Communicative dilemmas for practitioners in service encounters with people with intellectual disabilities: insights from a systematic review of conversation analytic research

Background: How do practitioners in service settings respond to communication support needs of people with intellectual disabilities? Conversation Analysis (CA) uses recordings of everyday encounters to understand the challenges practitioners face. 

Method: Following specialist guidance on systematically reviewing CA research, we reviewed 65 CA research articles examining staff communication in healthcare, education, social care and the police. 

Results: We identified five themes in the synthesis. Two were categories of interactional practices (Questions and Answers; Decision-Making), one examined non-verbal communication (Embodied and Non-Verbal Communication) and two considered contributions of other material and human agents (Communication Aids and Supports; Involvement of Companions). In each theme, we saw examples of competency-enhancing and competency-inhibiting practices. 

Conclusions: Practitioners face interactional dilemmas: (1) Orienting to the Person's Self-determination versus Getting the Job Done; (2) Adapting Communication versus Downplaying Difference. Future research should build on this review to develop and evaluate communication training for staff.