ABSTRACT
This chapter considers the ways and means of identifying distress in a person using alternative methods of communication. In people using alternative communication, the language is made up mainly of behaviours, signs and verbal expressions. Compared to spoken language, the vocabulary in language of observable communication (LOC) is small, the grammar is basic and the pattern of expressions is unique to each individual. The difficulty knows what the behaviours, signs and expressions mean. They can only be understood with close observation. A real difficulty is that any cause of distress can be accompanied by any behaviour, sign or expression. Although some LOC 'words' are the same or similar in most patients, each individual uses their own 'dialect' of LOC. Although a staff is often skilled in picking up distress they often have little confidence in their observation and perceive their observations intuitively as a 'hunch'.
