Friendship and Adults With Profound Intellectual and Multiple Disabilities and English Disability Policy Rachel Parry Hughes, Marcus Redley, and Howard Ring Cambridge Intellectual and Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK Abstract The authors analyzed references to “friendship” in the documents that set out the policy vision for adults with intellectual disabilities living in England. Friendship is commonly identified as one of the human “goods”—those aspects of life that contribute to our flourishing. Disability ethicists have suggested that friendship is especially important for people with the most profound intellectual and multiple disabilities, as a means of establishing their social and moral standing. However, the idea of friendship with adults with profound disabilities is problematic if friendship is defined as it is commonly understood in the contemporary English context. Citizenship and rights have dominated policy discourse since the publication of the English intellectual disabilities strategy, Valuing People, in 2001. However, recent policy documents give greater prominence to friendship and frame it explicitly as a“good” in the lives of adults with profound disabilities. The language used in these policy documents signals but does not openly acknowledge the tensions and complexities entailed in the idea of friendship with adults with profound disabilities. The authors suggest that the failure to address these tensions and complexities is a recipe for failure in the implementation of policy recommendations. They note the need for policy in this area to be reconsidered and suggest that this process should be informed by both empirical research and conceptual analysis. Keywords: England, friendship, intellectual disability, profound intellectual and multiple disabilities, policy INTRODUCTION This article focuses on a group of people who have been called “the excluded amongst the excluded” (European Disability Forum, 2000). Adults with profound intellectual and multiple disabilities (hereafter “adults with profound disabilities”) have a profound intellectual impairment, such that their IQ is effectively unmea- surable (Nakken & Vlaskamp, 2007), together with one or more physical or sensory impairment (Carnaby, 2004). All of these impairments will have been present from birth or childhood (American Psychiatric Association, 1994). Although there is con- siderable diversity among adults with profound disabilities, all need support in almost every aspect of daily living and most do not talk or use signs or symbols (Profound and Multiple Learning Disabilities Network/Mencap, 2008; Profound Intellectual and Multiple Disabilities Special Interest Research Group (PIMD SIRG), 2010). Some adults with profound disabilities would be character- ized by developmental psychologists and speech therapists as “pre-intentional” (Coupe-O’Kane & Goldbart, 1998; Zeedyk, 1996). This is to say that, if they make a noise, it is not made with the intention of conveying a message to another person, and if they move an arm, it is not moved with the intention of reaching an object. Their self-awareness is compromised to the extent that they have not realized that they may act purposively in and upon the world. Given appropriate support and learning environments (Lancioni, O’Reilly, & Emerson, 1996; Ware, 2003), these adults may develop intentionality (the capacity for purposive action). However, in common with all adults with profound disabilities, and even in the most responsive environments, their intentions may yet go unrecognized because their behavior is too restricted or too idiosyncratic to convey intentionality (Bunning, 2009). This is not to say that adults with profound disabilities or their families and carers necessarily experience their lives as restricted or impoverished; there are many testimonies to the contrary (Mansell, 2010; Profound and Multiple Learning Disabilities (PMLD) Network/Mencap, n.d.). Indeed, within the local con- texts in which adults with profound disabilities live their lives, a restricted capacity for purposive action may have little practical significance. The families and carers of adults with profound disabilities frequently report that they are attuned to their rela- tives’ or clients’ feelings and to the behavioral manifestations of these feelings (cf. Griffiths, 2010, who also reports that adults with profound disabilities attune to their families and carers). In Received December 13, 2010; accepted June 26, 2011 Correspondence: Rachel Parry Hughes, Cambridge Intellectual and Developmental Disabilities Research Group, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK. Tel: +44 01223 746124; E-mail: rmp49@medschl.cam.ac.uk Journal of Policy and Practice in Intellectual Disabilities Volume 8 Number 3 pp 197–206 September 2011 © 2011 International Association for the Scientific Study of Intellectual Disabilities and Wiley Periodicals, Inc.