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

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... lt 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 inte [...]