The biggest barriers people with disabilities encounter are other people
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Responding to Disability: A Question of Attitude

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This questionnaire is designed to stimulate thinking and dialogue. It is not intended to test knowledge of disability or attitudes toward people with disabilities. As people increasingly find themselves in situations involving people who are disabled they need to make quick decisions on how to respond. This questionnaire provides an opportunity to think about situations involving people with disabilities, to respond, and then to consider the various responses more carefully.

Q. You are talking to a woman with a severe speech impairment. You have asked the woman to repeat herself in order to understand what she is saying. The person has repeated one phrase five times and you still don't understand it. You should:

a) give up and go on, assuming you will get the meaning from the context of the rest of the conversation.
b) ask again and again to have the sentence repeated, until you do understand it.
c) ask the woman to spell the word, or use an alternate word or phrase.
d) get someone else who understands the woman better to serve as an interpreter.
e) make a joke about the situation and laugh at your inability to understand the woman.

c) ask the woman to spell the word, or use an alternate word or phrase.
The only option that really is not good is to go on with the conversation without having understood what was being said. Most (not all) people with speech impairments are used to having to repeat themselves and would rather try to help you understand than have you pretend you understand when you don't. Remember that you are probably more frustrated and embarrassed by the process than the person with the speech impairment. You will look more foolish if you give an inappropriate answer because you pretended to understand than if you ask the person to repeat over and over, to use an alternate phrase, to spell, or to do whatever is necessary so that the two of you can continue genuinely sharing in dialogue.
If neither of the above options work, you may want to resort to option d--asking someone else to interpret--or option e--making a joke. Asking someone else to interpret can be useful if there is someone available who can understand the person better than you can. However, it is not good to rely consistently on an interpreter rather than learning to relax and understand the person yourself. You should also not use an interpreter simply because you are in too much of a rush to take the time to understand the person yourself.
Making a joke is useful if you are talking with someone with whom you have good rapport. A joke might help relax both of you, therefore easing the communication. However, a joke may also offend. It depends both on your ability to make appropriate jokes and the other person's ability to laugh at jokes. The key here is that the joke is as much on your inability to understand as it is on the other person's inability to convey the message clearly. You have a mutual problem.