LANGUAGE ISSUES IN CLIENTS WITH COGNITIVE DISABILITIES:

SUGGESTED REMEDIES

Nancy Cowardin, Ph.D.

<          Lack of self-trust resulting in “outerdirectedness”

            Avoid leading the client by smiling, nodding, using facial expressions or body language that communicate an expected or desired answer. Support the client’s attempts to supply his own answers. Extend the “wait time” for the client to formulate answers.

<          Literal, concrete translations

           Use low level language; avoid abstractions and double-meaning words; be concrete.

<          “Parroting” the phrases of others without understanding

            Ask the client to paraphrase statements he takes from other sources by asking, “What does that mean to you?” or “How do you understand that?” Ask the client to restate using his own words.

<          Naivety: Inability to discern sarcasm, “in-jokes”, and subtle messages

Don’t confuse the client with sarcastic comments or esoteric phrases. Be direct in your questions, comments, and/or instructions.

<          Immaturity in terms of content and presentation style

            Be prepared to accept and parrot back immature terms and phrases rather than inserting your own. Use lowest language level terms and explanations in your communications.

<          Inappropriate or unrelated comments in specific situations

            You may wish to ignore such comments and redirect the client back to the topic that is underway OR use these utterances as communicative springboards. (NOTE: Several studies have shown that off-track utterances and verbal perseverations may have communicative intent that should be utilized to make a conversational connection rather than be extinguished.)

<          Semantic restriction of multiple meaning words

            Try to avoid using words that have more than one meaning. If you must do so, explain  the meaning of the word in your particular context (Example: A RIGHT is SOMETHING YOU ARE ALLOWED TO DO. It is different from BEING RIGHT or ON THE RIGHT). 

<          No/little incidental learning of common terms and phrases          

            Do not expect the client to understand slang, street terms, or other vernacular even

            though it may be popular in his/her age group. Avoid using such language as it can be quite confusing to the client.

<          No/little notice of peripheral details  -OR-  Focus scattered to peripheral details

            Be specific in pointing out details that you want considered; redirect attention to the

            main focus of your presentation.

<          Misinformation from unmonitored TV watching (or other experiences)

            Parents/caregivers should provide adult guidance to accompany televised programs.   Where lacking, correct misperceptions with clear explanations. Use real life experience and manipulative materials where possible.

<          Failure to grasp abstract concepts and terms

            Use concrete terms and explanations instead.

<          Associating unrelated terms and information

            Avoid terms which are vague. Simplify content and language.

<          Conceptual and/or perceptual confusion

            Ask client to rephrase what was said, listen for confusion, and correct it.

<          Confabulating or agreeing in order to please the questioner

            Question his/her answers and assertions. Ask, “Is that what really happened?” or Are you sure about that?” Discuss the difference between truth and lies. Admonish the client not to tell any lies whenever he talks to you.

<          Inappropriate disclosure of information can jeopardize personal safety

            Caution the client not to talk about his personal business where others can overhear him.

<          Limited vocabulary makes self-expression labored or confusing

           Take the time to sort out all the details in confused stories. Check to be sure you have received the intended meaning of utterances (Example: “Are you saying ...?” or “Let me be sure I understand you...”). Help the client stay focused and follow a logical sequence in telling and retelling the details of his experiences.