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Affect attunement in communicative interactions between adults with profound intellectual and multiple disabilities and support workers

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posted on 31.01.2017, 05:20 authored by Forster, Sheridan Lee
The quality of life of people with profound intellectual and multiple disabilities (PIMD) is affected by many factors, including health status, involvement in activities, and social networks; but most critical is the quality of interaction experienced by the person on a daily basis. For many people with PIMD, most of whom reside in residential services where they receive 24-hour support, the primary people for interaction are paid disability support workers (DSWs). Quality interaction is difficult to define and such definition is made more complicated when one of the communication partners does not use or seem to understand speech. Research on communication and people with intellectual disability has focused largely on people with existing symbolic communication skills (i.e., people who use words, pictures, or signs to communicate) or developing the skills of pre-symbolic communication so they can become symbolic (e.g., developing the use of objects as symbols or other consistent ways for expressing wants and needs). In interventions that aim to move a person to use symbolic communication, the focus has been on human agency. Agency refers to the quality of an individual expressing what s/he wants and a communication partner recognising that expression. Agency has been the underlying construct of interventions focused on enhancing choice and preference expression, and in research in which the estimated comprehension of the person with a disability is measured against the complexity of communication used by interaction partners. The findings of such research have indicated a tendency for DSWs’ communication to be at a higher level than the assessed comprehension level of their clients. Far less attention has been given by communication specialists in the intellectual disability field to concepts related to social closeness or interactive relationships, in which the goal is not the transfer of information, but just being together with another person. Some theorists have labelled such feelings of togetherness as intersubjectivity. Although there have been differences in definitions across theorists, intersubjectivity broadly refers to the sharing of minds of two people. It has been used largely in infant development to describe the nature of interaction between parents and infants, and the way that expressions of emotion are shared through subtle intimate interactions. Stern (1985) described three particular types of intersubjectivity: interattentionality, interintentionality, and interaffectivity or affect attunement. Affect attunement refers to the use of cross model means to recast affect expressions to share feelings. The use of affect attunement by a mother with her infant has been suggested to be a key feature of the quality of an interactive relationship. The examination of affect attunement in interactions between DSWs and adults with PIMD offers the potential to open new avenues for describing quality of interactions. The aim of the present study was to see if affect attunement is used and, if so, describe the nature of affect attunement used by DSWs in their interactions with adults with PIMD in natural interactions in residential settings. In particular, the focus was on describing the frequency, modal and amodal qualities of the behaviours of both participants, and examining relationships between DSWs’ gender, parenting experience, and length of time working with the person and their affect attunement. Interactions from 21 pairs of DSWs and adults with PIMD were video-recorded and 10 minutes of each dyad was analysed using the Affect Attunement and Behavioural Coding manual. Sixty-four incidents of affect attunement were found across 16 dyads. DSWs attuned to behaviours of the person with PIMD characterised by motor effort, attention, and some emotional expression. DSWs often used similar modes of expression to attune to the eliciting behaviour, but also used speech to demonstrate their attunement. Five DSWs did not use affect attunement. Exploring interaction from an intersubjective perspective has clear merit. Affect attunement is a pre-existing strength used by DSWs that may be enhanced. It may act as a much better indicator of quality of interactions than indicators focusing on the agency expressions of the person with a disability. Further research is needed to establish the relationship between the use of affect attunement and the quality of interactions. Being aware of the presence of affect attunement may have implications for therapists, both for their own engagement with people with PIMD and implications for how to encourage existing skills and support DSWs to further enhance interaction.


Principal supervisor

Teresa Iacono

Year of Award


Department, School or Centre

Centre for Developmental Disability Health Victoria / School of Primary Health Care

Campus location



Doctor of Philosophy

Degree Type



Faculty of Medicine Nursing and Health Sciences