How communication practices shape participation for children and adults with complex communication access needs Insights from Swedish habilitation and crisis management

Licentiate thesis, 2025

This licentiate thesis investigates how communication practices influence participation for children and adults with complex communication access needs (CCAN) and explores strategies that can promote equitable engagement in key societal domains within Sweden. The research progresses through three interconnected stages: first, identifying communication practices that act as barriers or facilitators to participation; second, conceptualizing shared characteristics that support or hinder participation across contexts; and third, proposing strategies to enhance inclusive practices across professional settings.

Data were drawn from four papers involving children with disabilities in paediatric habilitation, and adults with CCAN participating in crisis management systems. Findings reveal that participation is shaped not only by communicative accessibility and multimodal support, but also by social accessibility, respectful and empowering dialogue, opportunities for autonomy and meaningful choice, structured inclusion, and recognition of competence. Trust emerges as a central mediating mechanism, connecting communicative practices with individuals’ confidence, willingness to engage, and overall participation.

Building on these insights, the thesis proposes practical strategies for professionals, including preparation and use of multimodal supports, fostering trust and empowerment, and creating structured opportunities for participation. These strategies aim to reduce communication barriers and promote meaningful involvement for individuals with CCAN across diverse settings.