See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/51642814 How staff pursue questions to adults with intellectual disabilities Article in Journal of Intellectual Disability Research · September 2011 DOI: 10.1111/j.1365-2788.2011.01478.x · Source: PubMed CITATIONS READS 5 52 2 authors: W. M L Finlay Charles Antaki 48 PUBLICATIONS 1,067 CITATIONS 117 PUBLICATIONS 2,485 CITATIONS Anglia Ruskin University SEE PROFILE Loughborough University SEE PROFILE All content following this page was uploaded by Charles Antaki on 24 March 2014. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document and are linked to publications on ResearchGate, letting you access and read them immediately. Journal of Intellectual Disability Research doi: 10.1111/j.1365-2788.2011.01478.x 361     pp –   How staff pursue questions to adults with intellectual disabilities jir_ .. W. M. L. Finlay1 & C. Antaki2 1 Department of Psychology, Anglia Ruskin University, Cambridge, UK 2 Department of Social Sciences, Loughborough University, Loughborough, UK Abstract Background When support staff use questions to instruct, advise or guide adults with intellectual disabilities (ID), or to solicit information from them, the interaction does not always proceed smoothly, particularly when replies are ambiguous, absent or not obviously relevant. That can lead to interactional trouble and dissatisfaction, or worse. Methods We report on the ways in which staff members transform their questions over a series of conversational turns in order to solicit an adequate reply, and thereby to fulfil the interactional goal of the question. Our data come from approximately  h of recordings of natural conversation between staff members and adults with ID in two residential and one outdoor activities settings. Results We identify seven practices by which staff attempt to resolve the dilemma between undue direction and premature closure. These include: expansion of the original question, simplifying its format, changing its content in various ways and realising its alternatives in physical form. Conclusions We highlight strategies which produce answers satisfactory to both parties, and improve Correspondence: Dr W. Mick L. Finlay, Department of Psychology, Anglia Ruskin University, East Road, Cambridge CB BT, UK (e-mail: mick.finlay@anglia.ac.uk). the quality of interaction between staff and people with ID. Keywords communication, conversation analysis, intellectual disabilities, interaction, questions, staff Introduction In residential and day services for people with intellectual disabilities (ID), support staff have a number of tasks in their institutional dealings with those they support which require them to ascertain people’s preferences, determine their physical and emotional state, explore moral and social issues, give instruction and advice, and make suggestions. A major vehicle for carrying out these objectives is the use of questions. However, when support staff use questions with people with ID, their questions do not always result in adequate responses, particularly when replies are ambiguous, absent or not obviously relevant. Poorly delivered questions make for poorly designed answers – and subsequent turbulence in the interaction. Such turbulence can be merely a nuisance, but it can also be distressing to the person with ID. By identifying what goes wrong with these questions, we want to throw into relief what goes right. This article is a qualitative study of a sample of such questions, how they get clarified, and what ©  The Authors. Journal of Intellectual Disability Research ©  Blackwell Publishing Ltd Journal of Intellectual Disability Research       362 W. M. L. Finlay & C. Antaki • Pursuit sequences seems to be helpful practice in making sure that the interactional objective has been reached. Although people with ID vary widely in their communicative abilities, research has illustrated that those with this label are more likely to encounter a range of difficulties (e.g. Sabsay & Kernan ; Bedrosian ; Brinton & Fujiki , ; McLean et al. ; Abbeduto & Hagerman ; Beveridge et al. ). These include difficulties in the production of words and symbols, difficulties in designing utterances for the interactional context (e.g. the inclusion of appropriate content) and variable understandings of complex grammatical structures and abstract concepts. Conversation analysis is a methodology which allows us to see how social actions are performed through the medium of talk, and in recent years it has been used to study interactions between people with ID and service workers in a variety of contexts [e.g. Wootton ; Rapley & Antaki ; Rapley ; Dickerson et al. , ; Antaki et al. ; Stribling et al. ; Finlay et al. a; Williams et al. ; Pilnick et al. ; see also Keevallik () and Haddington () for recent conversation analysis work on non-verbal interaction]. The aim of this study was to report directly from the ‘front line’, as it were: to collect videotaped data from everyday scenes in the lives of people with ID, and to examine them very closely. This is still a rare research strategy, but yields vivid and direct evidence about how staff and service users deal with the problems that confront them. Our recordings allowed us not only to identify occasions on which a staff member’s question was answered inadequately, but also – and perhaps more importantly – to identify good practice in the way that the staff might go on to repair the damage, and to promote the persons’ better understanding of what was wanted. Inadequate answers lead to frustration, and worse; if we can show how to avoid that, we shall have done something worthwhile. To give more of a sense of what we mean, the following examples will illustrate the kind of practices we have in mind. In a typical scenario, the staff member might ask a person to choose between a range of alternatives of food. If the person gives an answer which is unintelligible as one of the options, the staff may rework their question in a series of yes/no alternatives. Another example might be when the person is being encouraged to pursue a certain course of action (e.g. clear away dinner plates). The staff member might initiate this with a question such as ‘Is it your turn to clear away?’ If this does not result in the person understanding or complying, the staff member might modify the question into a direct instruction. In the report below, we shall give real examples of these kinds of occasions and offer more rigorous listing of the practices by which the objectives were achieved. Data The data extracts presented here come from video shot in an ethnographic study of three locations: two residential services (‘Comber Hall Way’ and ‘Ashgrove’) for people with ID, located within a National Health Service Trust in the south of England, and a voluntary sector project (‘Foxwood Garden Project’) offering unpaid gardening activities to adults with ID (among other client groups) in the English Midlands.1 Ethical approval for the research was sought and gained from the second author’s institution, which held the grants which funded the research. Written permission to record and publish data was granted by all participants judged as having the capacity to do so; otherwise, procedures of assent based on consultation were followed. All names of speakers, and of individuals and places mentioned, have been changed. The people with ID participating in the research were all adults and had a range of communicative abilities. While some did not speak and relied on gestures and bodily movements, others spoke in single words or short sentences. It is important to stress that, after informed consent forms had been signed and permission given, the video recordings did not start until the researcher was well known to the staff and the clients, by virtue of a series of preliminary visits (without the camera). In the case of the two residential services, where the intrusion was greater, the researcher prepared for the recording over a period of weeks, and introduced the camera first as a resource for the residents themselves, and only starting to film when they had become quite comfortable with its use around the 1 We are grateful to Chris Walton for the recording in the residential services; the Foxwood videos were recorded by the second author and by Emma Richardson. ©  The Authors. Journal of Intellectual Disability Research ©  Blackwell Publishing Ltd Journal of Intellectual Disability Research       363 W. M. L. Finlay & C. Antaki • Pursuit sequences home. No staff member or client was recorded without their permission. We have provided a simplified transcription of each extract to get across crucial features of the talk: pauses are timed and given in brackets [short pauses as (.)], gaze or actions are given in italics and moments of overlap between different speakers are indicated by square brackets. Analysis In our collection of approximately  h, there were five main situations in which questions were used by staff as part of institutional activities:  Clarification of communication. When the person with ID did something unprompted, either verbally or non-verbally, that the staff treated as a request, a preference or other expression of their internal state (e.g. their level of comfort). The question then attempts to determine the meaning of the behaviour.  Assessment of a person’s choice or preference. When the staff asked a question as part of an activity which required the person’s choices or preferences to be recorded (e.g. a questionnaire was being completed, decisions were being made about current activities).  Initiation or pursuit of physical activity. When the staff were initiating or trying to complete an activity. Questions were used here to enquire about the person’s readiness or willingness to begin, continue or end an activity.  Giving advice or making suggestions. When staff use questions to lead towards a suggestion about a better way of doing something (e.g. to wear old clothes when gardening).  Encouraging reflection and/or social participation. When questions were used to get the person to participate in a conversation or provide information about their activities (either informally in greetings/ small talk or as part of a formally structured service activity such as a debriefing session). Identifying ‘failed’ questions It was quite common in our data for attempts by staff to use questions to achieve institutional objectives to run into difficulties. We had two criteria for identifying a question as ‘failing’:  If the response, verbal or non-verbal, was not appropriately formatted for the question. In the most extreme case, this would be the absence of response altogether; in other cases, a response to a yes/no question that was not yes or no; or a response to an open question that was manifestly unrelated in topic, or related in topic but not as an answer to the question.  If the questioner treated the answer as inadequate. In the most extreme case, this would be by explicit correction of the response, but otherwise by clarifying, editing or reissuing the question or soliciting an answer in some other way. We noted above the five types of actions that questions were used to achieve. For the most part, there was no relation between these types of actions and the means by which staff attempted to resolve the failed questions. In the sections below, then, the pursuit practices we describe were used in any situation, and often more than one was used in a single sequence. We will organise our findings under seven headings. Question repetition This is perhaps the simplest method of pursuit: the question is repeated, often more than once, in a more or less untransformed way. While sometimes the question is exactly the same each time, often there are small modifications, such as shortening or the addition of the person’s name. For example, here we find Damien sitting at a kitchen table with a coffee jug in front of him and a beaker of coffee in his hand. Extract . A-VD-. . Damien (drinks from coffee mug and sits at table looking around ) . Anna Have you got any left, Damien? . Damien (looking at camera; does not appear to respond ) . Anna Is there any coffee left in there [Damien? . Damien [(looks to side) . Anna Is there any left? Expansion Slightly more expansion of the question occurs when the staff member includes information not ©  The Authors. Journal of Intellectual Disability Research ©  Blackwell Publishing Ltd Journal of Intellectual Disability Research       364 W. M. L. Finlay & C. Antaki • Pursuit sequences explicit in the original version of the question. To give an illustration of a simple two-step clarification sequence, consider this exchange. Staff member Dave is asking what residents want to do in their leisure time in the coming week. Extract . CHW-VD-. . Dave (Looks at Dom) D’you want to go with Bill to the concert . next week? . Dom (Looks at Dave, moving hands slowly, no clear response) . Dave See [South Pacific and [a drink . [(twirls fingers) [(gestures drinking with hand ) afterwards? . Dom (Nods) . Dave Yeah? Note that in line , Dom gives no response to the staff member’s question. Dave makes no reference to Dom’s silence, and instead expands the characteristics of the activity he nominated in line . Questions about desire versus intention When service users gave no apparent response, staff were often observed alternating between questions about the person’s behavioural intention (e.g. are you going to . . . ?) and about their desire (e.g. do you want to . . . ?) (or vice versa). This was particularly the case when questions were used to get some activity done or enquire about the person’s preference. In the following extract staff member Jill is going around the lounge encouraging residents to go through to the dining room for dinner. Matthew is watching television. She starts with a question about his intention (Are you coming?) which, faced with Matthew’s ambiguous response, quickly becomes an imperative (‘come on’) and then a question about his desire (‘do you want some dinner’). We can see how such questions, apparently enquiring about his intentions or desires, are used in the course of the task of getting the residents to come to dinner. When this fails to produce an affirmative response, Jill alters her bodily proximity – she goes and sits next to him, they exchange a smile, and finally he gets up and walks to the dining room. That her questions were task-oriented is displayed in the celebratory ‘yay’ she issues in line . Extract . A-VD-. . Jill Are you coming Mister M? . Matthew (Looks at her, then looks away with hands over right side of face) . Jill Come on (.) d’you want some dinner? . Matthew (Looks up at J but does not get up) . Jill Want some dinner? . Matthew (Looks away from her) . Jill Come on, cheeky (Walks over to M and sits next to him) . Matthew (Looks at her and appears to smile) . Jill Want some dinner? (smiling at him) . Matthew (Smiles, then gets up and walks to dining room) . Jill Yay The opposite was also a frequent occurrence, and an example of the staff member starting with a question about desire and then following it with a question about the person’s intention is seen in extract , where the staff member starts by asking Damien if he wants to go to the toilet, eventually changing it to ‘coming to the toilet?’. Making a question more specific Questions were also edited in ways that altered the question content by making it more specific. For example, in this extract the staff Jill is sitting next to Dev and engaging in a conversation with him about another resident in the garden, who is making vocalisations. When he does not seem to reply to the enquiry about Jonny’s happiness, her questions then direct his attention to the evidence that he might be happy, and the question becomes ‘Is he chatting?’ Extract . A-VD-. . Jill Is Jonny happy, Dev? . Dev (Mutters, eyes closed, raising hand, pointing with thumb at own face) . Jill Is he? (.) Can you hear him? . Dev (Clicks fingers, looking away from her) . Jill [Chatting? . Dev [Uh ha woo ha . Jill [Uh? . Dev [(Chopping gesture with hand) Oh hello, hiya . Jill [Is he chatting? ©  The Authors. Journal of Intellectual Disability Research ©  Blackwell Publishing Ltd Journal of Intellectual Disability Research       365 W. M. L. Finlay & C. Antaki • Pursuit sequences . . Dev Dev . . Jill Dev [(shakes toy in hand, eyes closed ) (Smiles) Ah ah hup (?) (chopping gesture) . Is he? (Mutters, lifts hand upwards and looks at Jill ) Changing question format A very common practice in our data was for the staff member to reissue a question with a different response format, for example, changing an openended question into a single alternative or yes/no question. In the following extract, Damien is sitting at the dining room table, having finished drinking his coffee. The staff member Jill (who is off camera) begins with an open question (what would you like to do now?), then turns it into a yes/no question (would you like to go to the toilet?). After an exact repeat, the content gets dropped entirely (‘yes or no?), followed by a much more leading ‘coming to the toilet. Yes?’. Finally, the question is transformed again into a suggestion that the activity involves them both: ‘Shall we go to the toilet?’ Extract . A-VD-. . Jill Damien [what would you like to do now would you like to go to . the toilet? . Damien [(looks at her with smile) . Damien (appears to make no response) . Jill (laughs) Damien (.) would you like to go to the toilet? . Damien mmn (turns head away) . Jill huh? (.) yes or no? . Damien (head sways) mmn (turns head away) . Jill Tell me (.) coffee’s all gone (.) coming to the toilet? (.) yes? . Damien (looks at her, then sways head, looking to left and right) . Jill yes? . Damien (looks away, smiles, lets head fall, looking at table) nnhh . Damien (looks up, then away, then up, then away, grinning) . Jill shall we go to the toilet Damien? After approximately  s of further encouragement, Jill finally offers him an alternative to the toilet – providing him now with an either/or question: Jill: Shall we go to the toilet or do you wanna go and watch the television? Such editing can also be in the service of breaking up a complex question into its separate parts. In the following case, the staff member Georgie is recording Adam’s responses to a questionnaire about leisure activities. The printed format of the question requires an activity to be read out and the person to answer in terms of the degree to which they like it. This procedure requires that the respondent recognise what the activity is, judge whether they like it or not and then estimate how much they like it, all at once. This proves problematical for many people with ID. Georgie edits the procedure so that she first issues a yes/no question to establish whether Adam likes the event or activity, and then she finds out the degree of his liking by giving him two alternatives – a lot or just a bit. Extract . ./ FGP Georgie & Adam qnre. . . Georgie d’you like colouring? . (.) . Adam yuh . Georgie yeah? . (.) . Georgie d’you like it a lot, or just a bit . (.) . Adam (a luh) . Georgie a lot. Providing a visible realisation of the question Often, we saw staff using their own bodies when reissuing questions. This took a variety of forms: pointing, nodding or shaking the head, holding out their hand, standing or altering bodily proximity were some of the common forms. In the following extract, we see staff member Jill at various points rephrasing the question, holding out her hand, moving her face nearer to the person she is talking to and standing up. During the interaction, Mona responds with a variety of movements that are ambiguous in their meaning. It is when the staff member initiates the first step of the relevant behavioural sequence, suggesting that they do it together, that the person finally responds to the question. The staff member is going around the residents in the lounge trying to encourage them to ©  The Authors. Journal of Intellectual Disability Research ©  Blackwell Publishing Ltd Journal of Intellectual Disability Research       366 W. M. L. Finlay & C. Antaki • Pursuit sequences go to the dining room for dinner (extract  is also from this scene). The questions here are used in pursuit of this task. Extract . A-VD-. . Jill (Bending over Mona) Want some dinner? . Mona (Lying on couch. Looks at ceiling, does not seem to respond ) . Jill Want some dinner? [Come on (.) come on . [(Pats Mona’s hand ) . Come on ( patting Mona’s hand ) . Mona (Withdraws hand ) . Jill (Straightens up, takes Mona’s hand ) Come on . Mona (Continues lying on sofa, looking down) . Jill (Wiggles Mona’s arm) Come on . Mona (Withdraws hand and crosses arms) . Jill (Squats down, bringing her face close to Mona’s face) Get some . dinner? . Mona (Sits up, [looks at Jill, then away, crosses arms) . Jill [Dinner? (Nods at M ) . Mona (Looks down) . Jill (?) (Stands up and offers M her hand ) . Mona (Takes J’s hand ) . Jill Come on (Takes a step away from sofa, pulling Mona’s hand slightly) . Jill Come on. . Mona (Gets up and walks behind Jill to dining room) In this case, her initial approach is phrased as a question about whether Mona wants some dinner. When there is no response, an imperative is issued (‘Come on’) combined with a gesture (she holds her hand out to Mona). However, although Mona takes the hand, she does not stand up, and eventually withdraws her hand again and crosses her arms. Jill then adjusts her proximity, bringing her face closer to Mona’s, and the question is altered to ‘Get some dinner?’ Again, Mona seems to go some way to answering in the affirmative by sitting up, but her subsequent dropping of her gaze and crossing her hands makes her action ambiguous – she might have been sitting up to move her face away from Jill’s rather than to go to dinner. It is at this point that the staff member produces the first part of the behavioural sequence appropriate to a ‘yes’ response – she stands and offers her hand. When Mona takes Figure 1 Mona takes Jill’s hand. her hand (see Fig. ), Jill tugs it. Mona then also stands, and they walk to the dining room. In some cases, using physical modes of communication does not lead to identification of what the person does want, but does at least allow the person to reject the course of action being proposed. In this example, for reasons of space, we will describe the interaction and use a visual image rather than a transcript. Several residents of Ashgrove are sitting at a picnic table in the park (A-VD-.). Matthew makes a vocalisation that sounds like ‘yeye’. The staff member takes this as a request, asking ‘What darling? What do you want?’ Matthew then makes a series of slow hand movements, which she takes to mean he wants to go on the bus. She suggests this (‘You want to go on the bus?’) several times, but he neither confirms nor denies it; instead he rubs his hands together. At this point, the staff starts the behavioural sequence of helping him towards the bus by coming towards him, requesting that he lift his legs, and taking his hand. At the same time she says ‘Come on.’ In response, he pulls his hand away (see Fig. ), which she takes as indicating that this was not his intention. In the following example, the staff member Dave is asking Dom which of -day services he wants to ©  The Authors. Journal of Intellectual Disability Research ©  Blackwell Publishing Ltd Journal of Intellectual Disability Research       367 W. M. L. Finlay & C. Antaki • Pursuit sequences Figure 2 Matthew pulls his hand away. Figure 3 Dave holding out fists. attend. Here, we see Dave use both hand gestures as well as locating the two options in his right and left fist, requiring Dom to point in response rather than produce a verbal answer. Extract . CHW-VD-:2 . Dave (Looks at Dom) What about Pardew’s? . (.) . Dave is Pardew’s [good (.) or [bad. . [(thumbs up) [(closed hand) . Dom (Thumbs up) . Dave Pardew’s is better (.) which is – . which is (.) [which is better, . [(leans toward Dom . holding out fists) . Dave [Rose House ] or [Pardew’s. ] . [(taps left fist twice)] [(taps right fist once)] . Dom: (points toward Dave’s right fist) . Dave: [Pardew’s is better, ] . [(taps right fist four times, whilst looking at Dom)] . Dom: (nods) . Dave: [(points to his left fist) Rose House?] . [(shakes his head minimally) ] . Dom (shakes his head and right hand) . Dave [No: ] . [(shakes his head)] 2 A shorter version of this extract, without the accompanying images and slightly differently transcribed, appeared in Antaki et al. (). . Dave: [Pardew’s, ] . [(points to his right fist)] . Dom: (nods and points toward Dave’s right fist) . Dave: Ahkay (nods, picks up pen, leans back in chair and writes) Dom gives no response (line ) to Dave’s open-ended question what about Pardew’s? Dave immediately transforms this into a stem-question with options, and illustrates these with symbolic ‘thumbs up’ and ‘closed hand’ gestures. This is successful in that it receives an appropriately formatted reply (Dom signals a thumbs up to Pardew’s), but Dave, presumably in the interests of getting a more explicit choice between the leisure alternatives, now physically realises the two options by placing his fists on the tables (see Fig. ). In a careful series of probe questions (see Antaki et al.  for how this sequence works out in detail) he tests out Dom’s preference for one alternative over the other by dint of pointing to one fist or the other (see Fig. ). This has two virtues. It makes both options appear concurrently, making less demands on Dom’s memory, and it requires Dom actively to indicate his preference by pointing, making less demands on his vocabulary (and, perhaps, diminishes the risk of an acquiescent ‘echoing’ response). ©  The Authors. Journal of Intellectual Disability Research ©  Blackwell Publishing Ltd Journal of Intellectual Disability Research       368 W. M. L. Finlay & C. Antaki • Pursuit sequences Extract . .. FGP Georgie & Dave . . Georgie you’ve got a different jacket on . (.) . Dave yeah:: . Georgie haven’t you? . Dave (inspects wheelbarrow) . Georgie is that a new jacket Dave? . Dave (er ah oh) . Georgie have you got your other one? . Dave (no::) . Georgie cos you want to keep that one clean don’t you? . Dave (looks down) . Georgie p’raps you ought to bring the other one back here . and keep it in the shed to that you can ( ) okay? Figure 4 Dave pointing to one option. Using preliminary questions The practices above were ways in which the staff member was able to solve interactional problems manifested in the person’s inability to provide a suitable response to the original question. Staff members can also anticipate potential difficulties by using a conversational sequence which projects a further turn after their interlocutors’ potentially inadequate reply. For example, a single more complicated question can be edited into two simpler questions: the first which projects a second question which delivers the action (e.g. instruction). For example: ‘You know the big spade in the garden shed?’ ‘Yes.’ ‘Can you bring it over here please?’. Such devices are known as preliminary questions, that is, those that prepare the way for a further, more consequential turn at talk (Schegloff ). Here, the preliminary question builds into it the expectation that the respondent’s first turn in reply will not satisfy the original speaker, who then has a further turn in which to deliver the now preparedfor social action. In the following extract, staff member Georgie has noticed that Dave is wearing a coat which might be soiled by the gardening work he is about to embark on. She uses questions to work towards giving Dave advice on appropriate clothing. Here, the questions (‘You’ve got a new jacket on, haven’t you?’, ‘Is that a new jacket?’ and ‘Have you got your other one?’) are preliminary to the suggestion/expansion ‘cos you want to keep that one clean’ followed by the confirmation-seeking question tag ‘don’t you?’. Although Dave does not appear to confirm this, Georgie then produces some further advice about bringing a spare jacket. Discussion We want this article to be read as a ‘front-line’ report, showing everyday life as it actually happens, using video records. We offer what we hope is a clear and distinct take-away message: that the way that staff talk to people with ID can cause awkwardness and unhappiness, and that there are ways of talking to avoid, and ways of talking to encourage. Specifically, we identified ways in which staff used questions in instructing, advising, suggesting and soliciting information from those they supported – and how those questions fail and succeed. Where they fail at their first attempt, they cause interactional trouble or distress. We described the ways in which staff tried to overcome that by a variety of means (repetition, expansion, making the question more specific, alternating between asking about intention and desire, changing the format, using physical realisation of the question/options), and in one case how they pre-empted such difficulties (with preliminary questions). Examining how ©  The Authors. Journal of Intellectual Disability Research ©  Blackwell Publishing Ltd Journal of Intellectual Disability Research       369 W. M. L. Finlay & C. Antaki • Pursuit sequences mutual understanding is achieved on the ground between people with ID and those employed to support them is a crucial first step to determining which ways of working promote equity and participation, and which are less effective (for other studies in this vein, see Antaki et al. , ; Finlay et al. b). Many of the social actions being pursued in these instances could be addressed using a simple directive or suggestion, and we do see these issued by staff members from time to time in the extracts above. However, the question format has an implicit orientation to the recipient being able to decide and answer for themselves, and its expansion into other non-directive forms allows the staff member to pursue the action they are engaged in despite the fact that the person has not initially assented or not apparently participated in the interaction, while maintaining the person’s apparent priority in making the decision. The question of how successful the practices are in solving that dilemma depends on whether success is determined by the ability of the person to refuse a suggestion, the production of their ‘real’ preference or the completion of the action being proposed by the staff member. We have seen here that ‘adequate’ responses can occur after a number of pursuit strategies, such as expansions, changes in content and format, the use of preliminary questions and the use of physical prompts. Our data do not allow us to measure one against the other, since the success of a strategy is heavily dependent on the individuals and the context, and in most cases would require us to know the real intention or preference of the person. However, if we take success to be action completion by the member of staff (a controversial criterion), then one measure might be the rapidity by which the social action is performed and ratified. Inspection of the examples above show there is often a long chain of question pursuit before this is achieved. What is noticeable among the examples we have studied in this paper is that the chain seems shortest, and the staff members’ flexibility greatest, when the social action performed by the question is of a kind that permits its physical realisation (e.g. choice among alternatives, start of a behavioural sequence). The very fact that the embodied format can lead to rejection shows that, in some cases at least, it is able to allow the full range of options to be expressed by the person with ID. References Abbeduto L. & Hagerman R. J. () Language and communication in Fragile X syndrome. Mental Retardation and Developmental Disabilities Research Reviews , –. Antaki C., Finlay W. M. L., Sheridan E., Jingree T. & Walton C. () Producing decisions in service-user groups for people with an intellectual disability: two contrasting facilitator styles. Mental Retardation , –. Antaki C., Finlay W. M. L., Walton C. & Pate L. 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