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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
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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
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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
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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
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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
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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
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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
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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).
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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
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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.
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