A Critical Dialogical Methodology for Conducting Research With Disabled Youth Who Use Augmentative and Alternative Communication

Abstract

In this article, we present a theoretical examination of communication difference in the context of a critical qualitative study that explored “inclusion” with disabled youth who use augmentative and alternative communication (AAC). Drawing on Mikhail Bakhtin’s dialogism, we articulate a novel critical dialogical methodology developed to rethink dominant understandings of voice, authenticity, and the autonomous participant. Case examples illustrate how the methodology surfaced normative value judgments that tacitly deem some kinds of interview talk more valid than others. The approach helped recognize the agency of disabled youth as they worked to make sense of inclusion and its effects.

Keywords

disability studies interviewing methodologies new methods & methodologies dialogism

This article examines the authenticity and validity of alternative or mediated modes of communication in research by outlining a novel critical dialogical methodology. The methodology was developed for a study that examined the notion of “inclusion” for youth who use augmentative and alternative communication (AAC¹; Teachman, 2016). The methodological approach draws on the work of Mikhail Bakhtin (1981, 1994) to illustrate the ways that particular types of oral speech are tacitly privileged in interview research, while other forms of talk are deemed inauthentic or indecipherable. Indeed, as Oliver Sacks (1989) observed from his experience with people with neurological conditions,

It is all too easy to take language, one’s own language, for granted—one may need to encounter another language, or rather another mode of language, in order to be astonished, to be pushed into wonder again. (p. 9)

We suggest that undertaking interview research with people who communicate differently opens a space for reflexively reconsidering normative assumptions about what makes a “good” interview and who is the ideal interview subject.

We begin by briefly summarizing and critiquing the literature informing methods for conducting research with people who have little or no speech. Issues raised about the authenticity or validity of data generated through various alternative, mediated modes of communication are reviewed, and we add our own stance to the discussion. Having provided a contextual frame for thinking about talk in research interviews, we introduce Bakhtin’s dialogism and use it to theorize communication difference. Then, following a brief outline of the study context, methods, and procedures, we use examples from the research to illuminate ways that a critical dialogical methodology may be “good to think with.” We show how this theoretical stance disturbed traditional conceptualizations of “the research participant” and “voice,” and problematized tacit understandings of autonomy and authenticity in the co-construction of research data. We conclude by highlighting the advantages of adopting a critical dialogical methodology in research interviews with individuals with communication impairments. We also suggest that the insights gleaned through our theorizing might inform thinking about issues of voice and interview-based research more generally.

Emergent Methods for Research With Persons Who Use AAC

Until recently, the experiences and perspectives of youth who use AAC were absent from childhood disability research (J. Morris, 2003). Reasons for this are at least twofold: researchers assumed youth who use AAC would not be capable of “speaking for themselves,” and researchers lacked access to well-described methods to guide them in designing interview studies and generating participant data with this population. In the last decade or so, there has been an increase in knowledge and awareness of methods for involving people with communication impairments in research as respondents (Boggis, 2011; Lloyd, Gatherer, & Kalsy, 2006; Low, 2006; J. Morris, 2003; M. A. Morris, Dudgeon, & Yorkston, 2013; Nind, 2009; Philpin, Jordan, & Warring, 2005; Teachman, Mistry, & Gibson, 2014; Wickenden, 2011b), and a small body of work that examines substantive issues with youth who use AAC has emerged (Bennett, 2011; Gibson et al., 2014; King et al., 2014; Mitchell, 2010; Raghavendra, Olsson, Sampson, Mcinerney, & Connell, 2012; Wickenden, 2011a, 2011b). Still, there is relatively limited information on strategies and procedures for generating rich accounts with people who use AAC. Even less is known about methodological approaches for interpreting data generated with participants who communicate primarily in ways other than speech.

Use of a communication device to produce words or sentences that approximate speech has several advantages in that it is generally clear and readily understood across environments. However, the process is often extraordinarily arduous and fatiguing for the person using the device (Boggis, 2011; J. Morris, 2003; Teachman et al., 2014). As a result, the quality and quantity of data generated in a standard qualitative interview may be compromised. A number of techniques for improving data quality in research with persons who use AAC have been suggested. These include becoming familiar with participants’ preferred communication modes prior to data generation (Boggis, 2011; J. Morris, 2003), increasing researchers’ comfort and fluency with various AAC modes (Lloyd et al., 2006; Low, 2006), selecting a quiet interview location, and anticipating the potential need to conduct a series of shorter interviews due to participant and/or researcher fatigue (Boggis, 2011; Carlsson, Paterson, Scott-Findlay, Ehnfors, & Ehrenberg, 2007; J. Morris, 2003; Teachman et al., 2014). Fatigue can be reduced to some extent through study designs that combine electronic interviews with subsequent face-to-face interviews (Teachman et al., 2014) or provide participants with interview questions in advance of interviews. These strategies allow participants to prepare, at their own pace, by ensuring their communication system contains vocabulary to support conversation about the research topic and precomposing some responses (M. A. Morris et al., 2013; Philpin et al., 2005). More generally, it has been recommended that researchers adopt methods for generating data with persons who use AAC that are open, flexible, and readily adapted to best suit individual participants—what Boggis (2011) termed bespoke methods.

In setting out to develop interview methods to optimize data generation with youth who use AAC, we first considered how to optimize the quantity and quality of data generated while attending to the need for an interview approach that would be less onerous for participants. For example, persons who use AAC have reported that they are able to say more, and with less fatigue, when supported by a familiar communication partner (Collier, McGhie-Richmond, & Self, 2010). In the intimate and routinized context of the home, persons who use AAC might use communication devices much less than in other spaces. In part, this occurs because AAC devices can be difficult to access during a variety of activities, for example, when a person is not seated in their wheelchair or when involved in self-care activities such as dressing. It also happens that, over time, families might develop idiosyncratic, situated systems of communication that are more reliant on nonverbal gestures, facial expressions, dysarthric speech, and nonspeech vocalizations. Given these considerations, we elected to conduct the interviews in participants’ homes and encourage use of any and all preferred modes of communication, including mediation by familiar communication partners which had the potential to greatly reduce participant fatigue and increase the quantity and depth of the data generated. This decision necessitated that we address issues concerning the validity of researchers’ interpretations of alternative communication modes (Boggis, 2011) and whose voice is being represented when another person attempts to mediate communication between a participant and interviewer (Philpin et al., 2005).

Some scholars have raised concerns about the credibility or authenticity of the accounts of persons who use AAC. For example, in advocating for the development of methods for research with children, Boggis (2011) questioned the authenticity of communication mediated by a speech-generating device given that, most often, someone other than the AAC user programmed it. While explicitly framing the young participants as competent social actors, Boggis asked whether the children were being lent voices, and whether it was possible to adequately or justifiably speak about or for them by interpreting their nonverbal gestures or facial expressions. This led her to suggest that inarticulate voices might be difficult to authenticate. Validity concerns have been raised by other scholars (Philpin et al., 2005) who point out the variety of unanticipated (and unsolicited) ways in which spouses or caregivers supplemented or expanded upon participants’ responses during interviews. These interjections simultaneously prompted researchers’ concerns about bringing proxy perspectives into their research and underscored the shared nature of the experiences being discussed. Indeed, some even concluded that while the spouse or caregiver contributions added important perspectives and insights, the data could not be considered as part of so-called valid patient accounts (Philpin et al., 2005).

Queries about “whose voice” is being elicited reveal assumptions about voice as a personal attribute or property that can be possessed. Scant attention has been paid to how voice is conceptualized in AAC research, or to the potential effects of normative judgments about the validity and authenticity of research accounts from persons who communicate in ways other than speech. An exception is found in work by Ashby (2011) who, in research with autistic youth who typed to communicate, questioned whether attempts to access the authentic voice of the individual were possible, and argued these attempts deny the performative nature of identity. Ashby (2011) called on researchers to “think about facilitating agency in the research process rather than giving voice, recognizing the performative, often interdependent, and contextually bound nature of voice” (Hearing silence section).

Tacit assumptions about capturing a person’s “own voice” undermine the involvement of people who use AAC in research interviews. We argue that these types of concerns reproduce conventional positivist notions of autonomous speakers whose voices and views are faithfully “captured” through the research process. They expose broader, pervasive, and often unacknowledged assumptions about who is able to participate in research and how they are able to participate, as well as what researchers listen to and how they listen (Simmons & Watson, 2015). Contra dominant understandings of talk that produces “good” data in interviews, Lloyd and her co-authors (2006) argued that all qualitative research, by its very nature, is less concerned with truth-telling than with the ways participants ascribe meaning to the particular stories they tell that are themselves co-constructed through the research process. Thus, the interpretation and analysis of accounts from people with communication impairments are no more infused with the researchers’ views and perspectives than are the narratives of research participants who respond using putatively normal speech.

We have engaged with and problematized normative understandings of voice because, left unexamined, researchers unwittingly risk reproducing the very constraints that have excluded people who communicate differently. To be clear, our work owes a debt to the creative and committed work of scholars who developed the emergent methods reviewed here. However, moving forward in our own research with persons who use AAC, we were interested in developing methods flexible enough to build on participants’ abilities, rather than attending to deficits while generating and analyzing data. Accordingly, we looked for perspectives and theories that could help us understand communication difference and build on emergent methodological scholarship in this area. In the next section, we draw on the work of Mikhail Bakhtin (1981, 1994) and Bakhtinian scholarship (Baxter, 2011; Frank, 2005; Holquist, 2002; Linell, 2009; Tanggaard, 2009) to problematize and complicate conceptualizations of voice in research.

Bakhtin’s Dialogism

Bakhtin was a Russian philosopher and linguist whose aim was to reveal the relational and situated nature of all dialogue. His theory of dialogism (Bakhtin, 1981, 1994) is made up of a set of concepts and theoretical principles that can be used to analyze language, not in the conceptual terms of linguists but in relation to the active, creative capacity of utterances and the actualized meanings of communication interactions. It is worth noting that some scholars, when discussing research interviews, use the term dialogic to refer directly to Bakhtin’s work (Tanggaard, 2009); others use the term in a less-specific sense to frame research interviews as caring conversations between “egalitarian partners” (Kvale, 2006, p. 483). Here, we use the terms dialogism and dialogical as we extend Bakhtin’s work to theorize talk that does not conform to normative expectations for individuated voice, speech, and utterances contained in and emerging from a person. Although Bakhtin lived with physical impairments (at age 43 years his right leg was amputated subsequent to osteomyelitis), he did not write about speech or language in relation to communication impairments. Nonetheless, his work is helpful when contemplating how to interview and interpret the accounts of persons who use AAC in ways that highlight the legitimacy of their accounts.

We have synthesized two key propositions that run through Bakhtin’s dialogism and provide a lens for thinking differently about talk with youth who use AAC. The first highlights Bakhtin’s insistence that taken-for-granted assumptions about the individual, autonomous speaker are illusions. The second deals with the actualization of meaning through dialogue. Bakhtin’s first proposition provides a way to problematize dominant understandings of voice, which attribute talk in research interviews to individual bodies that produce autonomous utterances in response to an interviewer’s probes. Instead, dialogism locates voice in the space between speakers where “no one person’s voice is ever even his or her own . . . each voice is always permeated with the voices of others” (Frank, 2005, p. 968). In other words, all utterances are multivoiced in the sense that they are inextricably linked to what has been said before, and anticipate what will be said next. Accordingly, we are all limited and enabled in our talk by what has already been said, by the language we have available, and by our anticipation of what will and should be said next.

Bakhtin was more interested in the interplay of power among various social discourses than in power relations among individuals or groups engaged in talk (Holquist, 2002). While it remains important to consider power relations between the researcher and research participant, a dialogical approach explores what persons are able to say, to whom, and in what contexts. Wickenden (2011b) provided an evocative example of power relations at this discursive level. Drawing on her research with youth who use AAC, she described the thwarted desires of two study participants to have swear words programmed into their speech-generating devices. Programmers’ refusal to do so had the effect of regulating and censoring their talk. This example elicits reflection on the limits and enablers of all speech which are made material and visible in the context of use of speech-generating devices or other modes of AAC.

Bakhtin used the term monologic to describe dominant discourses involving truth claims, where alternative meanings or explanations are “ruled out” or, even, inconceivable (Holquist, 2002). Monologic discourses about voice as something individuals possess make it difficult to conceive of voice as a social construct. In research that involved young children, some of whom had communication impairments, Komulainen (2007) critiqued understandings of children’s voice as “a relatively straightforward mental, verbal and rational property of the individual” (p. 13). With Bakhtin, she argued voice is always a multidimensional social construction and that determinations of what is “true” and “real” are always therefore unresolvable. Describing discourses on communication as essentially moral, Komulainen points out that a focus on articulating the voices of inarticulate children brings their talk into line with notions about good and normal communication. Moreover, “giving voice” presumes a preexisting voice or utterance that has been subjugated or muted, and which is interpreted and brought to light by relatively more privileged researchers (Ashby, 2011). A dialogical view, in contrast, posits that voice only exists in the relation between two or more speakers in the context of talk. Thus, voice is not an individual property that researchers can retrieve, enable, and possess through interviews.

Similarly, Erevelles (2002) argued that persons who rely on human communication partners and/or various AAC devices challenge normative notions of autonomy and subjectivity even further by blurring the boundaries between human beings and machines. Powerful social discourses construct the human in ways that idealize independence, ability, and autonomy. Weighed against the rational, coherent, and autonomous ideal human subject, the speaker who uses AAC is found wanting. People with communication impairments are positioned according to their differences; they must prove the authenticity of their voice and reclaim agency that is denied them by virtue of having little or no speech. A dialogical approach insists that all communication is interdependent and a mediated co-production between persons and, in some instances, technologies. As Linell (2009), a preeminent Bakhtinian scholar, suggested, “nowhere it seems [sic] easier to demonstrate the relevance of dialogical theory . . . than in communication with persons with disabilities. You can immediately see the interdependencies with others, or for that matter, dependencies on the other” (p. 25). Thus, it is possible in research with persons who use AAC to recognize their agency without invoking hegemonic notions of communication as a morally requisite independent competency.

Bakhtin’s (1994) second proposition that meaning is actualized in dialogue can be distilled from his assertions that meaning is dynamic, relational, and always uncertain. From this perspective, “communication is a dialogic struggle, and out of this struggle identities are shaped.” (Baxter, 2011, p. 11) Here, struggles are over meanings: whose meanings count, how meanings are ascribed value, how meanings can change, and how life is made meaningful through relationships. Struggle seems a fitting term to describe the work of people who use AAC against dominant stereotypes that assume they have little to say. In the hierarchy of forms of talk, they are too often judged incoherent, unintelligent, and simple.

Bakhtin (1994) insisted, further, that verbal communication is not self-sufficient. Rather, “verbal discourse directly engages an event in life and merges with that event, forming an indissoluble unity” (p. 162). Following Bakhtin, utterances include signs, such as gestures or facial expressions, and are situated in the extraverbal context that is shared by the speakers, like “passwords” (p. 164) known only to those who belong in the same social space. As Bakhtin (1994) tells us,

To comprehend an utterance does not mean to grasp its general meaning, as we grasp the meaning of a “dictionary word.” To understand an utterance means to understand it in its contemporary context and our own, if they do not coincide. It is necessary to understand the meaning of the utterance, the content of the act and its historical reality . . . Without such an understanding, meaning is dead, having become some dictionary meaning of no necessity. (p. 157)

This view of utterances as creative or generative suggests that meaning is situated in time and place, and can evolve to decenter dominant “true” meanings or monologic utterances such as those in a dictionary. In the context of conversations, Bakhtin specified that speech is made up of a mix of utterances, some which are more monologic and others, more dialogic. In other words, in our speech we both conform to normative meanings and resist other meanings by creatively (dialogically) infusing new situated and relational meanings. Applying these ideas, Bakhtin’s work suggests research interviews, as dialogues, are never completely monologic. Instead, interview talk is made more or less monologic or dialogic through researchers’ interpretations.

Meaning, for Bakhtin, is constructed within the “unity of the real conditions of life that generate a community of value judgments—the speakers’ belonging to the same family, profession, class, or other social group” (p. 163). A readily apparent example of this is found in the idiosyncratic communication modes that accumulate between people who use AAC and their familiar communication partners. Over time, and in the context of common experiences, an upward gaze combined with a distinctive nonspeech vocalization by the person using AAC might convey a range of shared meanings. This dialogical view of meaning has implications for researchers who are immersed in traditions where participants’ perspectives are represented as if they were “true” accounts that capture some preexisting knowable position, perspective, or account. Drawing on Bakhtin, Frank (2005) suggested that a more ethical relation seeks to understand participants’ narratives “as one move in a continuing dialogue through which those participants will continue to form themselves, as they continue to become who they might yet be” (p. 967). In this way, researcher and participant come together and through their dialogue they are both changed.

Contra views of communication impairment as a barrier to research, we propose that a critical dialogical methodology opens fertile space in which to (re)conceptualize communication difference. We do this by shifting away from monologic approaches that valorize some types of speech and discount others. The critical dialogical methodology we propose seeks to interpret talk as generative, creating opportunities for multiple potential interpretations and resisting calls for any single authoritative interpretation. It aims to legitimate speech mediated by AAC by recognizing that all language and dialogue, including putatively natural speech, is multivoiced and frequently technologically mediated. Monologic discourses are those that “speak truth” and finalize, as might occur when researchers feel obliged to query the autonomy and authenticity of speech mediated by AAC. In the absence of dialogical methodologies, researchers who intend to “give voice” risk unwittingly shutting down dialogue even as they strive for recognition and legitimacy on behalf of people who use AAC. Having sketched out the principles that underlie this methodology, we move now to share applied examples from our research with youth who used AAC.

Implementing a Critical Dialogical Methodology

Study Overview

Existing research suggests that youth who have both physical and communication impairments experience high levels of social exclusion (J. Morris, 2001, 2003; Smith, 2005; Whitehouse, Watt, Line, & Bishop, 2009), yet, to our knowledge, there has been no research that explores inclusion and exclusion with youth who use AAC in relation to pervasive inclusion discourses. Complicating this lack of knowledge is the broader problem of how inclusion and exclusion are conceptualized in research and policy (Ravaud & Stiker, 2001). Dominant binary notions of inclusion/exclusion that characterize inclusion as a universal good do not necessarily reflect the perspectives of disabled persons and are silent on the risk of unintended harms (Graham & Slee, 2008; Holt, 2003; Spencer-Cavaliere & Watkinson, 2010).

We explored these issues in a critical qualitative study with 13 Canadian youth who use AAC. Participants had little or no speech because of neurological conditions, such as cerebral palsy, which caused motor impairments that interfered with speech production. More detailed descriptions of the study methods and processes, as well as the substantive study results, are discussed elsewhere (Teachman, 2016; Teachman, McDonough, Macarthur, & Gibson, forthcoming). Here, our focus is a theoretical examination of communication difference and the critical dialogical methodology that we developed to optimize data generation with youth in the study. The study purposes were to (a) contribute detailed descriptions of the daily activities, social networks, personal geographies, and material environments of youth who use AAC with a particular focus on their perceptions of inclusion; and (b) interpret the ways youth who use AAC accommodated, resisted, or reformulated dominant social inclusion discourses to position themselves in the various social worlds they inhabited. Interview, photo, and graphic elicitation methods were combined to generate multiple, complementary types of data. We drew on Bourdieu’s (1997) theory of practice to examine the ways that dominant inclusion/exclusion discourses were taken up and manifested by youth who use AAC through their talk and practices. Critical approaches, including Bourdieu’s, posit that individuals are not able to fully reflect on the sources of their own marginalization and everyday practices in relation to broader social structures (Kincheloe & McLaren, 2005). For this reason, nondiscursive visual methods (photo and graphic elicitation) were used, along with observations to generate data about participants’ social worlds that might not be elicited through interviews alone (regardless of participants’ communication modes). These ethnographic methods were particularly well-suited to the research because AAC strategies frequently incorporate visual symbols, photographs, or images to scaffold and augment other communication modes.

Each youth participated in two interviews (ranging from 30-150 min) at her or his home conducted by the first author. The initial interview focused on getting to know the participant, their communication modes, and details about their everyday lives. The second interview integrated the photo-elicitation (Drew & Guillemin, 2014; Gibson et al., 2013) and graphic elicitation methods (Bagnoli, 2009). Participant-generated photographs were reviewed with participants to foster discussion of their understandings and experiences related to inclusion and exclusion. The graphic elicitation component entailed asking participants to indicate their sense of belonging to places in the photographs by selecting a location on a graphic diagram of two-dimensional concentric circles termed Belonging Circles (or Inclusivity Circles; McKeever et al., 2015). All interviews were video-recorded and analyzed directly. We used a variety of AAC clarification strategies to optimize understanding during the conversation (see Teachman et al., 2014, for examples) and intentionally encouraged participants to use all of their preferred modes of communication during the interviews, including use of a familiar communication partner. All 13 participants elected to include a communication partner (12 were participants’ mothers or female guardians, one was a sibling).

We illustrate the dialogical methodology and Bakhtin’s propositions, by providing examples drawn from interviews with Jamila (all names are pseudonyms), a 17-year-old young woman with cerebral palsy and multiple, complex medical conditions that made her reliant on a number of life-sustaining and assistive technologies, including tube feeding, mechanical ventilation, wheelchair, and AAC. She lived with her legal guardian, Rebecca. Focusing on this single case allows us to explore the context and interactions in depth.

Dialogue With Jamila

To reiterate, Bakhtin’s first proposition is that assumptions about the individual, autonomous speaker are illusions. Instead, all utterances are multivoiced in the sense that they are inextricably linked to what has been said before and anticipate what will be said next. When a person communicates using AAC, Bakhtin’s dialogism is materialized in remarkably illustrative ways. AAC is nearly always multimodal; that is, a whole range of nonverbal gestures and expressions might be combined with a speech-generating device, a symbol-based communication book, or the spoken interpretation of a familiar communication partner. For example, when using a speech-generating device (or any material system such as a communication book or symbol display), utterances can only be constructed using symbols, letters, words or phrases that are already in the system. In most cases, these have been programmed or added to an AAC user’s system by a family member, a caregiver, or a paid professional (e.g., a teacher, a clinician) with or without the AAC user’s collaboration. Illusions about generating individual, autonomous speech through using an AAC device are dispelled when considering that all possible utterances that can be constructed by the AAC user will be made up of the assembled language or symbol set which incorporates multiple persons’ input, including foundational input installed by the device manufacturer. To program a device, the programmer must first consider what vocabulary will be needed, in which contexts, and with which types of communication partners. Thus, talk with youth in our study who use a speech-generating device was already dialogical at one level because their utterances relied on the language that had already been programmed into their devices. The relation between the AAC user, the programmer, and the technology provides both a material and a relational example of the interplay of multiple voices conceptualized through Bakhtin’s dialogism.

One trait of putatively authentic speech is the novelty of the utterance. Authenticity comes into question when listeners suspect a speaker of using another person’s words. When someone who uses AAC depends on another to program the utterances stored in their communication device (which is most often the case), they are called on to defend themselves as authors of authentic speech. Toward the end of the second interview, Jamila used her device to comment on her inclusion/exclusion experiences using a series of preprogrammed statements (a series of related utterances):

Most people assume that just because my muscles and lungs and stomach do not work the way theirs do, that my brain and heart and soul are disabled too . . . I am a real and whole human being . . . I want them to know that it is not OK to treat me like I am invisible, or talk about me like I do not exist . . . I am not the puppet of my [speech-generating device]. I am the puppeteer.

Here, Jamila was reusing phrases and paragraphs that had been programmed for past communication interactions. She reproduced (reuttered) a series of personal reflections and stories in the context of the interview with different intentions, ordering, and emphasis to share feelings of being left out and/or stigmatized because of her bodily differences and her use of a speech device. In a monologic view of dialogue, this reuse of past utterances might raise concerns about the authenticity of Jamila’s talk and its “proper” place in relation to the research interview. But seen dialogically, it is clear that “ultimately, virtually all sense-making depends on prior or present, actual or imagined contexts and interactions” (Linell, 2009, p. 26). Thus, our analysis represented Jamila’s responses as legitimate and important perspectives on how she resisted negative valuations of disability and made efforts to claim her position as fully human and worthy of recognition.

Jamila’s case can also be drawn on to illustrate the second of Bakhtin’s propositions—namely that meanings are dynamic, relational, and always uncertain. They are situated so that, between those who share the same purview, utterances can be like passwords. Accordingly, our analytic approach viewed conversations with participants as dialogical in the ways that meanings were generated, not only through a process of clarification and co-construction during the interviews but also through the rich, shared past that was brought into the interview context through the relations between participants and their communication partners. Bakhtin (1984) asserted, “To be means to communicate . . . A person has no sovereign territory, he [sic] is wholly and always on the boundary; looking inside himself, he looks into the eyes of another or with the eyes of another” (p. 287). In describing her communication with Rebecca, Jamila expressed a remarkably similar sentiment: “we love being able to cuddle on the couch and just look at each other and laugh or cry and know what we are thinking without using words.”

People who use AAC often use very short utterances that might not be grammatically complete or correct in order to save time and energy (Wickenden, 2011b). This strategy, sometimes termed telegraphic speech, is akin to the style of text messages. For example, in talking about her favorite television shows, Jamila used her speech-generating device to say “hope,” but the interviewer, was unable to clarify her meaning. As Jamila gazed over to Rebecca, the two suddenly broke out into laughter. Rebecca explained that Jamila was talking about a new show called “Saving Hope.” The inside joke was that, although Rebecca had programmed that title into Jamila’s device, the two had recently reorganized the system for storing vocabulary. Neither could recall where the words were stored in the complex language software that is used to organize thousands of words and phrases. The utterance was meaningful in the context of their past shared language relations, so that Rebecca was able to clarify Jamila’s meaning without the necessity of additional language.

The form of the interview dialogue shifted across the course of the two interviews. At the first interview, Jamila worked hard to present herself as a competent independent communicator. She made extraordinary efforts to construct grammatically correct utterances using her speech-generating device, perhaps anticipating we might be more likely to value her contributions to the research if she demonstrated this competency. The process was very slow and arduous (3-4 min to compose a short sentence). As she became more comfortable over the course of the interview, and to avoid becoming overly fatigued, Jamila began to shorten her responses and more often indicated that she wanted Rebecca to provide details or clarification. Rebecca and the interviewer took care to clarify Jamila’s utterances, seeking situated understandings within the interview interactions. Jamila and Rebecca drew on their past shared experiences, as well as anticipation of what the interviewer might want to hear. The dialogical orientation of our methodology allowed our analysis to consider how each of these influences shaped the co-construction of Jamila’s account. Thus, we interpreted meanings of interview talk as relational, situated, dynamic, and always uncertain. However, with Bakhtin, we argue these meanings were uncertain only in as much as this can be said of all dialogue.

By adopting a critical dialogical lens, the interview process generated data that illuminate the ways that participants co-constructed a version of themselves in the relational communication space consisting of themselves, the researcher, the communication partner, and the communication device. This in between space contains more than just the utterances of the interviewer and interviewee; it also encompasses those that have gone before and those that are anticipated. As Bakhtin (1986) reminds us,

Our speech . . . is filled with others’ words, varying degrees of otherness or varying degrees of “our-own-ness,” varying degrees of awareness and detachment. These words of others carry with them their own expression, their own evaluative tones, which we assimilate, rework and re-accentuate. (p. 89)

Conclusion

In this article, we have outlined a novel critical dialogical methodology that extends Bakhtin’s dialogism to provide a framework for interview research with people who have communication impairments. The methodology helps make visible the normative assumptions that uphold traditional notions of voice, authenticity, and autonomy in the context of qualitative research. We propose that the value of a critical dialogical methodology is that it opens space for a reconsideration of the ethics that shape interview-based research, not only in relation to communication difference, but in research more broadly.

A critical dialogical methodology has potential to ethically represent research accounts from people who use AAC by more fully acknowledging all of the ways they communicate as legitimate and valuable. We have shared a conceptualization of communication difference that is able to overcome the limitations of more positivist framings of research interviews that risk systematically excluding people who communicate in ways other than speech. It questions whether there is such a thing as single voice and whether any dialogue is authentic. In so doing, our methodology contests normative assumptions about what makes a good interview and who is the ideal interview subject. Consistent with interpretive and critical epistemologies, a critical dialogical methodology sets aside monologic assertions that research participants autonomously and independently provide “true” accounts, and extends this discussion to those who communicate differently. We have shared here what might be described as a provisional sketch of the methodology that will likely be refined and revised through continued application.

In summary, Bakhtin asserted that every individual is able to resist and confront imposed meanings, and generate personal meanings through social exchange. In dialogism, consensus or shared meaning is not necessarily a preferred outcome; instead, meaning is always relational, embracing difference and uncertainty. A critical dialogical methodology, as outlined here, views utterances and language as never finalized and therefore never authenticated. The researcher engages in dialogues with participants that inextricably link their utterances. Neither is a sole author, and the individual autonomous speaker is recognized as an illusion. Their relationship is constructed through their dialogue. Communication impairment, rather than limiting a person’s involvement in research, provides an opportunity to reconsider and expand the ways we think about talk in interviews and how social relations are formed in the dialogical relation that is all of our communication.

Footnotes

Appendix

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by a grant from the Canadian Occupational Therapy Foundation.

Notes

Author Biographies

Gail Teachman is a postdoctoral fellow at McGill University in Montreal, Canada, where her research is focused on childhood disability and ethics. She completed her doctorate at University of Toronto in association with the Critical Disability and Rehabilitation Studies lab at Bloorview Research Institute. She worked for over 20 years as an occupational therapist in children’s rehabilitation.

Peggy McDonough is professor of social and behavioral sciences in the Dalla Lana School of Public Health at the University of Toronto. Her research interests lie in social inequalities in health dynamics, health and the welfare state, and health and culture.

Colin MacArthur, MBChB, PhD, completed his medical training at the University of Glasgow Scotland and doctoral training in epidemiology and biostatistics at McGill University, Canada. He is currently a senior scientist in the Child Health Evaluative Sciences Program at the Hospital for Sick Children Research Institute and professor in the Department of Paediatrics and the Department of Health Policy Management and Evaluation at the University of Toronto.

Barbara E. Gibson is a physiotherapist whose research investigates the intersections of social, cultural, and institutional practices in producing health, inclusion, and identity with disabled young people. She is an associate professor in the Department of Physical Therapy at the University of Toronto and a senior scientist at the Bloorview Research Institute where she holds the Bloorview Children’s Hospital Foundation Chair in Childhood Disability Studies. She is the author of Rehabilitation: A Post-critical Approach (2016) published by CRC Press.

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