The dangers of ignoring non-verbal cues and possible solutions

Ignoring non-verbal cues from individuals with a learning difficulty can lead to misinterpretations and harmful situations.

Non-verbal cues are primarily and must be considered as a means of communication, especially for people who have limited verbal communication.

 

Here are some examples of what could happen and what we can do to minimise risks and increase understanding and trust.

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Basic needs and preferences

For basic needs and preferences to be acknowledged and understood there must be clarity, emotional connection, and trust. There must also be a willingness to be patient and to learn that a person with a learning difficulty may need more time to process information and situations and may respond in a different way that you might expect. We all want to feel safe and respected in our interactions with others and that is no different for people who are non-verbal or have limited communication.

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So, what can we do?

People need to feel heard and valued. In someone that has limited, to no verbal communication we need to change or adapt the way we listen. We need to be much more observant as their way of communication may be through facial expressions, movement, gestures, behaviours, verbal sounds, or use of communication aids such as Makaton, switch devices, or a talking app on an iPad.

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Clear communication and awareness of an individual’s needs must be understood so distress or escalation of behaviours can be minimised or avoided. Therefore, we need to provide the time and the space to fully understand their needs and preferences; this is known as reasonable adjustments. You may have heard this term within a clinical setting and at times this can be challenging to achieve especially in adult services. Not providing the time and space could result in much more stress and the need to reschedule an appointment. At times, the reasonable adjustments may not be reasonable enough, so clear, upfront planning and an understanding of an individual’s needs are paramount.

 

Delayed or misdiagnosis

Within a care or medical setting, a person with a learning difficulty may not be able to verbally communicate how they are feeling, so professionals may see their behaviours as ‘the norm’, when in fact the behaviours may be displayed due to unmet needs. This could lead onto what is known as diagnostic overshadowing which is explained further on this website.

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If a person’s behaviour, symptoms, or visual appearance is attributed to their existing diagnosis, this can lead to a very serious and even fatal situation.

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If someone’s non-verbal cues were not noticed or acted upon whilst they are in a clinical or care setting, this could leave them in a huge amount of pain and distress. Their pain and suffering could be avoided if further exploration of different communication methods is had, rather than presuming the actions or behaviours are ‘the norm’ because of their additional needs.

 

So, what can be done?​

Care and healthcare providers must focus on the individual and not solely on their disability or original diagnosis. Treating every symptom as something potentially new whilst also having a clear picture of past medical history and interventions is important.

 

Patients who lack capacity are society’s most vulnerable and can’t speak up for themselves. Therefore, it’s vital that medical staff take all steps possible to ensure they communicate between themselves and with loved ones to ensure a patient’s care needs are met.

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​Observing, listening to care givers, having professional curiosity and being extra vigilant are all crucial to alleviate pain and potentially stopping the risk of avoidable death. When an individual cannot tell you how they are feeling by way of speech, then you must listen in another way. You must use your eyes and go above and beyond because if you do that you just may save someone’s life.

 

Escalation of behaviour’s that challenge, including physical harm and self-injury

Ignoring non-verbal cues of distress, frustration or boredom can escalate behaviours such as hitting, biting, throwing, banging head on hard surfaces, and thrashing their bodies. These behaviours are often termed as ‘challenging’ because we may find them difficult to manage at times. We have all experienced times of frustration when we are not being listened to, or not being understood, but most of us are able to voice our opinion, argue or try to explain.

Imagine that you do not have a voice, or the capacity to express how you’re feeling, how would you react? These behaviours stem from an unmet need and the inability to express themselves in what we know in a conventional way.

 

So, what can we do to help?

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We need to find a way to understand. Behaviours intensify to get a message across, so we need to try our best to listen, observe and act upon what is being communicated to us. We need to provide a way for an individual to communicate their needs and wants, give them more choices and control over their environment and help them feel that they have been listened to and understood.

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At first, try to discover what is causing the escalation of behaviour so you can understand what may be going on for them.

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Environmental factors should be considered. Ask yourself, is the environment too noisy, chaotic, bright or overwhelming? This could be triggering, particularly for those with sensory sensitivities.

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Where possible, if this is known trigger, remove the individual from that environment that is causing them stress or provide them with comforts you know they need or enjoy such as earphones, weight blankets, iPad etc.

 

If changing the environment is unsuccessful in identifying the reason behind their behaviour/s, you could attempt to use distraction. This includes, redirecting their attention to something you know they enjoy.

 

In clinical settings, you must not lose sight of the possibility that these behaviours are as a result of an undiagnosed, or untreated medical issue, therefore distraction, environmental changes etc, won’t be effective. Always consider something medical, especially if all else fails.

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Some individuals display behaviours to get a desired outcome, if that outcome is granted then the individual will learn that this is an effective form of communication which we do not want to encourage in most circumstances. It is important to note, desired-outcome communication is often controlled, whilst genuine distress signals are far more difficult to fake. To differentiate between the two, often physical responses will occur if a person is genuinely upset or stressed, such as sweating, trembling, anxiety, or complete shutdown, these are conflicting signals that are very hard to control.

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Being misunderstood

People with a learning difficulty can be unfairly perceived as anti-social, rude, attention seeking, shy, or unmotivated when they are being misunderstood. This can lead to physical and mental health risks and social isolation. We make judgements. We all do it, we see someone looking and acting differently and we make assumptions of that person. Our assumptions are not factual and can quite often be further from the truth than we realise.

 

So, how can we change our views?

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Do you think that other people know everything about you?

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Do they know your history, or feelings, your preferences, your lifestyle and how different you are to them?

 

Often, the answer is no. Why do we make judgements on people that appear to be different to ourselves?

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Why can we not change our views and start to accept people for who they are?

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Why don’t we start to help and support others who may need it without judgment?

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If we stopped and asked ourselves what someone may be experiencing to make them react in a certain way, maybe we would be able to help them feel more safe, accepted, and comfortable in their interactions with us. People with a learning difficulty can often withdraw from society because they fear they will not fit in. Our judgements are at fault here, not them. Let’s build relationships based on trust and a willingness to learn and listen.

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Summary

Non-verbal cues in individuals with a learning difficulty are fundamentally a form of communication and should not be assumed otherwise and ignored.

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There are several things we can all do to minimise distress, pain, frustration, and isolation.

We can all use the total communication approach; support individuals by using any combination of methods that works best for them and not solely rely on speech.

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We can explore other ways of communicating both by way of using them or observing and listening to them.

 

Visuals: Photographs, pictures, symbols, social stories, timetables and PECS (Picture Exchange Communication Systems).

 

Vocal sounds: Some people with a learning difficulty make sounds and these sounds may change depending on their needs and emotions.

 

Alternative communication (ACC): Devices with a voice output.

 

Signs and gestures: Facial expressions, body language, signing such as Makaton.

 

Non-verbal cues: Touch, eye-tracking, movement, expressions, and sounds.

 

Understanding that non-verbal cues are a method of communication will:

• Build stronger relationships between individuals and their families/ carers/ other professionals

• Improve your understanding of an individual’s needs and wants

• Reduce stress and anxiety

• Minimise risks

• Prevent misdiagnosis or delayed treatment

• Promote inclusiveness

• Make people feel safer and understood