1. Developmental Disability Etiquette
Patti Higgins, RN
CCBDD
(216)

2. DISABILITY ETIQUETTE Presentation Objectives:
Identify the different modes of communication that individuals with DD utilize
Discuss general communication strategies when working with individuals with DD
Identify actions to take when individuals with DD have behavioral issues.

3. Communicating with Individuals with Developmental Disabilities
MYTH # 1
People with DD cannot
understand speech, let
alone medical
information

4. Premise #1 Many people with DD can effectively communicate their needs
People with DD have a wide variety of communication skills and abilities

5. Premise #1 (continued)

6. Premise #1
Individuals who are non-verbal can communicate with gestures and / or body language.

7. Premise #1 – Medical Info
Many people with DD are very involved with their healthcare.
Healthcare providers may have to adapt their physical environment and interaction techniques.

8. MYTH # 2
People with DD cannot make decisions

9. Premise # 2
People with developmental disabilities participate in decision making in a variety of ways.

10. PREMISE #2 (cont’d) Many individuals with DD are their own guardians
Many individuals with DD are capable of informed consent for medical procedures / treatment.

11. MYTH #3 People with DD are sick.
People with DD are dependent on others to meet many / all of their needs.

12. Premise #3
Many people with DD are not sick, incompetent, dependent, unintelligent or contagious. They are like the typical population, i.e. healthy, chronic medical conditions, mental health diagnoses and acute care issues
People with DD have master’s degrees, work full-time, drive, own businesses, participate on committees, are married and have children.
They are individuals and you use the same assessment skills as with typical population.

13. Premise #3 – (cont’d) Triage Communication issues Baseline health
Mirrors other individuals that may be in shelters, with mental health issues, alzheimers, elderly, typical population.
Cooperative, communcative and compliant

14. MYTH #4
People with disabilities can
access health care easily.

15. Premise #4 Healthcare providers may have to adapt their physical
environment and
interaction techniques.

16. Premise #4
Talk to the person, rather than through their caregiver or sign language interpreter.
If the caregiver needs to be involved in their healthcare conversation, ask the individual’s permission.
Listen patiently. Don’t complete sentences for the person unless he/she looks to you for help.

17. Premise #4
Allow extra time for the visit and give specific directions.
Don’t pretend you understand a person with a speech disability just to be polite.
Be prepared for various devices or techniques used to enhance or augment speech.

18. General Communication Strategies
R (adapted from Seigel-Causey and Guess, 1989)

19. Nurture Develop a trusting and supportive environment
Show real interest in communicating
Act and speak naturally

20. Opportunity
Communicate about what is happening now
Provide choices

21. U “You” always play a key role in assuring effective communication
Talk to the person
Ask permission to talk with whoever is assisting them
Listen
Clarify
Restate

22. Sensitivity Recognize an individual’s readiness to communicate
Respond at the person’s level
Recognize the communication modes of the individual
Respond appropriately to all communicative attempts

23. Sender Get the person’s attention
Present info using person’s receptive mode
Repeat the message once, then restate
Rephrase using different words or modes
Recognize all attempts to respond

24. Sender
Treat Adults as Adults
Do not shout at the person with DD

25. Receiver Pay attention and be aware Ask for clarification when needed
Be honest
Encourage individual to use many modes

26. Cognitive Disability Use very clear, specific language
Be patient. Allow the person time to tell or show you what he or she wants.
Condense lengthy directions into steps
Use short, concise instructions
(Commission for People with Disabilities, November 2007)

27. Cognitive Disability
Present verbal information at a relatively slow pace, with appropriate pauses for processing time and with repetition if necessary, e.g. “In five minutes, we’ll be going to lunch.”

28. Cognitive Disabilities
Reinforce information with pictures or other visual images
Use modeling, rehearsing and role playing
Use concrete rather than abstract language
Limit the use of sarcasm or subtle humor

29. Cognitive Disabilities
If you are not sure what to say or do, just ask the person what he/she needs.

30. Dealing with Behavioral Issues
Dual Diagnosis:
Individuals who have
both a mental illness
and a developmental
or intellectual
disability.
Increase incidence of
mental health issues with
in people with DD – may
be due to brain pathology.

31. Behavioral Issues
“Unlike the general population, individuals with a dual diagnosis may be more likely to exhibit sign and symptoms of their disorders in the form of behavioral outbursts including verbal or physical aggression, self-injury, property destruction, impulsive behaviors and/or elopement .”
(Family Crisis Handbook, Donna Icovino & Lucille Esralew, Ph.D.
July, 2009)

32. Behavioral Issues
Not uncommon for people with Pervasive Developmental Disorder (PDD) or Autism to display aggressive
behavior.
May be a response to frustration, pain and limited communication skills.

33. Behavioral Issues
For individuals who are non-verbal, behaviors may be their way of expressing frustration and/ or pain.

34. How to Cope with Behaviors During a Disaster
Stay calm
Use verbal and non-verbal techniques including relaxed body position
Limiting space by directing the person to another room or area away from others
Soothing tone of voice
Avoid giving commands

35. How to Cope with Behaviors During a Disaster
Identify feelings (if able)
Ask Caregiver for assistance with behavior (may be aware of behavior plan to de-escalate aggressive behaviors)
Redirect to a different activity, preferably something soothing

36. Self-Injurious Behavior
For some individuals, i.e, people with autism and those who are non-verbal, aggression may be expressed by self-injurious behavior.
Head banging, hitting themselves, biting themselves.
Interventions are the same as previously discussed.

37. A FINAL WORD
People with DD are individuals with families, jobs, hobbies, likes and dislikes, problems and joys. While the disability is an integral part of who they are, it alone does not define them. Don’t make them into disability heroes or victims.
Treat them as individuals.

38. RESOURCES www.disabilityisnatural.com
Commission for People with Disabilities
(November, 2007)
The Ten Commandments of Communicating with People with Disabilities
Ohio Developmental Disabilities Council
Self Advocates Being Empowered