Friday, October 24, 2014

Program: Making Choices




I have mentioned before on my blog that the skill of making choices is something I like to teach my kiddos pretty quickly once I start working with them. Particularly for the younger or nonverbal clients, when I meet them they often spend their days having choices made for them. They wake up in the morning and mom picks their clothing. They they go to school and the teacher tells them what work to complete. Then its home again, where dad puts dinner in front of them. Their day is a series of following other peoples instructions and demands. Does that sound fun to you? Sure doesn’t sound fun to me.

When creating a Behavior Plan, teaching the skill of choice making is often an antecedent intervention I recommend. I find that many problem behaviors are maintained or strengthened by the individual having a lack of control over their environment, or a lack of a communication system to let others know what they want or need. Hopefully all my readers know this, but just because a kiddo doesn’t speak does not mean they have nothing to say or don’t desire anything

·         So why teach choice making? Making a choice is really making a decision. What you are really doing is teaching the individual how to evaluate (Which one do I want), decide (Hmm, I want that one), and accept (If I pick red that means I can’t have blue). Beyond teaching decision making, allowing for choice making during teaching or therapy involves the kiddo in what is going on. You are now a team working together to complete something both of you are interested in. It’s just human nature that if I help decide or somehow invest in something, I am going to care more about the outcome. Lastly, teaching an individual to make a choice is a communication skill. If a nonverbal 3 year old can lead me to her toy cabinet and point to a teddy bear, she is now communicating with even though she can’t say “I want to see that teddy bear”.
·         How can choice making skills be taught? There are lots of ways to create a choice making program. What is most important is to focus on this key criteria:
1)   Begin with tangible and visual choices over abstract choices. Hold out a doll and a train to the child and tell them to “Pick one”, before you try to have them choose before eating dinner at 5:00 or 7:00. Also, start with just 2 choices to keep it simple.
2) If the kiddo doesn’t choose anything, then you choose. They need to understand that “I can pick, or you can pick”.
3)   If the kiddo tries to reach for both items, don’t allow them to. Move the items away and explain they need to pick one. Then try again.
4)   Once the kiddo has made a choice, that’s it. Do not allow them to keep bouncing between two choices, or to say “But I want that one”. Once a choice has been made, remove the other choice. This is very important especially when initially teaching the skill.
5)   Accept the form of communication the individual is capable of. This could be telling you their choice, gesturing, sign language, pointing, etc. Be sure to reinforce appropriate choice making so the skill will increase in the future.

There are a few ways teaching choice making can go wrong. It’s important to consider how to program for and prevent issues such as: When should the choice options begin to increase? When should choice making move from tangible objects to more abstract concepts? Does the child understand that choosing something means saying “yes” to that thing, and “no” to the other things? What if the child wants to choose both items, or make more than one choice? What happens if the individual makes a choice but meant to pick something else (didn’t understand what they were picking)? When is offering a choice not appropriate?
                 

*Tip – This isn’t just a skill useful for early learners, or lower functioning clients. For older clients or higher functioning clients, I embed TONS of choice making into their therapy. They not only choose where we work (in your room or in the backyard?), which programs to complete and in what order, but their individual preferences are included in the materials they use and telling me what they want to work for. I also teach them about good choices vs. bad choices (I call them Green & Red Choices). Green choices add things: reinforcement, fun, and my attention/interaction. Red choices remove things, or cause fun things not to happen. When the individual is having difficulty listening, completing work, or using nice words, I may give them a reminder such as “Are you making a green or a red choice right now?”, and then together we discuss how to get back to making green choices.


Resource: “Solving Behavior Problems in Autism” by Linda Hodgdon



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