Complex Communication Needs
2884-11
Queensland Government (Department of Communities, Disability Services and Seniors).
Image. Young person at home, smiling and laughing with pet kelpie dog, using a wheelchair and a voice output device. 
Image. Peoples with complex communication needs can be Aboriginal and Torres Strait Islander peoples. A Primary-school-age young person and their teacher are using communication tools including plastic blocks, gesture, voice, body position, and facial expression.
Image. Senior person with disability plays electronic piano in social setting at home. Music is a communication tool
Image. Baby and mother communicate using smiling, light touch, eye contact, and head and body posture.
Third Edition, October 2018
© The State of Queensland (Department of Communities, Disability Services and Seniors) 2018. Copyright protects this publication. Excerpts may be reproduced with acknowledgment to the State of Queensland (Department of Communities, Disability Services and Seniors).
Department of Communities, Disability Services and Seniors
GPO Box 806
Brisbane Q 4001 www.disability.qld.gov.au
Contents
Complex Communication Needs
Acknowledgments
Communication and why it is important
How we communicate
Who may have complex communication needs?
What is it like to have complex communication needs?
The role of communication partners
Strategies for communication partners
What is a communication-friendly environment?
Supporting effective communication
Communication breakdown
Australian professional guidelines on AAC
References
For further information:
Acknowledgments
The original version of this booklet was developed with contributions from the staff and students of The University of Queensland. Particular thanks go to Carole-Ann Grieg, Tanya Hirst, Laura Parkhill, Sarah Sinnamon, Anna Walker and Shaun Ziegenfusz.
Communication and why it is important
Communication is the act of giving or receiving information.
Communication is:
•	fundamental to all aspects of life
•	important for quality of life
•	a foundation for learning
•	a human right (United Nations Convention on the Rights of Persons with Disabilities 2006).
Effective communication enables people to:
•	express their thoughts, opinions and personality
•	ask for and receive information
•	build relationships
•	make decisions
•	express and meet their basic needs
•	refuse or reject
•	make requests and suggestions about services they receive
•	take part in social activities
•	be heard and understood
•	participate in their community.
A person’s ability to communicate effectively may have an impact on his or her ability to build relationships, make choices and participate in everyday life
How we communicate
Everyone uses a variety of methods for communication, which can include:
•	speech
•	writing
•	touch
•	eye gaze
•	tone of voice
•	body language
•	signing
•	actions
•	facial expression
•	miming
•	behaviour
•	vocalisations
•	gestures.
People may use any number of these methods, in any combination.
Both action (response) and inaction (lack of response) convey information or messages.
All forms of communication are equally valid.
Important principles for supporting people with disability and complex communication needs include:
•	the right to:
•	express their feelings, needs and wants in a way that others can understand and respond to 
•	understand the communication of others
•	support to develop an effective, efficient, reliable and independent means of communication
•	support through a range of communication methods
•	access to an effective means of independent communication, which provides a safeguard for people with disability and complex communication needs. 
Who may have complex communication needs?
People who have complex communication needs may not have the communication skills to meet all of their needs. For some people this is temporary, while for others it is ongoing.
Some people may not have speech and will rely on other methods of communication, such as pointing or gestures.
Some people may use speech but it may be difficult to understand.
Some people may be able to communicate but have difficulties understanding what other people say.
People with complex communication needs can be of any age, of any culture and from any socioeconomic background
Complex communication needs may be associated with developmental or acquired disabilities.
Developmental disabilities are present at birth or occur before the age of 18, and may affect social or cognitive development.
Some examples of developmental disabilities are:
•	intellectual disability
•	Down syndrome
•	cerebral palsy
•	autism.
Acquired disabilities occur as a result of illness or injury. Some examples of acquired disabilities are:
•	traumatic brain injury
•	multiple sclerosis
•	stroke.
Image: Peoples with complex communication needs can be Aboriginal and Torres Strait Islander peoples. Young man and teacher are of Aboriginal and Torres Strait Islander heritage, and are learning and socialising together using the communication tools of voice and touch.
What is it like to have complex communication needs?
It can be difficult to appreciate what it is like to be unable to communicate using speech or through writing. The following quote provides some insight.
“If you want to know what it is like to be unable to speak, there is a way. Go to a party and don’t talk... Here is what you will find: people talking; talking behind, beside, around, over, under, through and even for you. But never with you. You are ignored...” Rick Creech in Beukelman & Mirenda 2005
Communication is part of daily life and cannot be considered separately from other activities. Having an effective communication system influences the success of our personal interactions, our involvement in activities, and our ability to make decisions. These can range from everyday decisions, such as which shirt to wear, to life-changing decisions, such as where to live.
The role of communication partners
Effective Communication maximises participation and minimises limitations.
A communication partner is anyone who talks or interacts with another person. We are all communication partners.
It is important for communication partners to support people with complex communication needs to identify and use the communication methods that work best for them and enable their own independent communication.
Communication partners of people with complex communication needs should be aware of the following:
•	Communication is a constant experience.
•	For people with complex communication needs, not having access to an effective communication system can be frustrating. This frustration sometimes results in behaviours of concern.
•	The way we communicate with people with complex communication needs influences how they are perceived by others and how they perceive themselves.
•	People with complex communication needs are more vulnerable to abuse, assault and neglect than others, as they are less able to report incidents. The ability to communicate is an important mechanism for reducing the risk of abuse, assault or neglect.
•	Communication enables people to express their personality, humour, interests and dislikes.
Strategies for communication partners
Friends, family or carers who know the person well will have suggestions on how you can assist the person to better understand you and to communicate effectively with you.
It is important to respect and understand that common barriers may cause people with complex communication needs to have difficulty or be unable to demonstrate their communication skills. 
To be an effective communication partner for someone with complex communication needs you should consider having:
•	competent communication partners
•	communication-friendly environments
•	essential communication tools and resources.
Identify the methods the person uses to communicate.
•	These may include speech, signs or gestures, or using pictures, facial expressions, or a communication device.
•	Use the person’s effective communication methods appropriate to the environment—for example, sign as you speak or point to objects in the environment.
Demonstrate respect and remember:
•	to use respectful and age-appropriate communication
•	that a person’s expressive skills may not represent their ability.
Gain and maintain attention
•	Use the person’s name.
•	Use facial expressions, tone of voice and humour to add information and interest.
Talk about things that are interesting and relevant to the here and now
•	Talk about the current activity.
•	Explain what you are doing as you do it.
•	Create or use a chat book with photos and captions to help others learn about the person’s interests and prompt interaction.
•	Give specific examples.
•	Communicate for a variety of reasons—for example, make observations, share opinions, tell jokes.
Cue the person with complex communication needs to initiate a response
•	Give expectant pauses.
•	Provide verbal cues or physical prompts.
Offer choices
•	Provide real opportunities for choice within activities, such as what to wear, eat or do.
•	Provide visual representation of choice—for example, show cereal packets when discussing breakfast options.
To be able to make an informed choice, people need to experience and know what the alternatives are. The alternatives need to be presented in a way meaningful to them. Choice may sometimes be indicated by things such as:
•	participation or non-participation
•	picking up the chosen object
•	looking or pointing at the desired item
•	vocalising.
Keep sentences short
•	Chunk information together.
•	Be specific.
•	Talk about one step at a time.
Support the person with complex communication needs to develop his or her communication skills across a range of environments and with different people
•	Identify opportunities for communication to take place—think about the person’s interests, activities and routines.
•	Acknowledge all communication attempts.
•	Develop and use ‘about me’ books and communication passports to share this information between communication partners.
Listen attentively
•	Use eye contact.
•	Use gestures such as nodding your head.
•	Rephrase what is being said.
•	Be aware of your non-verbal communication.
•	Try not to talk too much.
•	Wait for the person to finish.
It is important that all communication partners have a shared understanding of how someone communicates. 
What is a communication-friendly environment?
A communication-friendly environment is one that provides opportunities for communicating about a range of topics, has communication partners that can support different ways of communicating and has a range of tools available to support communication success.
Communication partners can contribute to communication-friendly environments in the following ways.
Minimise distractions.
•	Consider background noise, such as TV, radio, fans and air conditioning.
•	Avoid crowded or busy places. Move to a quieter location.
•	Consider lighting.
•	Have communication aids nearby—prepare materials in advance that will support communication in specific activities.
Ensure the person is comfortable.
•	Check the person’s positioning.
•	Consider whether equipment is required such as a more comfortable chair or a table to put communication aids on.
Place yourself at eye level.
•	Face the person and use eye contact.
•	Gain their attention.
•	Position yourself at the same level as the person.
Consider involving other communication partners.
•	Is there someone else who might be interested in joining the conversation?
•	What are the person’s communication needs and methods?
•	Bring people together through shared activities or interests.
Avoid talking about the person in front of him or her.
Supporting effective communication
The use of objects, photographs, pictures and symbols can support people to understand information they are given and to express themselves to others more effectively.
Supporting understanding
Spoken language is fleeting—some people may miss information and not be able to follow the conversation. Using tools to aid understanding can be very effective.
For example, holding an object or pointing to a picture when you are talking reinforces the spoken message and increases the likelihood that your communication partner will understand.
Objects and pictures are present for longer than the spoken word. They can be understood more easily because they represent something tangible.
Where a person has difficulty understanding too many things at once, only introduce one concept or piece of information at a time. When you give instructions, use short steps and introduce only one or two steps at a time.
Tools can also be used to:
•	jog the memory—for example, a visual calendar used as a pictorial reminder of activities for the week ahead
•	assist a person to know what is expected of them—for example, holding up a set of keys to indicate that it is time to go for a drive
•	help organise thinking—for example, an illustrated recipe with photos of the sequential steps to be taken to complete the task
•	enable someone to feel in control and less anxious—for example, a daily schedule with photographs of people who are likely to be visiting.
Supporting expression
People who do not use speech or whose speech may be difficult to understand can use tools to assist their communication partners to understand their ideas, thoughts and feelings.
The use of tools can help a person with complex communication needs to:
•	clarify and provide information—for example, pointing to various symbols to clarify the topic he or she wishes to talk about
•	ask for something—for example, holding up a towel and goggles to indicate he or she wants to go swimming
•	express his or her feelings—for example, pointing to the word ‘excited’ from a list of emotion words.
Communication breakdown
Communication breakdown occurs when a message is not conveyed successfully from one communication partner to another.
If someone you are communicating with does not understand you:
•	repeat or rephrase the information
•	reduce the amount of information in the message
•	use visual supports
•	seek help from communication partners who know the person well.
If you do not understand someone you are communicating with:
•	let the person know that you have not understood—do not pretend you understand
•	ask the person to show you what he or she means
•	ask the person to say it in a different way
•	check if the person’s non-verbal communication supports his or her message.
To avoid communication breakdown, support your message by using visual aids such as pictures and objects in the environment. You can also demonstrate or use actions and pointing to enhance the message.
You can also help by:
•	using clear, simple language and avoiding the use of slang
•	slowing down and shortening the message
•	saying the message in a different way.
Continue to develop your knowledge of the way a person communicates. Record successful strategies and share observations with other communication partners.
Australian professional guidelines on AAC
Speech Pathology Australia (SPA) is the national peak body for the speech pathology profession in Australia.
SPA develops clinical guidelines that incorporate research to identify evidence-based approaches and practices. These guidelines are an important guide for best practice in supporting people with complex communication needs.
SPA revised its clinical guideline on Augmentative and Alternative Communication (AAC) in 2012. While the clinical guideline has been written for speech language pathologists, it may also be referenced by managers and consumers. 
Some key elements of the Augmentative and Alternative Communication Clinical Guideline are:
•	the need for speech pathologists to work collaboratively as part of a team using a person-centred approach when supporting people with complex communication needs
•	that communication supports are informed by evidence-based practice
•	that all people with disability and complex communication needs are comprehensively assessed for their use of augmentative and alternative communication
•	that people with complex communication needs should be provided with a range of communication systems and strategies to support them to meet their varied communication needs.
SPA also provides specific guidance in relation to a method called facilitated communication (also referred to as ‘supported typing’ or ‘assisted typing’, or ‘rapid prompting’). In these clinical guidelines SPA concludes that, after evaluating the research evidence base, facilitated communication remains an approach with little supportive evidence and a preponderance of evidence that contraindicates its use, and its use is not recommended.
If facilitated communication is raised with them, speech pathologists have an ethical responsibility to inform their clients and families of the lack of supportive evidence and evidence of known harms associated with facilitated communication in the literature, including the harms of subconscious facilitator influence and false allegations of sexual abuse. 
Furthermore, speech pathologists supporting people who use facilitated communication cannot assume that messages communicated by facilitated communication are the person’s own messages.  Speech pathologists have an ethical responsibility to: (a) assess whether the communication is the person’s own communication or has been influenced by the facilitator; and (b) explore all Augmentative and Alternative Communication system access methods (including direct and indirect access) and strategies that allow the person to communicate independently (p. 29-30).
To find out more about SPA and download a copy of the AAC clinical guideline, visit Speech Pathology Australia.
References
•	Beukelman, D and Mirenda, P 2013, Augmentative and alternative communication: supporting children and adults with complex communication needs, 4th edn, Paul H. Brookes Publishing Co, Baltimore, Maryland.
•	Speech Pathology Australia 2012, Augmentative and Alternative Communication Clinical Guideline, Speech Pathology Australia, Melbourne.
•	United Nations General Assembly 2006, Convention on the Rights of Persons with Disabilities.
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