I have mentioned before on my blog that the skill of making choices is something I like to teach my clients pretty quickly once I start working with them. It is a sad truth that many disabled children (and adults!) can go through an entire day where other people have made all choices for them, not with them.

What to wear, what to eat, where to sit, what activities to complete, what rewards are available, etc.

The 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 child 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 child doesn’t choose anything, then you choose. They need to understand that “I can pick, or you can pick”.

3)   If the child 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 child has made a choice, that’s it. Do not allow them to keep bouncing between two choices, or to say “But I wanted 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. For older 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 great choices vs. not great 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 keeping their hands to themselves, 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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Tameika Meadows, BCBA, Blog Author

“People don't care how much you know until they know how much you care” 

Theodore Roosevelt

*Super highly recommend reading: On Autism and ABA (no really, go read this)

I was very recently having a discussion with some colleagues about a quite real issue in this field of…lets say a lack of bedside manner. I have posted previously about ABA Haters. While there are some people who are anti-ABA because they truly are against what we do and do not wish to see individuals with special needs receive intervention, there are others who don’t really hate ABA. They hate US. By “us” I mean the professionals who provide ABA services. They find us to be about as enjoyable to work with as sucking on a lemon.

For some families out there, it was after an experience with a not so nice, not so humble, and not so patient ABA provider that they formed their current opinions about ABA as a field. Which is sad, but also upsets me as a professional in this field. I wish I could say that I have never seen or experienced anything even close to the horror stories some of my clients tell me, but…..no. I have experienced:

~Clients who call me with every compliant or concern because my supervisor or boss never bothered to return their phone calls. So instead, they would call me.

~Rude and arrogant company owners who won’t come out to my sessions and provide supervision because my client lives in a not so nice neighborhood.

~Unprofessional colleagues who tell parents they “aren’t working/trying hard enough” when their child consistently doesn’t make progress.

~Unscrupulous agencies who hire direct staff and send them directly into the field after 1-2 days of “shadow” training.

~The egotistical BCBA who took me to one of my first IEP meetings and verbally berated everyone at the table, while speaking in an alphabet soup of jargon that no one could understand

 

Your role as an ABA Therapist, BCBA, Behavior Tutor, etc., is not to be “The Wizard Who Knows All”. Your role is to disseminate the science, share your expertise, and cooperate with people to teach them the steps to do what you do. I have heard many company owners say to clients “our ultimate goal is for you to not need us….for you to learn all of this so thoroughly that you can implement it yourself”. 

Hmmm, really?

If that is really the goal then handing a stressed out single mother a 12 page behavior plan won’t meet that goal. Definitely not.

Consider this a call to action to my fellow troops in the field. Strive daily to NOT be the type of professional who views their caseload as “Me” vs “Them”. The client is not your enemy. They also are not idiots. Do they have your knowledge of behavior and data analysis? Maybe not. What they do have is an impressive data base of knowledge about their child (or student) that you need, in order to do your job. 

Repeat after me: I do not know everything. I need this parent/teacher/staff to work collaboratively with me, and they won't care how much I know until they know how much I care.

To sum it up, here is an excerpt from an open letter written by a parent to any therapist who may work with her child:

You are with my child for an hour, maybe a couple hours or half a day. I am with my child 24 hours, 7 days a week. Do not talk down to me either or good luck to you. I have to hold strong even at 3am and he decides it's time to get up after 3 hours of sleep for me……. When we discuss goals- make them functional for his life at home with me - not just your hour or two hour session. I need to know what works even when we are all bone dead tired or stressed to the max or when we have some down time to cuddle. Until you know what it’s like to be with my child 24/7, don't ever assume your way is best or think I "should" have done something. Cooperation is the key word here.

Source: http://www.kreedsworld.blogspot.com/2014/08/10-simple-rules-for-working-with-my.html

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Tameika Meadows, BCBA, Blog Author