Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Communication Sciences and Disorders

First Advisor

Paul R. Hoffman


Ninety caregivers of 30 adults with moderate-to-serve cognitive, sensory, and physical challenges living in an institutional setting participated in this study to investigate caregiver perceptions of communicative abilities. A mixed effects design was used to compare communication scores of thirty adults. The adults were assigned to three communication proficiency groups. The communicative scores with challenges that were generated with three different assessment activities: a direct/participatory evaluation conducted by a certified speech-language pathologist, an interview of the caregivers, and an observation of daily routine activities. Results indicated that all of the rating procedures differentiated the three communication proficiency groups. Correlations between professional and caregiver judgments were high, indicating that caregiver reports were a valid source of data about how the targeted population interact and communicate in their daily environments. Significant differences were found for the different methods of gathering observational data. Data collected via passive observation of activities in the natural environments were markedly different from both the professional assessment findings and caregiver report findings. The communication performances observed under the natural sampling conditions were significantly less proficient, less effective, and less efficient than those obtained through direct interaction with the professional or through interviews of the caretakers. The problem with the observational technique appears to be related to the relatively infrequent occurrence of communication opportunities in the environment under the direction and control of untrained service providers. These findings may be interpreted to support the clinical use of caretaker observations in forming goals and plans. The use of caregiver report may reduce the time and effort needed to assess the needs, intervention, and supports for persons with moderate-to-severe challenges. The results also suggest that effective communication intervention in this setting must increase the frequency of communication opportunities.