Developing communication in adults with profound and multiple learning difficulties using objects of reference

Objects of reference were used to develop communication in adults with profound and multiple learning difficulties (PMLD). The use of objects specific to individuals is recommended, but it makes heavy demands on care staff who implement such programmes. This study investigated the effectiveness of using a standard set of objects with a group of 13 adults with PMLD. Progress was monitored over a 20-week training period using an assessment based upon the cues provided by staff to promote the use of the objects. Results indicated that the group as a whole made significant gains, although a plateau effect was reached after the first 10 weeks of training. Some individuals within the group were near to ceiling performance after training, while others, though progressing, still made limited use of the objects. There was evidence, as suggested in the literature, that greater and more sustained progress was made with objects at the index level of representation. The views of the care staff who implemented the training programme were sought through semistructured interviews. Although the use of a standard set of objects presents a number of difficulties, it is concluded that it is desirable in situations where the use of individual objects with each client is unfeasible. It has the additional advantages that it instructs and motivates care staff and provides a means by which the use of objects of reference by individual clients may be assessed and planning for the development of their communication may be informed.