Communicative Dilemmas for Practitioners in Service Encounters With People With Intellectual Disabilities: Insights From a Systematic Review of Conversation Analytic Research

Background: How do practitioners in service settings respond to communication support needs of people with intellectual disabilities? Conversation Analysis (CA) uses recordings of everyday encounters to understand the challenges practitioners face. Method: Following specialist guidance on systematically reviewing CA research, we reviewed 65 CA research articles examining staff communication in healthcare, education, social care and the police. Results: We identified five themes in the synthesis. Two were categories of interactional practices (Questions and Answers; Decision-Making), one examined non-verbal communication (Embodied and Non-Verbal Communication) and two considered contributions of other material and human agents (Communication Aids and Supports; Involvement of Companions). In each theme, we saw examples of competency-enhancing and competency-inhibiting practices. Conclusions: Practitioners face interactional dilemmas: (1) Orienting to the Person's Self-determination versus Getting the Job Done; (2) Adapting Communication versus Downplaying Difference. Future research should build on this review to develop and evaluate communication training for staff. Plain language summary Need for communication support: People with intellectual disabilities often need communication support in order to present their views, make decisions and engage in activities, but there is not much research that shows how this support is delivered by practitioners in real life. Using Conversation Analysis research to understand everyday interactions: We reviewed existing research that used a method called Conversation Analysis (CA) to understand how ordinary ways that staff ask questions, offer choices, use communication aids and respond to body language strongly shape whether people with intellectual disabilities are heard, understood and treated as competent decision‐makers. Support can both help and hinder: The research demonstrated that strategies intended to help—such as simplifying language, guiding decisions or speaking on someone's behalf—can unintentionally limit autonomy and participation if they prioritise efficiency or control over listening and choice. Implications for practice and research: Practitioners can improve their practice by being aware of the implications of offering support in different ways. This review provides information that can underpin evidence‐based communication training at a level of detail beyond what is currently available.

Citation

Chinn, D., Bruun, A., Worrall, D., Buell, S., & La, J. (2026). Communicative Dilemmas for Practitioners in Service Encounters With People With Intellectual Disabilities: Insights From a Systematic Review of Conversation Analytic Research. Journal of applied research in intellectual disabilities : JARID, 39(3), e70239. https://doi.org/10.1111/jar.70239

DOI

10.1111/jar.70239

URI

https://hdl.handle.net/20.500.14709/1496

License

CC BY 4.0

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Usage rights

CC BY 4.0

License

https://creativecommons.org/licenses/by/4.0/