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Using wordless books to support clinical consultations

Sheila Hollins (Department of Psychiatry, St George’s University of London, London, UK)
Barry Carpenter (University of Worcester, Worcester, UK)
Elspeth Bradley (University of Toronto, Toronto, Canada)
Jo Egerton (Leeds Beckett University, Leeds, UK)

The Journal of Mental Health Training, Education and Practice

ISSN: 1755-6228

Article publication date: 10 July 2017




Based on a literature and practice review, the purpose of this paper is to examine the theoretical and clinical basis for using wordless books with patients who have intellectual disabilities (ID) and/or autism.


A literature review identified seminal peer-reviewed English language articles relating to the neuroscience of information and emotion processing for adults with ID and/or autism. In addition to published examples, illustrative case examples were contributed by clinicians regularly using wordless books.


Many people, including those with ID, selectively attend to visual information. Minimising the cognitive load by using wordless pictorial narrative reduces anxiety, and empowers the patient. Clinicians using such resources describe positive clinical outcomes. Only the Beyond Words wordless books have been identified in published clinical trials.

Research limitations/implications

Although existing evidence suggests a strong positive impact, further research into the use of wordless books for people with ID is needed.

Practical implications

Wordless books are reported to help develop staff skills and empathy for supporting adults with ID. The books facilitate some legally required reasonable adjustments to increase service access. Staff training is needed for effective use of wordless books.


Wordless books specifically designed with and for adults with word processing difficulties, ID and/or autism to enhance health literacy and explore their own narratives and emotional responses around health experiences and personal traumas are a unique approach. This paper may also offer the first exploration of their neuropsychological underpinnings.



The authors thank the clinicians who contributed case examples: J. Williams, Dr P. Wallang, Dr K.-M. Lodge; and Dr Tuffrey Wijne, Dr Helen Riess and Dr Ramya Mohan for comments on an earlier draft of this paper.


Hollins, S., Carpenter, B., Bradley, E. and Egerton, J. (2017), "Using wordless books to support clinical consultations", The Journal of Mental Health Training, Education and Practice, Vol. 12 No. 4, pp. 260-271.



Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

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