The Big Picture
Clients with speech and language disorders may have difficulty understanding other people or making themselves understood. Communication can take extra time and effort, and clients may become tired or frustrated.
Your communication style matters. Speak clearly, give the client time, watch your facial expressions, and change how you communicate when needed. Follow the care plan and your supervisor’s instructions.
Respect and patience remain important throughout the interaction. Include the client in conversations, speak directly to the client, and support the communication methods that work best for that person.
Quick tip: Tap, click, or press Enter on any term with a dotted underline and an ⓘ icon to see its plain-English definition.
Start Here If You’re Overwhelmed
Focus on these core ideas:
- Follow the care plan and your supervisor’s instructions when communicating with the client.
- Reduce distractions and give the client your full attention.
- Speak slowly and clearly, using simple words and short sentences.
- Give the client enough time to understand and respond.
- Adjust the communication method to fit the client’s needs.
- Protect the client’s dignity, independence, preferences, privacy, and safety.
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Course Notes: Key Ideas You Need to Know
Start With Your Own Communication
Before communicating with a client who has a speech or language disorder, think about how you communicate.
Ask yourself whether you:
- speak clearly or mumble
- use gestures
- show frustration or impatience through your face or body language
- need to change how you speak for this client
Follow the care plan and your supervisor’s instructions. Use communication methods that work best for the client.
Your facial expressions matter. A client may notice frustration or impatience even when you do not say it aloud.
Watch for Fatigue
Trying to understand others and trying to be understood can be exhausting. Other health problems may also contribute to fatigue.
Be alert for signs such as:
- drooping shoulders
- irritability
- lack of interest
- reduced understanding
When the client seems tired or loses interest, allow the client to rest. Return to the subject later.
Reduce Distractions
Background noise and activity can make concentration harder and may upset the client.
Reduce distractions by:
- closing doors and windows
- turning off the television or radio if the client agrees
- keeping cell phones on silent
- keeping your hands and lap free from distracting objects
A quieter setting can make it easier for the client to focus on communication.
Make Sure You Can See Each Other Clearly
The client should be able to see your face clearly, and you should be able to see the client’s face.
Adjust the lighting when needed. Reduce glare from lights or windows.
Do not sit or stand between the client and a window. Glare may make your face harder to see.
Give the Client Your Full Attention
Sit close to the client and face the client.
Before speaking:
- get the client’s attention
- look directly toward the client
- allow the client to see your face
- use facial expressions and gestures to show that you are listening
Do not perform another task while talking with the client.
Learn the Client’s Communication Style
Early in your work relationship, you can ask questions when you already know the answers. This can help you become familiar with the client’s speech.
Knowing the topic of the conversation can also help you understand the client.
Pay attention to nonverbal clues such as:
- gestures
- eye movements
- body language
- words or parts of words that may describe something
Follow the Client’s Lead
Change your communication method when needed.
A client may respond better to gestures than spoken questions. Another client may communicate more effectively through writing or a communication board.
If the client becomes tired, frustrated, or uninterested, allow time to rest and return to the subject later.
Speak Slowly and Clearly
Speak:
- slowly
- clearly
- in a normal tone of voice
Adjust your speech to the client’s needs.
Speak to adults in a mature and professional way. Do not talk down to the client.
Avoid slang and figures of speech because some clients may not understand them.
Use Simple Words and Short Sentences
Long or complicated sentences may be harder to understand.
Focus on important words, especially words describing:
- actions
- people
- places
- things
Keep the message direct. For example, a short statement about going for lunch may be easier to understand than a longer explanation containing extra details.
Give the Client Time to Respond
Do not rush the client.
Pause between sentences so the client has time to think and respond.
When someone asks the client a question, do not answer for the client. This includes questions you asked yourself.
Be Patient When the Client Does Not Understand
Repeat your words when needed.
If repeating the same words does not help, rephrase the sentence.
Your patience, facial expression, and body language should show respect rather than frustration.
Use Positive Statements
Positive statements can be easier to understand than negative ones.
For example, telling a client what action to take may be clearer than telling the client what action not to take.
Use Questions That Are Easier to Answer
Ask questions that need only:
- a short answer
- a head shake
- another simple response
You can also paraphrase what the client said. Paraphrase means to summarize the client’s message using your own words.
Ask the client whether you understood correctly.
Give Cues When Needed
A client may have trouble remembering a word.
You can give cues by asking questions such as:
- What does it look like?
- What is it used for?
- Where is it found?
Encourage gestures and pointing.
If you think you understand the client, check with the client instead of assuming you are correct. If the client’s words or gestures show that you misunderstood, encourage the client to try gestures, pointing, or symbols again.
Try Other Communication Methods
Some clients may write more easily than they speak.
Follow the care plan and use methods such as:
- writing
- gestures
- pointing
- symbols
- communication boards
Use the method that fits the client’s needs.
Support Clients Who Seem Withdrawn
Some clients with speech and language disorders may appear withdrawn or uninterested.
Spend extra time with these clients. Social interaction can support self-esteem and recovery.
Always include the client in conversations, even when the client cannot understand you.
Remember DIPPS
DIPPS refers to five principles of support work. Keep this term in mind as you review the communication guidelines below.
Protect Dignity
Dignity includes treating the client with respect, warmth, and compassion.
Never talk about the client as though the client is not there.
Speak directly to the client when asking questions or making comments about the client. Do not direct those questions or comments to other people who are present.
Some clients may feel embarrassed speaking in front of other people, especially strangers. Do not force the client to speak in front of others.
Support Independence
Clients with speech and language disorders need opportunities to gain, regain, or maintain independence and control.
Support this with:
- encouragement
- patience
- appropriate communication methods
- communication approaches listed in the care plan
Never show impatience, frustration, or worry when the client has trouble speaking or understanding.
Do not talk down to the client.
Provide Individualized Care
Individualized care means adapting care to the individual client.
Communication should fit the client’s:
- choices
- physical strengths and limitations
- cognitive strengths and limitations
- personality
- care plan
Ways to communicate effectively with the client can be posted so they are easy to refer to.
Avoid situations that may embarrass the client when the client is trying to communicate.
Help the Client Express Preferences
Limit the number of choices when too many choices would make communication difficult.
Be encouraging and supportive.
Writing the available choices down beforehand may help the client choose more easily.
Protect Privacy
Keep information about the client confidential .
Remember your professional role and your relationship with the client when communicating.
You do not need to fill every silence. Learn to be comfortable when the client is silent.
Support Safety During Procedures
Take extra time when explaining procedures.
Do not explain every step at once. Explain each step just before you perform it.
Avoid medical terms. Speak slowly and clearly.
Watch for signs that the client has not understood you.
Remember Expressive Aphasia
Expressive aphasia means difficulty speaking or writing.
Exam Clue Words
- Follow the care plan: Use the communication methods and directions identified for the client.
- Never: Never talk about the client as though the client is not present, and never show impatience, frustration, or worry when communication is difficult.
- Do not: Do not rush the client, talk down to the client, answer questions for the client, or explain all procedure steps at once.
- Avoid: Avoid slang, figures of speech, unnecessary medical terms, distracting surroundings, and situations that embarrass the client.
- Always: Include the client in conversations, even when the client cannot understand you.
Common Mix-Ups
| Wrong Idea | Better Idea |
|---|---|
| Answer for a client who needs extra time. | Give the client time to respond. |
| Talk to others about the client while the client is present. | Direct questions and comments to the client. |
| Repeat a confusing sentence the same way every time. | Rephrase it when the client does not understand. |
| Explain every procedure step at once. | Explain each step just before doing it. |
| Keep using one communication method. | Adjust the method to the client’s needs. |
| Assume you understood the client correctly. | Ask the client to confirm your understanding. |
Fast Review
Clients with speech and language disorders may need extra time, fewer distractions, and communication methods suited to their needs. Your patience, words, facial expressions, and attention all affect the interaction.
- Follow the care plan and your supervisor’s instructions.
- Reduce background noise and other distractions.
- Make sure you and the client can see each other’s faces clearly.
- Give the client your full attention and do not perform other tasks while talking.
- Speak slowly, clearly, and in a normal tone.
- Use simple words, short sentences, and positive statements.
- Give the client time to think and respond. Do not answer for the client.
- Use gestures, pointing, writing, symbols, or communication boards when appropriate.
- Watch for fatigue, including drooping shoulders, irritability, lack of interest, and reduced understanding.
- Speak directly to the client and protect dignity, independence, preferences, and privacy.
- Explain procedure steps one at a time, just before each step.
- Expressive aphasia means difficulty speaking or writing.
Final Pep Talk
There are many communication guidelines here, so focus first on the pattern behind them: slow down, pay attention, respect the client, and adapt your communication to the client’s needs. Review the specific guidelines in smaller groups until the differences feel familiar.