a more robust evidence base about the ‘best’ interventions.


The approaches reported as being used by SLTs working with people with PMLD and those evaluated in published research do not match. Further research is needed to evaluate commonly used intervention approaches. In-service training is also needed to raise SLTs awareness of the evidence base to support certain approaches.

Things you may want to look into:

Profound and multiple learning difficulties

Developing communication in adults with profound and multiple learning difficulties using objects of reference

Implementing AAC with children with profound and multiple learning disabilities: a study in rationale underpinning intervention

Micro-switch programmes for students with multiple disabilities and minimal motor behaviour: Assessing response acquisition and choice

Added to site May 2015