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Background: Adults with intellectual disability, autism, and psychotic symptoms display severe disorganisation, which affects their ability to communicate and to perform well-known tasks. They display an aggravated loss of ability to initiate interaction with their staff. Aims: The aim was to examine whether a set of chosen staff communication skills was effective related to psychotic disorganised behaviour and initiatives in the patients. Materials and methods: Three hundred and seventy sequences of dyadic staff and patient interactions were analysed. Thirty-four staff and four patients with intellectual disability, autism, and psychoses were included. Staff and patient interaction was observed by video camera in the natural settings. Two independent observers scored each category. Data were analysed using contingency tables and the significance level was computed using Chi-square analysis. Results: The probability of disorganised behaviour in the patients decreases significantly and the amount of initiatives increases significantly when the staff communicates effectively. The four main categories of staff communication have different effects upon the disorganised behaviour and initiatives from patients. Task sustenance was most effective on disorganised behaviour, whereas emotional support encouraged most patients' initiatives.

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