Choice for People Experiencing Significant Learning Difficulties

Choice Pickings

The Development of Choice Making Skills in
Individuals Experiencing Significant Learning Difficulties:
Theory and Practice

   "When you have to make a choice and don't make it, that is in itself a choice."
William James

"No previous research has looked specifically at how best to offer choices to people with mental handicaps but several studies have addressed the issue of how to ask questions of people with mental handicaps. the findings suggest that their responses to questions are often restrained by the structure of the question rather than the content. for example, in response to questions requiring a yes/no answer people with a mental handicap tend to respond with a yes (Gerjuoy and Winters 1966; Rosen et al 1974; Sigelman et al 1981)"
(March 1992 page 122)

"People with learning difficulties should be enabled to make informed choices and take reasonable risks."
(Sutcliffe 1990 page 3)

"Self advocacy should be a key component of learning, underpinning the development of a curriculum built on student choice, decision-making and empowerment."   (Sutcliffe 1990 page 19)

"Learning should offer maximum opportunities for students to plan for themselves and to make choices and decisions."
(Sutcliffe 1990 page 21)

"It was a common experience for people living in hospital to suffer physical and verbal abuse, be denied choices and rights, and have few educational, social or employment opportunities. Those people who lived in the community fared little better. They too had restricted choices, went to institutionalised day centres and had limited opportunities for employment and education"
(Virginia Moffat 1996 page 13)

"Even in supposedly enlightened community care settings, I have often seen situations where supporters control, intimidate and restrict choices"    (Virginia Moffat 1996 page 14)

"The communication needs of children and adults with PMLD are complex. Many children and adults with PMLD have no formal means of communication, such as speech, signs or symbols. They may use a range of non-verbal means such as facial expression and body language, to communicate and be highly reliant on others to interpret these and enable them to be involved in choices and decisions. Because of this, they are often excluded."
   PMLD Network Valuing people with Profound and Multiple Learning Disabilities (PMLD) Page 9

"Developing the pupils ability to make choices is an important extension of the capacity for enjoyment. It is a vital achievement on the pathway of achieving autonomy."
(Coupe-O'Kane, Porter & Taylor 1994)

"However, choice making – an important skill for all developing youngsters is even more important for those with PMLD. Error free choices may support the development of understanding. It is only by being offered choices on a very regular basis that the usefulness of being able to make choices will become apparent. Choices can vary between real object, picture or symbol depending on pupil’s need. If objects are used consideration for accompanying the object with a picture and/or symbol is needed in order for the pupil to get the connection and be prepared for moving on."
  SCOPE: Supporting Communication through AAC, Module 9

"People with intellectual disability, however, attached greater importance to all aspects of their lives than did people without a disability. This may be linked to their aspirations, preferences, and opportunities for choice, which may, therefore, be a more meaningful way of considering their life quality." (Hensel 2000 page 35)

"We believe that everyone should be able to make choices. This includes people with severe and profound learning disabilities who, with the right help and support, can make important choices and express preferences about their day to day lives."
  (Valuing people, Department of Health 2001, Page 24)

"One of the most important things that practitioners can do in their work is to respect the choices that people with disabilities make from the options that are available to them." (Brown and Brown 2003 Page 222)

"Many people assume that the presence of an intellectual disability precludes a person from becoming self-determined. Recent research, however, has suggested that the environments in which people live, learn, work or play may play a more important role in promoting self-determination then do personal characteristics of the person, including level of intelligence."
(Wehmeyer & Garner 2003)

"Choice continues to be a major concern for those responsible for service provision to people with learning disabilities and it is one of the cornerstones of Valuing People (Department of Health, 2001). While initial assumptions and instincts might lead one to think otherwise, a substantial body of research suggests that many people with PMLD are able to make choices reliably."
(Carnaby 2004 page 8)

"The main findings in these studies were that choice interventions led to decreases in inappropriate behavior and increases in appropriate behavior, and that various preference assessments could be used to identify reinforcing stimuli."
    Cannella, O’Reilly, & Lancioni (2005)

"Choice is often restricted for people with learning difficulties. Food choice is an integral part of our life – it is often an unconscious process that is taken for granted. However, people with intellectual difficulties are often prevented from making choices about food because they do not have the means to do so."
   Goodman & Keeton (2005)

"Over the last two decades, an increasing number of authors have advocated for providing individuals with disabilities the right to make choices. The majority of discussions focused on the importance of choice-making opportunities to the overall quality of life for persons with disabilities (see Bannerman, Sheldon, Sherman, & Harchik, 1990, for a discussion). For example, choice can be seen as a means of incorporating the preferences of individuals into their daily home, school, and work environments. Choice also allows clinicians to identify and use the most potent reinforcers, thus enhancing learning and performance. Research has demonstrated that choice may be associated with increases in appropriate behavior, improvements in task performance, and decreases in problem behavior (see Kern et al., 1998, for a review). Furthermore, the right to make choices allows for a more normalized lifestyle and thus should be a goal of all who serve individuals with disabilities."
  Vorndran (2005)

"One of the most basic building blocks leading to enhanced self-determination is the ability to make informed choices for opportunities within one’s daily life. Considering the skills involved in becoming self-determined, choice making is one of the first and most basic skills to develop and build upon."
  Wolf, J., & Joannou, K. (2012)

"Training and education must be provided to persons with ID in order to help them develop better decision-making skills."
Werner, S. (2012 Page 23)

"Best and recommended practices now highlight the importance of providing students with disabilities with meaningful opportunities to develop the skills, attitudes, and behaviors that can enhance their self-determination."
Lane, Carter, & Sisco (2012 page 238)

"Choice constitutes a core element of the human experience. To deny this right can be seen as a denial of basic human rights and yet for people with learning disabilities this has often been a reality. Some argue that choice is different for people with learning disabilities for a variety of intellectually based reasons. The effect of choice on people with learning disabilities therefore is an important area of concern for researchers to establish the underlying meaning and drivers for increasing choice for this group of people." (Bradley 2012)

"The choices we make define who we are. People with learning disabilities have often had been denied a diverse range of choices, from small day-to-day to significant health care decisions. Empowering people contributes to an enhanced dignified experience of health care."
   Royal College of Nursing (2013 Page 12)

"Research supports the idea that almost all people are capable of purposeful choice making if they are provided with a functional way of doing so that accurately interprets their behavior (Agran et al., 2010; Lancioni et al, 1996; Snell & Brown, 2011)."
    ( Littrell S. 2013   page 3)

The 'provision of an opportunity to make an uncoerced selection from two or more alternatives' is perhaps how people might define the delivery of choice to individual Learners within Special Education. This web page is devoted to an exploration of the concept of the provision of choice for Individuals Experiencing Learning Difficulties (IELD). While few would argue that the notion of giving IELD as much choice in (and, thus, more control over) their life is a bad thing, every form of practice in this area cannot be considered as good. Indeed, as this page will attempt to show, some of what is proffered as choice making activity in our educational establishments (and beyond) might be considered questionable practice.

Although we all make hundreds of basic choices every day (from what to eat, and drink, to what to do, wear and watch), in the past, Individuals Experiencing Learning Difficulties were provided with almost no opportunities to make choices (See Bambara & Koger, 1996; Kearney, Bergan, & McKnight, 1998; Stancliffe & Abery, 1997; Stancliffe & Wehmeyer, 1995). While it might be argued that this issue is a problem that was related to the past, a recent report (Bradshaw, J. Beadle-Brown, J., Beecham J., Mansell, J., Baumker, T., Leigh, J., Whelton, R., & Richardson, L. 2013) showed that (page 25) on average people with an Intellectual Disability:

were engaged in activity for less than half the time (44%);
had little contact from staff for around 75% of the time;
received direct assistance to partake in activities for only 6% of the time;
typically had little support for choice with 22% getting what they considered to be good support in this area.

As you can see, this is an on-going area of concern.

Lancioni, O’Reilly, & Emerson, (1996) showed that individuals with profound developmental disabilities can make choices and Browder, Cooper, & Lim (1998) showed that supporting staff are able to learn to provide more choice within the daily routine. The benefits of such increase in the level of choice provision include:

an increase in the dignity of the individual Learner (Perske 1972);
a reduction in behaviours that staff may find challenging (Dyer, Dunlap, & Winterling, 1990; Carr & Carlson, 1993; Lindauer, Deleon, & Fisher 1999, Lohrmann-O’Rourke & Yurman, 2001);

"The results of this experiment add to the literature by providing direct evidence that choice making can produce reductions in
specific, objectively measured problem behaviors." (Dyer, Dunlap, & Winterling, 1990 page 519)

an improved staff awareness of preferences of individual Learners (Browder et al; 1998);
a continuing increase in number of choice opportunities offered by staff (Cooper and Browder (2001);
an increase in the the engagement of the Learner in the task (Dunlap et al., 1994, Cole & Levinson, 2002);
the development of early communication skills (Stephenson & Linfoot, 1995);
an increase in spontaneous speech production where physically possible (Dyer, 1987);
an improvement in student performance on curricular materials and interventions (Cole & Levinson, 2002)
a higher quality of life outcomes (Willis, Grace, & Roy, 2008, Stancliffe et al., 2011);
a higher scores on quality of life indicators (Neely-Barnes, Marcenko, & Weber, 2008);
an increase in social interaction with general education peers (Kennedy & Haring, 1993).

Thus, the provision of choice for IELD is, in theory at least, as evidenced by the research, a very good thing to do. However, how we choose to provide choice and what we assume in response to the choices seemingly made by individual Learners can be problematic. What exactly is choice? Is choice a good thing? Can there be too much choice? How should choice be provided? How can you be certain that an Individual has made a choice? These and other questions are addressed on this page.

As with many other pages on this web site, a contact form is provided at the bottom of the this page such that you can make comments, give your opinions, agree or disagree, ask questions, seek further information, point out errors, and the like. If you disagree with some of the items on this page, I hope, at the very least, they will make you reflect on your current practice...

This webpage was last updated on:
26th February 2015.
As the page is updated further, I will update this counter such that you will be aware if any further information has been added.

Too much of a good thing?

"Sometimes too much choice can be confusing." (Jackson & Jackson 1999 page 81)

While the provision of choice throughout the day is undoubtedly a good thing, too much of anything may itself be problematic. Learners (indeed, any of us) may become overwhelmed or stressed if presented with too much choice at any one time (Baumeister, Bratslavsky, Muraven, & Tice1998; Iyengar & Lepper, 2000; Schwartz, 2000).

Thus, while the ability to make choices during the day should not be restricted, it might be wise not to overburden the Learner with too much choice at any one time. Of course, that assertion itself is problematic! If choice is to be limited at any one time:

who is decide on what options are to be made available?
why did they decide on these?
how are they to decide?
are these decisions, once made, fixed?
what if the Learner does not want any of them?

The Convention on the Rights of People with Disabilities 2008

United Nations

"The basic human right to choice is mandatory according to the CRPD which was adopted by the United Nations in 2006 and came into force internationally in 2008. To date, 153 nations have signed the Convention and 119 have ratified it. Ratifying nations commit themselves to implement all obligations of the Convention. The CRPD is the first disability-specific international treaty and the first treaty to adopt the human rights approach to disability. Specifically, the CRPD promotes freedom of choice and autonomy, non-discrimination, full participation and inclusiveness in society, respect for the differences evident in persons with disabilities, equality of opportunity, accessibility to core social goods and services, and the identification and removal of barriers."
(Werner, S. 2012. Page 3)

The United Nations Convention on the Rights of People with Disabilities came into force in 2008. It has been signed and ratified by 119 nations including Australia, Canada, New Zealand, and the United Kingdom but, although signed, it has still not been ratified by the USA or Ireland.

In the UK, the CRPD builds further on the MCA (Mental Capacity Act 2005) which came into force in 2007:

"The Mental Capacity Act 2005 is the first piece of legislation to clearly state that people can no longer make decisions on behalf of others without following a process." (Fulton, Woodley, & Sanderson 2008 page 5)

Many other countries have similar legislation. This means that choice is not just a right, it is the law and we all need to understand what is considered best practice in this area.

The MCA is governed by five core principles:

Presumption of capacity. Learners have the right to make their own decisions if they are able. Significant Others must assume that a person is able to do so unless it can be shown that the Learner is unable.

Maximising decision making capacity. Learners should always get the necessary support to help them make their own decisions. It is important to take the necessary steps to help Learners decide for themselves before any assertion of incapacity to make a decision.

Right to make unwise decisions. Learners have a right to make decisions others may think are not wise. Just because others may think a decision is unwise does not mean that the Learner is incapable of making a decision

Best interests. Any act of substituted decision-making must be in the best interest of the Learner. That is, if someone other than the Learner makes a decision on his or her part, it must be in their best interest.

Least restrictive option. Any substituted decision made should be the least restrictive option possible for the Learner..

The SEN Code Of Practice 2014 came into force in September 2014. It made several changes to structure including continuing to put the Learner at the centre of planning and provision. Among a whole raft of recommendations and requirements it states:

1.2 These principles are designed to support:
- the participation of children, their parents and young people in decision- making;
- greater choice and control for young people and parents over support.
1.3 Local authorities must ensure that children, their parents and young people are involved in discussions and decisions about their individual support and about local provision.
1.6 Children have a right to receive and impart information, to express an opinion and to have that opinion taken into account in any matters affecting them from the early years.
1.39 Independent living – enabling people to have choice and control over their lives and the support they receive, their accommodation and living arrangements, including supported living
1.40 All professionals working with families should look to enable children and young people to make choices for themselves from an early age and support them in making friends and staying safe and healthy.
8.15 As young people develop, and increasingly form their own views, they should be involved more and more closely in decisions about their own future.

The Code also makes specific reference to the Mental Capacity Act 2005 in dealing with advocacy issues. As you can see, Learner choice and control are among the fundamental features of the code.

What is choice?

While this might, at first glance, seem like a rather strange question to ask at this point on this webpage, it is more difficult to answer than one might expect. Try to define the word choice without using either any form of the the word 'choice' itself (choose, chosen, choosing, choices ...) or any synonym for the word 'choice' (for example without using word such as: decide, determine which, elect, opt, pick, prefer, select, …). It's not so easy is it? Look up choice or choose within the available web dictionaries and they all fall into this trap of stating that Choice is 'choosing between alternatives', 'the selection between two or more options', 'deciding between presented alternatives'. What we thus have is something of a tautology - choice is choosing!

Did you manage to define choice without using a synonym for choice in the definition? It's not easy! It's perhaps even more complex when we consider what choice means for those Individuals Experiencing PMLD.

For the present, Talksense will define choice as:

"The independent knowledge (understanding, consciousness) that a particular behaviour (action, vocalisation, physical movement, indicating strategy) will lead to (result in, be commensurate with) a specific (desired) result (goal, need fulfillment, attainment) when presented with a set of recognised (known, comprehended), whole (not selecting for a part of or an attribute of), alternatives at a particular point in time."

Here choice is regarded as a specific observable independent behaviour which has a particular consequence in response to a given range of currently available alternate stimuli. The notion of individual consciousness of the behaviour plays an important role in all aspects of this. The Learner has to be conscious of the:

stimuli (alternatives);
the situation (that a specific action on his/her part will result in one particular response. The other alternative will no longer be available);
his/her behaviour and how it will effect an outcome.

All of this from an individual whose understanding of the world is limited as a result of his/her condition. The Learner therefore has to be conscious of the situation, each of the alternatives, what is being (t)asked of him/her, his/her response strategy, others understanding of his/her response strategy (theory of mind). Is this really feasible from an Individual Experiencing PMLD?

When a staff member states that a particular individual has 'made a choice' are they really implying all of the above? Are they aware of all of the above and does anyone ever ask them to qualify their statement? What they are likely to be stating is that a Learner appeared to indicate (in some manner appropriate to the Learner's physical abilities) an item from a range of other items. However, is this a choice?

Note that the definition makes reference to 'whole' as opposed to 'part of' or 'attribute of'. Imagine a choice of two items being present to a Learner. the Learner s attracted to an attribute of one of the items (colour, luminosity, shape, ...) and therefore looks at it (even Learners registered as 'blind' may be able to 'see' an item if it is illuminated more than another by sunlight for example) and then staff taken this (assuming it) to be a conscious choice made by said individual. Is it a choice? No! The individual has just responded to a feature of an item in a particular manner (exhibiting a specific behaviour) and the response has been read as a choice by others.

Knowing what choice means (having a definition) is a way of deciding what issues need to be addressed in teaching Learners to make choices. The clearer the definition the clearer the pathway to the goal.

The Goal is Control

"There is a real danger that any sense of the identity of a person with learning difficulties is subsumed beneath a prevailing desire to label, to pigeon-hole, to file and thereby to control."
(Gray and Ridden 1999)

"People with disabilities are more visible and more vocal than ever before, and they are increasingly demanding more control and choice in their lives."
(Field, Martin, Miller, Ward, & Wehmeyer 1998 page 11)

"Students become empowered by taking control of their own learning." (Sutcliffe 1990 page 13)

"Good quality support is to do with giving people power."
(Virginia Moffat 1996 page 37)

"a high quality of life is one in which people receive individually tailored support to become full participants in the life of the community, develop skills and independence, be given appropriate choice and control over their lives, be treated with respect in a safe and secure environment”. (Emerson et al 1996)

"Empowerment occurs when control, or power, is passed to an individual or group. In rehabilitation, medicine, social work, psychology, education, and many allied disciplines, it is gradually becoming recognized that the healthiest and most effective individuals have personal control and make decisions for themselves with advice and input from others. The belief here is that, for best results overall, final decisions should be made by the individuals who are most closely affected by the decisions." (Brown and Brown 2003 page 227)

"Choice can be viewed as a key component of empowerment where individuals maintain control over their own lives and as such increase their ability to influence their future goals and ideals." (Bradley 2012)

Generally speaking, the more independent people are and the less external control they receive from others, the more satisfied they are (higher quality of life) (See Legault 1992).Thus, a fundamental goal of all special education should be equipping Learners to live as independent a life as possible. This has long been recognised:

"... citizens with a mental retardation have a right to receive such individual habilitation as will give each of them a realistic opportunity to lead a more useful and meaningful life and to return to society." (Bannerman, Sheldon, Sherman, & Harchik 1990)

"even children with profound learning difficulties , given suitable conditions provided by modern technology, can make choices; in this case between sounds, voices, and rhymes provided on speakers. Moreover, they show enjoyment while so occupied and are motivated to further choice making. At the beginning of this chapter, the opinion was expressed that every step on the way to having more control over our lives is worth taking. In the case of these children, opportunity to exert control, however limited, appears to be leading to increased motivation and increasing self-regulation." (Beryl Smith 1994)(Page 5)

In order to meet this goal, staff within special education should be developing ways in which more and more control can be passed to Learners. Staff should rarely ever be doing it 'for' (there are some exceptions to this rule) and should hardly ever be doing it 'with' (again with some exceptions) but, rather, be facilitating individuals to do it for themselves. The goal of control therefore is one in which choice is not just permitted at certain points at the dictate of others but one which is a fundamental and integral part of the day:

"Our profession has focused on choice-making as a permissible activity, rather than as a teaching target" (Shevin and Klein 1984, page 60)

However, while we may find a philosophical commitment to a particular idea or an approach fairly easy, often it is much more difficult to make that approach a reality. For example, to make any establishment (which caters for people with cognitive and physical disabilities) run smoothly, there has to be some sort of ordering and scheduling to accommodate staff coming and going. Such scheduling may impact on the ability to offer free choice at all times of the day to every member of that community: Johnny cannot simply go swimming when he wants to because the pragmatics of the situation do not allow it, any more than they allow me to do anything I want when I want to do it (although it would be nice!). The logical outcome of this apparent dichotomy might be a balance between the demands of the establishment and the needs of the individual for freedom of choice and control. Inflexibility in timetabling and structures lead to a reduction in the opportunities for real choice:

"Inflexible scheduling often precludes opportunities for choice. For instance, clients may not be allowed to choose the order or timing of activities. They may be discouraged from taking breaks or from choosing activities that are not scheduled." (Bannerman, Sheldon, Sherman, & Harchik 1990)

and, at the same time, complete freedom of choice at all times of the day and night would pose insurmountable problems for those with the duty of care. While a balance must be struck, we must keep in mind that the 'goal is control': not the institutional control of the Learners (leading to passivity and learned helplessness) but the Learners control of their lives and their destinies.

Passivity is commonplace amongst people with a severe communication impairment. In a study by Sweeney (Sweeney L. 1991) 42 out of 50 users of AAC showed some level of learned helplessness when interacting with one or more Significant Others. The more severe the communication impairment the greater the degree of helplessness. It would appear that, the development of an individual’s ability to communicate also effects an improvement in an individual’s desire to act independently. The factors that are involved in creating an atmosphere that is supportive of communication are also the factors that tend to demand more interactive skills of an individual. The relationship is reciprocal: greater communicative ability may lead to greater independence and greater independence may lead to greater communicative ability. Prevention is better than cure: the role of communication in the avoidance of personal passivity should be stressed:

"Without an effective means of communication during childhood development of autonomy, exploratory/experiential opportunity, and relative strength of self-image/esteem will be compromised" (Sweeney L. 1993)

While it has been shown that the act of providing real time choices helps with the development of early communication skills (Stephenson & Linfoot, 1995), I want to go further and state that 'choice is a voice'. This notion will be developed further in one of the sections to follow. Of course, offering a choice to a Learner does not mean that they are in control:

"Offering someone a choice does not mean that you are relinquishing control to that person. You are teaching independence."
(Rowland and Schweigert 2000 Page 15)

Indeed, the majority of choices offered in educational establishments are 'contained' (see next section below); that is the choices offered are decided by another (staff member) and not by the Learner her/himself. However, for me, the goal is eventually to hand over control to the Learner (with staff acting as facilitators) with the provisoes that:

the Learner comprehends the consequences of control and can take responsibility for it;
the choice is safe.

Prerequisite Factors

click to enlarge

It is always concerning when I read articles on Significant Learning Difficulties that state prerequisite factors. Of course, there are certain things that require physical abilities; riding a push bike typically requires the ability to control and to move your legs, for example. Thus, I do accept that for some things there are some prerequisites. However, for Individuals experiencing PMLD, prerequisites are a barrier to entry to almost every skill; if these Learners have to meet pre-requisites before being taught to make a choice for example, they may never be taught! Staff may just assume that John is not capable because he lacks the necessary prerequisite skills and just choose for him.

"Having a self-concept or a self picture is a pre-requisite for making a choice" (Jackson and Jackson 1999)

While I do not want to devalue the works of the Jacksons and understand the point they are making, I would want to state, once again, that prerequisites can be a barrier to learning: it may only through being given a choice (for example) that a Learner begins to understand what s/he likes. That is, the practice itself may be a tool (indeed, in some cases, the best tool) by which certain pre-requisite factors can be addressed.

Having made that point, the Jacksons quote above should not be simply dismissed: if the Learner understands his/her needs s/he will be better able to make an informed choice. In their story (see Jackson and Jackson 1999), Danny (one of the characters) knows that he has lots of possessions (they are moving into a new home and deciding who should get each of the rooms) and therefore needs to choose the bigger room to get everything in. However, isn't the way we sometimes learn in life through making ill-informed choices? Had Danny chosen a smaller room because he was attracted to its colour, for example, he would have come to understand the consequences of his decision and learned a lesson. If we try to eliminate every risk then progression may not be possible (see the section on risk on this webpage) although, undoubtedly, there may be some risks that are too big.

A Continuum of Choice

"The starting point is not a test of capacity, but the presumption that every human being is communicating all the time and that this communication will include preferences. Preferences can be built up into expressions of choice and these into formal decisions. From this perspective, where someone lands on a continuum of capacity is not half as important as the amount and type of support they get to build preferences into choices."
Beamer and Brookes (2001, page 4)

Making a decision involves having a choice. However, having a choice and decision-making cannot be viewed simply in one way; there is in fact a 'Continuum of Choice'.

The continuum may be split into four areas:

Independent Choice (Contained and Complete);
Supported Choice;
Substitute Choice;
Hobson's Choice (No Choice);

Independent decision-making involves the Learner deciding for himself without the assistance of any outside person. Even if the Learner were to ask another's opinion, any decision reached would still be considered as independent.

Contained Choice is defined as a choice that is governed by some external limiting factor imposed by another. Examples of Contained Choice include the provision (by an another) of an array of items from which a Learner may select: for example, apple juice or orange juice at break time. The choice is 'contained', decided and thus constrained by another person.
Complete Choice is defined as a complete freedom of choice. Although circumstances themselves may act to constrain the choice. While many would consider this notion chimeric, an important factor in reports on quality of life issues is the amount of control an individual is able to exert over daily events and his/her ability to makes choices.

One may argue that the notion of Complete Choice is an illusion and that all choice involves some aspect of constraint:

" Human beings are essentially social creatures. What they are and what they might be depends both on themselves and upon the societies in which they grow up and make their choices. Choices, however, are always made within some framework of constraint." (Twine 1994)

but, as choice becomes increasingly controlled by outside agencies so quality of life is reduced to the point where the individual becomes a puppet or a slave acting only on the permissions of another.

While both contained and complete choices may have consequences, typically, Significant Others support contained choices by removing those that may have detrimental long term effects. Although some individuals may be able to make an everyday contained choice independently (tea or coffee?), they might need significant assistance with complete choices that have far longer term consequences (Live at home or live in sheltered provision in the community?).

It should be noted that, at different times and in different situations, Learners may be independent in one area of choice and supported in another and 'experience' (in a sense the Learner does not experience as another makes the choice on his/her behalf) substituted choice at others.

Supported decision-making is an approach for assisting Individuals Experiencing Learning Difficulties to make choices. The Learner is assisted to make important decisions either by a particular group of Significant Others or a Specific Other ( perhaps a parent or other relative, carer or teacher). The role of those supporting is NOT to make the decision on behalf of the Learner but to help him/her to:

gather information;
evaluate the options;
consider the consequences of each choice.

and to think about all aspects of the decision before making a decision for him/herself. One route for developing supported decision making is to use Choice Charts (see later this page).

Substitute decision-making involves an advocate acting on behalf of a Learner in his or her 'best interest'. If the Learner was believed to be incapable of understand the varying aspects of the choice or was so ill as to be temporarily incapacitated, a Significant Other (or Others) might be asked to make a decision on the person's behalf.

Hobson's Choice refers to the 1915 play by Harold Brighouse and four subsequent films of the same. However, it's origins date back to the mid to late 16th century to Thomas Hobson, a livery stable owner, who was reputed to have given his customers 'no choice': they could either take a specific horse from a specific place or leave with nothing at all. Hobson's choice is therefore no choice at all (Here's some tea) perhaps made on a belief that this is what the Learner wants (without any real evidence) but, more likely, at the whim of another or to meet the needs of the establishment itself (We got a bulk order of tea cheaply and so everyone will have tea!).

At different times of the day, and faced with different types of decisions, an individual Learner may encounter every type of choice on the continuum:

at morning break, s/he may make an independent choice of a contained set of drinks;
at a meeting in the morning, s/he may make a supported choice on some aspect of future curriculum choice;
during a hospital visit a parent may decide on the best course of action regarding a particular medical issue;
a trip out with the family in the evening may be to see a film decided by another member of the family with no reference to the Learner.

Click on the above image to download it.

A Preference for Choice: A Continuum of Consequence

"An important distinction needs to be made between ‘expressing a preference’ and ‘making a choice’. Preferences are presented as expressing a subjective like/dislike of a particular thing which the individual already has some prior experience (for example, preferred foods, activities, people). In contrast, choice making is a process in which options or alternatives are identified, weighed up and a selection made (Kearney & McKnight, 1997; Ware, 2004; Smyth & Bell, 2006). Choice-making is therefore a cognitively more complex and demanding activity. At the same time, choices vary from simple to complex according to the demand made on an individual’s cognitive processing skills and abilities. For example, making choices about the future requires the ability to anticipate events and weigh-up potential consequences (Ware, 2004)."
Mitchell W. (2012) page 7

I am not sure that I agree that a preference is not a choice although it is but a matter of semantics. If an individual is stating a preference, s/he is indicating a choice (I prefer Heinz soup) even though another option is what has been actually provided (the Learner was given another brand of soup and communicated a preference for Heinz while consuming the soup provided). If a Learner was in a conversation with others and someone stated they loved Campbell's soup, the Learner might also indicate his/her preference for Heinz: while nothing is given and, thus, no soup is actually consumed here, there is still some form of choice in the Learner's consciousness - Heinz over Campbell's. However, Ms. Mitchell is pointing out that there is a continuum concerning the importance of specific choices with some having significantly more impact on the future quality of life of an individual than others ( a choice of future placement vs a choice of what to drink today for example). While agreeing on that issue, it would be wrong to somehow devalue the notion of 'choosing' what to drink as a mere 'preference' and therefore unimportant (I am certain that this is not what Mitchell is saying: she is simply pointing out some choices have longer term impact and consequences); Learners have to learn to choose and this should begin with arrays of items from the far left of this 'continuum of consequence' (see diagram below); that is, for example, with choosing a drink rather than choosing where to live. Indeed, for some Learners, quality of life may be determined, in part, by being able to express such simple choices. Furthermore, skills developed in making choices at this level will make it more likely that choice from other parts of the continuum are made with more comprehension. It is also likely if choice is routine at this 'lower' level, it is less likely to be overlooked when it comes to items from the far right of the continuum, However, Significant Others may adopt a varying stance on the involvement of the individual in choices as they move to the right portion of the continuum, assuming a Learner inability to comprehend the complexity, the consequence, or the risk:

"Complexity was also spoken about in terms of its ‘significance’, and this meant the potential consequences or impact of a decision on future well-being. The importance of their child being able to comprehend consequences and, more importantly, being able to understand possible future outcomes was noted by parents of young people with different levels of learning disabilities (both moderate and severe). When parents felt their child did not have the cognitive ability to comprehend the ‘significance’ of a choice, the level of the young people’s involvement in the choice-making process was reduced." Mitchell (2012) Page 17

While some choices are obviously more complex, more risky, and have longer term consequences, it should be possible to involve the Learner in the process by making the necessary information available to him/her at an appropriate level:

"Other parents recognised and valued their son/daughter developing choice-making skills. Parents described supporting the acquisition of these skills by, for example (as noted above), simplifying choices and, where possible, providing direct experience of choice options. Parents also acted as information providers, seeking out information and/or interpreting complex information into a more understandable format for their child. Information filtering was here used in a facilitative rather than protective manner." Mitchell (2012) Page 21

click to download

Typically the continuum of consequence is thus painted as depicted above with an inverse relationship between the significance (and risk) and any Learner involvement (as the significance of the consequences increases so Learner involvement in the choice decreases).

"Too often, families, teachers and other well-intentioned people protect youth with disabilities from making mistakes and avoid discussing the details and potential ramifications of the youth’s disability. Instead, they focus on the positive and steer the youth away from many experiences where there is a potential for failure."
(Bremer, Kachgal, & Schoeller 2003)

This is not an ideal state of affairs although it is understandable. However, as has already been shown, it need not be one of selecting different approaches to the involvement of an individual Learner in the choice making process at different points in the continuum but, rather, one of making information and experiences available at an appropriate level so as to:

be inclusive;
teach and develop Learner choice making abilities.

"Respecting and understanding choice plays an important role in safeguarding adults. Listening to individuals’ preferences about issues such as where they wish to live and with whom, can help ensure that people with learning disabilities are able to live alongside others with whom they feel comfortable and safe. Thinking carefully and wisely about how individuals make choices and any limitations they may have with regard to choice making and consent, can enable their supporters to ensure that choices are respected, while still taking steps to protect individuals from risks or dangers which they have not appreciated or anticipated."
Department of Social Work, University of Hull 2009

Thus, a 'better practice' Continuum of Consequence might be more akin the diagram below where Learner training prepares for future need such that the individual may be empowered to take more control over his or her life choices.

click to download

It is important that Significant Others:

praise the Learner for making a choice (even if they disagree with it);
give positive feedback on good choice ("That's a great choice John because it will ... well done!")

"Always offer positive feedback when a choice is made. This will help the person making a choice by reinforcing their actions.
Example: 'Good . . . that's a good choice." (Jackson and Jackson 1999 page 78)

provide non-coercive consequential feedback on poor choices ("If that is what you want John OK. If you choose that though it will mean ... It's OK to choose something else if you want to but its also OK to keep that choice. What do you want to do?"). The point here is not to make the Learner change his/her mind and go with what you want but rather to help them think about the consequences of their actions. Sometimes it is only through making a bad choice that we learn what a good choice looks like and thus we should not try to prevent all choices we consider to be poor unless it is threatening to the Learner.

"The long term consequences of a choice made can be understood more fully if you talk it through carefully.
Always give time appropriate to the persons's abilities." (Jackson and Jackson 1999 page 78)

allow Learners the option to change their minds. A change of mind is not unusual, it is something that we all do and therefore should be as acceptable, without criticism, in Learner s too. Of course, it is an undesirable state of affairs, if you have already purchased tickets and booked a journey as a result of a choice made and the Learner then changes his/her mind at the very last minute.

No Choice

While choice is generally a good thing for staff to be providing for those they facilitate there will inevitably be occasions when they have to say 'no'. This is likely to be experienced by the Significant Others involved with a sense of guilt and or frustration:

"Although most participants felt that choices were on the whole never impossible there were clearly times when they had to say ‘no’. Being unable to provide choices in these instances often left participants feeling both guilty and frustrated." (Bradley 2012)

Unless you are a person with unlimited resources there will be times in your life when you are unable to do something that you desire to do. This probably applies to 99.9 percent of the population. Some will go into debt and cause themselves additional problems in response to such a situation, some will attempt to put off the desire until some future time and work towards making it a reality, and some will understand that this particular desire is but a pipe-dream and get on with their day to day existence. Learning to live with the practicalities of timetables and resources is a necessary facet of everyone's existence: you cannot simply elect not to turn up for work or for school without some consequence and you cannot simply go out and spend a few million on a country estate if your income does not support such an expenditure. We all have to learn to live with 'no'. However, we have the benefit of understanding the reasons why 'no' is the outcome, how much more problematic would it be for an individual without the mental capacity to understand such closure of a desired path? As we have seen, it is also problematic for the majority of Significant Others who have to communicate that a particular desire is currently or permanently unavailable.

Why do we have to say no? There are a number of reasons why a Significant Other may have to say no to a person in their care:

lack of resources (availability of necessary staffing, finance, equipment or venue);
too great a risk;
too much of a good thing is likely to be bad for the Learner;
dictate from a superior;
environmental or occupational dictate (for example: timetable states that Learner is required to go to physiotherapy at this time);
against the law;
against the rules of the establishment;
infringes another's rights;
harms another;
not in the individual's best interest;
other pressures.

Strategies

Avoidance: Do not provide options within choice arrays when they cannot be immediately provided (because staff are not available for example) if selected;
Bypass: offer up a choice that brings the Learner back on track. For example, if the Learner is due in Physiotherapy and wants to go out to the park (and this cannot be provided) you might offer a choice of routes to get to Physio: Do you want me to come with you and we'll go by the tuck-shop or do you want Doreen to go with you? Bypass can also mean the provision of hopefully attractive alternative options that can be provided at that moment; "We can't do that just now but we can do this or this, which would you like to do?"
Consistency: We all have to learn to live with 'no'; it's a part of life. However, if Significant Others are inconsistent in their approach it is confusing for the Learner. When no is said, it must be meant such that the Learner understand that there is no pint in pursuing the matter further because it will not serve any purpose.
Deferred choice: If the Learner is able to understand explain that the option cannot be provided at this moment in time but you will be able to do it at a future time that you must specify in a manner to which the Learner can relate.
Explain: Set limits in a way the Learner is able to understand for items that cannot be supplied indefinitely (see section below); Explanation also entails using alternatives to the word 'No'. For example, if the Learner wants to go to the park and this cannot be supported because of staff pressures, do not say 'NO'! Rather, explain the situation without the negativity - "Ah, you will need someone to come with you and there may not be anyone who can do that right now. I could take you later today after you have had your lunch. Would you like me to do that?".You may also try to explain using the 'however' approach "We might do that however ..." and then list the issues and consequences of the choice.
Fix a time (or quota or ...): It may be that someone else is using the resource requested by the Learner and thus it is not currently available. The Learner may be able to book a session at a later time (which should be represented in a manner the Learner can comprehend).
Give Alternatives: If possible, provide other options that can be obtained immediately.
Humour: the use of humour is sometimes a way out! "What! Go to the park again? You've been 100 times this week already. I think the ducks know who you are! Wouldn't you like to do X instead? Or, what about Y?

No Choice Too

"Absenting oneself, or refusing to comply with a request, should be recognised as legitimate responses and areas where further learning can take place"
(Jackson and Jackson 1999 page 84)

There are two aspects to this section of this webpage. The first involves teaching the Learner to appreciate it is OK to say 'no' (although, on some occasions, this choice may have to be countermanded) and the second involves Significant Others respecting that right and dealing with a 'no' when it occurs.

In the short story by Herman Melville 'Bartleby the Scrivener' the main character begins to repeat the phrase "I would prefer not to" to every request made of him with eventual disastrous results. While the fictional Bartleby had a perfect right to 'prefer not to do' whatever was requested of him, it is very unusual for any person to behave in this way. However, it is not uncommon for a Learner to indicate a preference not to do something that is being requested by others.

All Learners have a right to say 'no'. The vast majority of Learners do not need to be taught how to communicate a decision not to partake in an activity, they will show it by refusing to cooperate:

"At this point we can see that Matthew has given multiple signs that he does not want to take part in the activity. Apart from his non-standard vocalisation, he has turned his body away from the direction of the scales, looked away, not taken a hand offered to him, and not stepped onto (indeed, edged away from) the scales when they were brought to him." (Finlay. Antaki, & Walton 2008)

In the above, real life example, Matthew refuses to be weighed as a part of the routine of the establishment concerning personal care. The staff recognise that Matthew has clearly refused to partake in the activity and, although, they accept the refusal, they continue to offer Matthew renewed opportunities to partake without becoming angry or apportioning any blame:

"We have also seen that although these behaviours are recognised (indeed explicitly announced) to be refusals, the staff persist in their requests, indicating that Matthew’s refusals are not treated as definitive. Neither Jill nor Sandy, however, are ordering Matthew to get on the scales, or invoking their authority as staff members. They are solving their dilemma (between respect and persistence) by no-blame encouragement – their responses treat Matthew’s refusal as either due to lack of support or encouragement on their part, or due to problems in the way they have issued the invitation." (Finlay. Antaki, & Walton 2008)

It is my experience that this practice is fairly typical of the staff approaches to such situations. Staff generally do not use coercive tactics to force a Learner to participate. Indeed, in the example above, Matthew is not weighed as staff respect his response although they provide him with several opportunities to participate. However, staff can become worried about institutional perceptions of their abilities to 'get the job done': in this instance, a failure to monitor Matthew's weight might cause him some form of harm:

"Refusing staff requests is a test of the staff and the system, as it puts in conflict two opposing institutional objectives: to respect choice and to get the job done. We set out in this article to use video records to examine, for the first time, what happened on two occasions when residents with severe communication difficulties tried to refuse an activity proposed to them by staff." (Finlay. Antaki, & Walton 2008)

In some cases, staff can deflect such a negative response to a situation by proposing a more positive choice of route to the desired goal. For example, if it is known that Chris often refuses to leave class to go to physiotherapy, rather than saying 'It's time for physio now Chris, let's go' (issuing a command), offer a choice:

"Hey Chris, would you like Abby or David to go with you to physio"?
"Oh! And would you like to go via the pond or through reception"?

As can be seen, the choices incorporate the movement to physiotherapy in a positive way as a given. In choosing from the alternatives, Chris is tacitly accepting the movement to physio but controlling some aspects of it (with whom and by what route). While Chris is more likely to respond positively to such an approach, it does not take away his/her right to say 'no'.

Generally, Learners do not refuse to participate in an activity for no reason. It may be a fear of some aspect of the activity for example. While such a fear may seem irrational to others, it must be realised that it is of genuine concern to the Learner. Thus, another strategy for such situations is to try to ascertain what underlies the Learner's concern: work on allaying his/her fears over a period of time to make the experience as enjoyable as possible such that it is something that is not to be missed!

A third strategy is the replacement of the 'done to' methodology with the facilitation of Learner control (the goal is control). That is (and continuing with the above scenario), rather than staff having to weigh every person (done to), they enable each Learner to control as much of the process as possible for themselves. For example, some stores have an 'I speak your weight' machine which generally is not that expensive. A Learner might find such an experience fun especially if the accompanying staff model the behaviour in a really positive way by getting on the scales and being weighed themselves. At no point should the Learner be coerced into such practice but choose to do so because s/he sees that others are having fun with it and is simply offered to opportunity to feed in the money and have a go.

In order to provide an opportunity for a Learner to say 'no', a further strategy that might be employed is to ask a closed question before moving to a choice continuum. For example, staff may ask, "Do you want a drink?" (CLOSED QUESTION) (Note: a closed question is one that can be answered by either a 'yes' or a 'no' response). This practice allows the Learner to state 'no' clearly. However, if the Learner responds in the affirmative then staff can ask "What do you want to drink?" and proceed to simplify the process by offering alternatives. There are at least two problems with this approach:

It's too complex for an Individual Experiencing PMLD who is just starting out on developing an awareness of choice;
Research shows that there is a statistically significant likelihood that Individuals with Learning Difficulties will answer 'Yes' to all closed questions. While, in the example cited, this may not be too much of an issue there will be other cases in which it might play a vital role and therefore staff need to be aware.

What about the promise of a reward for participation?
While, undoubtedly, this may result in the Learner participating in the activity it is not a recommended practice. It may lead to the Learner always requiring a reward to perform the activity and not viewing the activity as worthwhile in it's own right. If a reward is to be given, it should not be used to coax the Learner to participate but after participation has taken place, in the form of praise, to say well done and increase the Learner's esteem for having been involved. Any other tangible reward (such as candies or sweets, etc) should be reduced over time such that the Learner does not become dependent on them to perform the action.

Self-Determination and Choice

"When self-determination is interpreted strictly to mean ‘doing it yourself’, there is an obvious problem for people with significant disabilities,many of whom may have limits to the number and types of activities they can perform independently."
Michael Wehmeyer (1998 page 65)

"One of the reasons that students with disabilities have not succeeded once they leave school is that the educational process has not prepared students with special learning needs adequately to become self-determined young people."
(Michael Wehmeyer and Robert Schalock page 2)

Michael Wehmeyer defined self-determination as:

"acting as the primary causal agent in one's life and making choices and decisions regarding one's quality of life free from undue external influence or interference"
(Wehmeyer 1996)

"A self-determined person is one who sets goals, makes decisions, sees options, solves problems, speaks up for himself or herself, understands what supports are needed for success, and knows how to evaluate outcomes. The capabilities needed to become self-determined are most effectively learned through real-world experience, which inherently involves taking risks, making mistakes, and reflecting on outcomes. These experiences help a young person test his or her strengths and limitations and identify appropriate short- and long-term goals."
(Bremer, Kachgal, & Schoeller 2003)

Why is self-determination important?

"There are a number of reasons why educators should devote instructional time and resources to promoting self-determination. First, adults with disabilities have consistently emphasized the importance of this outcome for an enhanced quality of life (Gagne, 1994; Kennedy, 1996). Second, the acquisition of attitudes and abilities related to self-determination can contribute to increased student involvement in educational planning and decision making (Van Reusen & Bos, 1994; Wehmeyer & Ward, 1995). Third, students who leave school as self-determined young people should achieve more positive adult outcomes."
(Wehmeyer, M.L., & Schwartz, M. 1997, page 246).

Wehmeyer and Schwartz go on to define four essential characteristics of self-determination. These are:

autonomy: The Learner is able to act independently (free from outside influence/interference) according to his/her own preferences, interests and/or abilities;
self-regulation: Learner is able to scrutinize the task, take decisions and formulate and act upon a plan using their available skill set;
psychological empowerment: Learner's belief in him/herself and his/her abilities and capacity to reach planned outcome.
self-realization: Learner's own knowledge of personal strengths and weaknesses and its use to achieve goals.

They go on to break this down further into 11 component elements:

choice making;
decision making;
problem solving;
goal setting and attainment;
self-observation skills;
self-evaluation skills;
self-reinforcement skills;
internal locus of control;
positive attributions of efficacy and outcome expectancy;
self-awareness;
self-knowledge.

Self-determination also has a positive relationship with the 'quality of life' experiences of an individual experiencing a disability (Wehmeyer and Schwartz 1998: see also Wehmeyer & Schalock):

"examined the link between self-determination and quality of life for 50 adults with mental retardation living in group homes. Controlling for level of intelligence and environmental factors contributing to a higher quality of life, we found that self-determination predicted group membership based on quality of life scores. That is, a person's relative self-determination was a strong predictor of his or her quality of life; people who were highly self-determined had a higher quality of life, and people who lacked self-determination had a less positive quality of life."
Wehmeyer & Schalock Page 9

While the above 11 point listing may be far from a check list of the skill set possessed by a Learner experiencing PMLD it is not out of the bounds of possibility for these areas to be addressed in the classroom. Indeed Wehmeyer & Schalock go on to state three primary routes that help to enhance the development of self-determination:

Instruction to promote capacity (skills and knowledge);
Opportunities to experience control and choice;
The design of supports and accommodations.

It is beyond the scope of this page to expand on each of these component elements, However, it will focus on the development of choice and control.

Self-Regulation and Choice

"Such a move brings with it many new choices and responsibilities for the individual such as deciding what and how much to eat, whether to engage in regular exercise, which clothes to buy, whose company to keep. In order to fulfill these responsibilities adults will need to be able to set their own goals (e.g., staying healthy) and to manage their own behaviour so that they maximise their chances of success in meeting their goals."
(Cuskelly, Zhang, & Gilmore 1998)

Self-Regulation is something that many of us might say we lack! Lots of people have cravings and many have addictions; being able to say 'no, I am not going to do that now', curb an impulse buy, or put things off until a future time are things that not all people are able to do. How much more of an issue is it then for those experiencing significant learning difficulties? Self-regulation implies self-control and, typically, control has been extrinsically imposed on those experiencing learning difficulties by others.

"However, people with high support needs (who may be labelled as having severe or profound learning difficulties and, sometimes, also physical and sensory impairments) may find themselves excluded from these developments. Choice and control can be a matter of ‘pot luck’. Many people find their opportunities restricted by other people’s assumptions."
(Joseph Rowntree Foundation 2001)

Self-regulation is something that can be supported within any special education setting. It's an asset that all have a potential to begin to develop which can help to improve quality of life:

"One effective tool that students can use to improve academic performance, regardless of ability, is self-regulation. Self-regulation is the process by which students take charge of their own learning, monitoring their behavior and progress and making adjustments along the way to get from idea to execution. It’s the transformation of thought into purposeful action." ( Gajowski 2014)

However, studies have shown that that self-regulation appears to be inversely proportional to level of measured intelligence:

"We found that students with a learning disability were more likely to possess low academic self-efficacy, to believe that intelligence was fixed and non-malleable, to prefer performance over learning goals, and to interpret the exertion of effort as meaning they possessed limited levels of ability." (Baird, Scott, Dearing & Hamill 2009)

While self-regulation may appear to be a skill far beyond the capabilities of those experiencing Significant Learning Difficulties, the ability to choose is an important component. Thus, it is important Significant Others believe that:

intelligence is not fixed: all can learn, all can improve;
the ability to make a choice can be taught and the skill further improved over time;
the ability to choose is a component of self-regulatory behaviour;
those experiencing Learning Difficulties can acquire basic self regulatory skills;
little by little, the skills inherent in self-regulatory behaviour can be taught.

Choice is a Voice

While it has been shown that the act of providing real time choices helps with the development of early communication skills (Stephenson & Linfoot, 1995), I want to go further and state that 'choice is a voice'. Thus we must not just:

teach Learners how to make choices;
provide choice as commonplace in the routine;

Important though these things undoubtedly are, we must empower the Learner such that s/he understands s/he has a choice: not one decided from without, imposed by another and restricted (Contained Choice) but one that provides self determination for the Learner, one that the Learner chooses (Complete Choice) - choice as a right and choice as her/his voice - choice as a voice!

Contained Choice

"Notions of a well run school, where a tight timetable laid down by the teacher is strictly adhered to and pupils have a prescribed set of activities , needs questioning in the light of of opportunities it provides for individuals to develop choice. Choice is not to be viewed as something that occurs on Friday afternoons or at milk time." (Coupe-O'Kane, Porter & Taylor 1994)(Page 19)

"Chances for students to express choices can be minimal. Despite the fact that even the most profoundly disabled child has definite preferences which are known by staff, time in which pupils can express these preferences is generally determined by staff when it is most convenient for the management of the whole class" (Barber 1994 page 56)

In my experience, the majority of choice provided within special education settings is contained; that is, it is confined, constricted and consigned by a Significant Other. The Significant Other decides the:

need to provide a choice;
parameters of the choice;
number of choices available;
time at which the choice is to be provided;
method by which the choice is presented;
outcome of the choice.

Thus, control is external to the Learner. That is not to say all Contained Choice is a pejorative, it is not. Choice must be taught and, in teaching a Learner to make choices, staff must necessarily decide on what, when, and how. Furthermore, all establishments must have some form of routine necessitated by available space, staff and finances which serves to restrict what the members can and cannot do: Johnny cannot simply choose to go horse riding in the middle of a hydrotherapy session for example. Even if the establishment was blessed with an on-site stable and spacious grounds, there may not be staff available and the hydrotherapy might be something of a necessity for the amelioration of Johnny's condition. Some choices are dangerous (I could choose to go sit in the middle of the fast lane of the local motorway for example); some choices are illegal (I could choose to go to my local BMW dealer's showroom and drive away a car without asking); some choices are immoral (I could choose to curse at everyone I meet); some choices are uneconomical (I could choose to stay in bed all day and not go to work), some choices are ... It can be seen that, almost by definition, most choice is constrained and therefore we cannot provide unconstrained choice with a school, college, centre or residential unit. However, Contained Choice sets further limitations on the constraints as set out above and, as such, should be used only as a part of an educational program designed to empower the Learner with the goal of Complete Choice.

Complete Choice
The majority of us have Complete Choice, it is the norm: we are free to choose what we want when we want it (although some would argue that we do not really have 'free will'; see Sam Harris for example http://www.youtube.com/watch?v=pCofmZlC72g Also, there may be dire consequences to some choices we are 'free' to make). Complete Choice is what it implies; intrinsic choice, Learner initiated choice, coming from within the Learner, not decided or directed or supported by others. That is not to say there are not constraints on us all (on our choices) some of which were detailed in the previous paragraph. We do not typically choose to go and sit in the middle of the motorway because we know they are consequences to that action. However, with Complete Choice, I can (if I was so foolish as to not consider the consequences) choose to drink the water from the ditch by the side of my local road. Is Complete Choice simply hypothetical? Maybe, but that need not concern us here, as the 'goal is (Learner) control' then Complete Choice must be an aim. However, to provide Complete Choice without an education in consequences would be an immoral act (not withstanding that it would be almost impossible to provide in any establishment setting).

Complete Choice does not mean that a Learner is prevented from asking for the opinions of others or, indeed, listening to the opinions of others proffered at the time. In the above video clip from YouTube (http://www.youtube.com/watch?v=ZKNdoRWgLoI) and in most of the other Lou and Andy clips from the 'Little Britain' British TV series, Lou always provides Andy with Complete Choice. However, while Lou always explains the consequences to Andy (such as the consequences of getting a tattoo on his face) Andy always insists on his choice and Lou always goes ahead with it to great comic effect but with, often, rather less than desirable results. Complete Choice therefore comes with a proviso; the Learner must be able to understand the consequences of his or her choice and, if that choice is life changing and permanent then, others should not assist in its action if they consider it to be mistaken and ill judged..

As 'Choice is a Voice' and having a 'voice' is a major part of Control (the goal is control) then working towards that goal of Complete Choice (Learner initiated) is desirable. However, the pathway to this goal will necessitate the use of Contained Choice. Contained Choice should therefore be a milestone on route to empowering the Learner with Complete Choice at the end of a period of education. We should not be aiming to provide the same format for choice throughout the entire length of education; we should be seeking to move from Contained to Complete Choice and to turn Choice into Control.

Who chooses the choices?

Click to Enlarge

"This ‘filtering’ of options and/or information was frequently premised on the belief that they (as parents) knew the most ‘appropriate’ or the ‘best’ choice options to present to their child."
Mitchell (2012) Page 17

"Limited choice, in that it is frequently staff and not students who make decisions about who should have the chance to learn - and what"
(Sutcliffe 1990 page 36)

While the provision of choice is considered to be good practices, we must ask, 'who chooses the choices'?! How do we know those are the choices that would have be made by the Learner had the Learner been in a position so to do? Parsons and Reid (1990) studied Learners with significant disabilities (who did not speak). They showed that Significant Other opinions of the Learners preferences didn't reflect what the individual actually chose in many instances. If we consider a situation in which Significant Others are deciding what options should be available for Learner selection:

on a four location communication board;
from the range of fast food outlets in town.

How do they make that decision? Perhaps the four outlets staff choose:

are the only ones in walking distance of the point at which they are dropped by transport;
have always been used by staff in the past and no one has questioned why;
have sufficient disabled access and provision while other possibilities do not;
provide a better (wider, healthier, ... ) selection of menu;
are more affordable.
are more helpful;
are more accommodating;
are the ones that staff prefer.

Even with good justification, questions still remain:

Was the Learner involved in deciding which items were put onto the choice board?
Did the Learner get to pick his favourite four fast food restaurants from all the outlets available before a choice board of places to eat was created or did someone else decide that those four would be best on his behalf, perhaps because too much choice would be 'confusing' for him?

If we take the above four location screen (from an iPad fast food option) set as an example, there are certain questions that require our consideration:

Why do none of the above options allow for a choice that is 'NOT one of the above'? That is, why don't they provide an 'other' option? Thus James, for example, could choose between McDonalds, KFC, Domino's, or Other. The choice of 'Other' providing access to more alternatives and as a way of indicating 'I don't want any of those options'!
Who chose the symbols used to represent each of the options? Why were they chosen?
Are we certain that the Learner recognises, understands and can differentiate between them? How do we know this?
How often does the Learner actually get to choose from this set? If in a group of Learners, do they have a vote?
Why only four options?

While choices selected by others (Contained Choice) maybe a necessary part of the path towards Complete Choice, the rationale for any Contained Choice should be explicit; that is, are those who set Contained choices able to answer the above questions?

The above requirement holds for all option systems. It might be argued, in the classroom, there are a limited range of options at any one time and the options are set by the specific requirements of the session (it is not appropriate to offer a visit to 'Subway' during a class history session for example. The items on the school dinner menu are not infinite), but it could also be argued that even such restricted choice systems should include an 'I do not want (to do) any of them' option.

That's crazy! What if the Learner simply chooses to do nothing all lesson or eat nothing at lunch?
Well, at least s/he has made a choice! It's debatable whether any Learner would make such a choice but let us suppose that one did. If we imagine our Learner does not have any special needs but an 'ordinary' pupil in an average state school, surely such a pupil could refuse to do anything in a session or not have anything to eat at lunch (my son used to keep his dinner money for 'other things' but not tell us that he had skipped lunch). In such circumstances, what would the teacher/ school do? Would they deny this individual the right to ever make choices while at school? Could they take away the pupil's ability to say 'no'? Would they address the behaviour in some other way? Certainly, one option would be to withdraw the option to say 'I do not want to do that' and simply provide 'choices' of which the teacher approves. However, I would want to begin by addressing the behaviour with the Learner and Significant Others to see if there is a way in which this issue could be resolved.

Are you saying that the Learner should always select the choices?
As a general guiding principle, yes! However, there will be times when choices are limited: for example, the teacher may decide to provide a choice between two activities in a numeracy class to assist the learning of a particular concept. While there might be other ways of learning such a concept, the school may not have those particular resources available and the Learner is unlikely to know of them anyway. Thus, it is not always appropriate to let the Learner select the choices but the starting point should be:

Learner selects but, if not appropriate, then others will guide the selection.

and NOT:

Staff select and perhaps, on occasion, staff permit the Learner to select.

Of course that begs the question what does 'if not appropriate' mean? Who decides if an option is 'not appropriate'? In a school situation staff have a duty of care (in loco parentis) and, as such, they must make the ultimate decision on what is and what is not appropriate and in the best interest of the Learner. What does 'best interest' mean? As we saw in the section on the MCA earlier on this page, the act states that the least restrictive option for the Learner should always be selected if 'best interest' is invoked.

How can a Learner select choices without any experience of the options?
Good question! S/he cannot. Therefore, as has already been stated, there must be a period of Contained Choice while the Learner learns about making a choice and the options available.

Evidence Based Research

Research on the increased provision of choice by Significant Others for those experiencing learning difficulties has shown that:

there is an improved staff awareness of preferences of individual Learners (Browder et al; 1998);

there is a continuing increase in number of choice opportunities offered by staff (Cooper& Browder 2001);

individuals will participate more fully in situations where there is greater choice (Dattilo & Rusch 1985; Realon Favell & Lowerre 1990; LaMore & Nelson 1992; Rice & Nelson 1992; Kennedy & Haring 1993; Dunlap, DePerczel, Clarke, Wilson, Wright, White, & Gomez 1994, Cordova & Lepper 1996; Heller, Miller & Factor 1999; Cole & Levinson, 2002)

individual task performance is typically enhanced in situations where there is greater choice especially with preferred choices (Parsons, Reid, Reynolds & Bumgarner 1990; Rice & Nelson 1992; Bambara, Ager, & Koger 1994; Dunlap et al., 1994, Smith, Iwata, & Shore 1995; Cordova & Lepper 1996; Dibley & Lim 1999; Cole & Levinson, 2002; Stenhoff, Davey, & Kraft 2008;)

the development of early communication skills is enhanced (Stephenson & Linfoot, 1995);

where physically possible, there is an increase in spontaneous speech production (Dyer, 1987);

behaviours that staff may find challenging tend to reduce when there is more choice (Kern, Vorndran, Hilt, Ringdahl, Adelman, & Dunlap 1988; Dyer, Dunlap, & Winterling 1990; Carr & Carlson, 1993; Vaughn & Horner 1995; Verpillot & Dattilo 1995; Seybert, Dunlap, & Ferro 1996; Vaughn & Horner 1997; Kern & Dunlap 1998; Dibley & Lim 1999; Lindauer, Deleon, & Fisher 1999, Frea, Arnold, & Vittimberga 2001; Kern, Mantegna, Vorndran, Bailin, & Hilt, A. 2001; Lohrmann-O’Rourke and Yurman 2001; Romaniuk & Miltenberger 2001; Cole and Levinson 2002; Foxx & Meindl 2007)

individuals show increased happiness/pleasure when choice is provided (Green, Gardner, & Reid 1997; Lancioni, Singh, O'Reilly, Sigafoos, Didden, Oliva, Severini, Smaldone, Tota, & Lamartire 2007; )

individuals have higher quality of life outcomes (Foster & MacLeod 2004; Neely-Barnes, Marcenko, & Weber, 2008; Willis, Grace, & Roy, 2008, Stancliffe, Lakin, Larson, Engler, Taub, & Fortune 2011)

there is an increase in social interaction with general education peers (Kennedy & Haring, 1993; Heller, Miller & Factor 1999).

The above listing does not pretend to be fully comprehensive. There will be other studies not cited that add to the volume of evidence regarding choice as a factor in significant outcomes for those experiencing physical disabilities and accompanying learning difficulties, If you are aware of others not cited above please let me know using the form provided at the bottom of the page.

Note: in many of cases effects were noted only when preferred options were included in the choice array. Indeed, the majority of the studies indicated that simply obtaining a Learner’s most preferred item or activity (BEST = Best Ever Stimulating Thing; see later this page) was more significant than being allowed to choose.

Note: the majority of the above studies had a small sample set and thus generalisation across all populations is called into doubt. However, as all the above studies posited some benefit to the availability of choice then , taken together, it seems more likely that their findings are sound.

Note: the are some studies that, contrary to the above, show little or no effect between choice and no-choices states (Lerman et al 1997; Killu et al 1999; McKnight & Kearney 2001; Schartzman et al 2004). While such studies may pose an interesting debate, they seem to be outnumbered by those that suggest some form of positive outcome. I have insufficient evidence to suggest a reason as to why they should find no benefit but even if the studies were soundly conducted, they do not present a case for NOT making choice routine in the lives of Individuals Experiencing Significant Learning Difficulties. As they show no distinction between choice and non-choice and do not show any negative effects of either approach, the case is still weighed heavily in favour of the provision of choice option especially when the choice option array include a BEST or BESTs (preferred item or items).

"Generally choice appears to have an impact upon the engagement in activities, task performance and seems to encourage individuals to have more interest in these tasks and stimuli. Furthermore, choice seems to have beneficial effects on aspects of quality of life including increased levels of integration within wider communities." (Bradley 2012)

Note: Is there any reason why the availability of choice for Individuals Experiencing Learning Difficulties should be any different than the availability of choice for any one of us? Are we not all human? Don't we generally prefer to have some choice but may find too much choice overwhelming? Don't we generally prefer to make our own choices and not have others tell us what choices we can make? Aren't we motivated more and on-task when we choose to do something than when we are told to do something? Isn't all this self-evident from our own life experience? Why should these other people be any different simply because they may happen to have a physical disability and or a learning difficulty?!

Areas Four Choice!

Brown and Brown (2009) suggested that the development of choice making can be divided into four areas:

freedom and opportunities for choice making;
familiarity with choice options/activities;
individual initiative to make choices;
the development of skills and methods for making selection of choices.

All Learners have a right to make choices in their life and not to be controlled by others (the goal is [Learner] control). As such, there needs to be opportunities for the exercise of that right. It has been shown (see, for example, Cannela, O’Reilly, & Lancioni, 2005; Stancliffe & Abery, 1997) that many Learners have had restricted opportunities to make choices in the past. Furthermore, it has been my experience that in the hurly burly of many present day special educational environments, opportunities for providing choice are simple missed or not taken because of time pressures (it is often easier to do it for rather than take the time to allow a Learner to decide between alternatives and then facilitate him or her to do it for her/himself). As the positive effects of an increased opportunity for choice are evident in the research (as has already been shown in the sections above) there can seem little reason to restrict the use of choice in the classroom.

Choice has been defined as “an individual’s selection of preferred alternatives from among several familiar options” (Shevin and Klein 1984, page 160). While, for me, this definition is simply couching choice in terms of choice (Choice is an individual's choosing from among several familiar choices) for the purposes of this section of the webpage let's move forward. Both explicitly and implicitly contained in the Shevin and Klein definition are several 'concerns' that need to be addressed when working with Individuals Experiencing PMLD:

means of selection;
familiarity with options available;
consistency of approach;
awareness of results of selection;

Establishing a methodology for a Learner selection amongst items must be applied across the curriculum (and beyond) consistently. It is potentially very confusing if different techniques are used by different staff members at different times of the day and then after school yet another procedure is utilised. Initially, at least, a consistent methodology should be adopted by all Significant Others when working with a specific Learner (each Learner may have their own approach). Thus, at first, all Learners will have to come to grips with a means of making a selection. However, simply assessing for and training in a means of making a selection does not guarantee that any Learner choice is unproblematic. It is my experience that staff might claim a Learner has made a choice between two proffered items when, in reality, it has not been established the Learner has any concept of 'choice'. That is not to say the established methodology is incorrect or that the Learner should not be offered such a choice using the methodology rather, what is claimed from such actions should not be overstated. Such a methodology is a means of allowing a Learner to come to understand that what s/he looks at or touches (or otherwise indicates) is what she will receive (what s/he has chosen).

While, in some sense, familiarity is a by product of consistency of approach, if the Learner is offered an alternative that s/he has never previously experienced (and, thus, of which s/he is not cognisant) then s/he may select the known option even if the other was, in fact, the better.

"The possibility of being able to actually experience the different options constituting a choice facilitated increased levels of involvement for young people. Educational and leisure choices were examples of areas where experience opportunities appeared to support young people’s involvement in choice-making." (Mitchell 2012 page 19)

Thus, the Learner needs to have experienced each of the choices in order to:

be aware of what will happen following a particular selection.
make a real choice.

It may be that the staff use:

real objects (for example: glass of orange or glass of water);
representative objects;
photographs;
pictures;
symbols;
sign language (visual or tactile);
spoken language;
text.

or any combination of the above as a means of representing any of the number of choices offered. If one of the options on offer is a 'walk around the sensory garden' how is that represented as a choice in the classroom? Is the Learner aware that the object, picture or symbol (or whatever) being used represents the particular outcome? How do we know this? Has it been taught? Has it been assessed? How has it been assessed? We should not simply assume Learner awareness and understanding of that which is providing the reference or to what it refers (referent) nor should we assume that the indication of a particular reference is because of that understanding; it may be that the Learner indicated a particular option because:

of its colour;
the light was shining on that choice more than the others;
s/he is attract by some attribute of the item;
it is the only location on the choice board s/he is able to physically access!
s/he was unable to coordinate her/his movements sufficiently and selected an option by accident when, in reality, s/he meant to select another option.
we have 'taught' the Learner to 'fly-swat'; to reach out and touch (or otherwise indicate) an option when something is presented. Fly-swatting is selecting without any cognitive engagement.

It is good practice to build familiarity of items encountered in a Learner's day while be aware of all the above issues. A learner needs to have awareness of an item in order to be able to make a choice based on preference. Thus, in order to begin to establish preferential choice we have to build awareness. This is covered in greater depth in the following sections (See 'Preferential Treatment' below).

The third quadrant of the circle depicted above refers to Learner 'initiative', that is to whether the Learner is motivated to make the choice. If a Learner is not motivated (intrinsic motivation) to make a choice then s/he should be encouraged and supported to do so. Such encouragement and support are vital in the development of initiative for Learners with significant disabilities (Cobb, Lehmann, Newman-Gonchar, & Alwell 2009). While the use of extrinsic motivation plays an important role in the development of skills it should be faded over time such that the Learner is making selections without encouragement (at first, via Contained Choices but with the goal of Complete Choice). It may be argued (with some justification) that a failure to make a choice could mean that a Learner is saying, "I don't want any of those things" or "I don't want to do any of those things". However, this would be an assumption on our part especially during the period when a person was learning to make a choice. If choice making was routine and the Learner had made many previous choices using a particular methodology and was suddenly not cooperating with a particular routine then we might reasonably make such a claim (and inquire as to why s/he does not want to choose from the available options).

Learners Experiencing PMLD and Severe Learning Difficulties are unlikely to posses the necessary expressive communication to be able to make a choice and will, therefore, require the support of Significant Others in the process (see Antaki, Finlay, Sheridan, Jingree, & Walton 2006). The methodologies employed by staff in supporting Learners to make choices may, in themselves, be problematic especially if assumptions of understanding are not assessed. Thus 'methodology' occupies the final quadrant of the circle. As methodology is covered extensively on this page it will not be expanded further here.

Preferential Treatment

In order for a Learner to express a preference s/he must be aware of each of the alternatives in any choice. Thus, the development of Learner awareness of items in his or her day is a vital component of any educational program. While awareness might occur naturally through some form of situational osmosis staff should not simply assume this to be the case and actively promote awareness: that is we should 'choose to teach' (see section entitled 'Choose to Teach' below).

What factors will promote the development of awareness and which others will lead to confusion and a lack of understanding? One of the main constituents of developing awareness is a 'consistency of approach'. A consistency of approach involves not just the how but also the which, the what, the where, who, and the when. Why? Why is not missing, it's already been stated: why do we want to adopt a consistency of approach? What is likely to happen if we elect to do otherwise? Confusion, lack of understanding, and little progress.

What: What needs to be done? As stated, there needs to be a consistent approach to Learner encounters with POLEs (People, Objects, Locations, and Events) at all times and in all spaces. Thus the 'what' is a team event involving all Significant Others (see who). The team need to decide how they can best eliminate Learner confusion and build awareness. That doesn't necessarily mean setting severe limitations on what a Learner can experience but ensuring that regular experiences of POLEs are not confusing. For example, if a range of ten drinks are available at different times during the day (tea, coffee, water, milk, orange juice, apple juice, blackcurrant juice, coke, lemonade, orange pop) then each much be presented in exactly the same way at each encounter. It would be confusing if tea were presented n a brown cup in one situation, as a tea bag in another, and the Learner shown a box of tea in yet another. Whatever is decided to be used to represent and to present tea should be maintain by all throughout each day. If the presentation involves signing the word tea in Makaton and saying 'tea' then this too should follow through all encounters. It would be less than consistent if some said 'tea' while others used 'cup of tea' and yet others 'drink of tea'. Worse still if some say such things as 'fancy a cuppa?' or 'like a brew?'!! This brings us to the 'how' ...

How: How can a development of awareness be supported? You are likely to have already thought of a few strategies to response to this question. If we look at product awareness in supermarket sales we are giving some valuable pointers. Manufacturers and suppliers are keen to sell their wares to potential customers and thus look to promotional techniques which develop awareness. One of these is a positive brand image: the brand has to be clear, familiar, seen to be reliable based on past experience and word of mouth from others which includes all the advertising gimmicks used to promote the product. Another technique in use is product placement: Suppliers are keen to have their products placed in positions in supermarkets in which there is a high probability that they will be noticed by the customers. A further technique in use is clarity: the packaging must be clear and it should avoid customer confusion about which of a particular product to purchase (bio or non-bio for example). Too much confusion and the customer is likely to vote with their feet and purchase a rival product.

How does any of this help us when trying to develop awareness of POLEs that are likely to be introduced as choices at some point in the future? When working with building awareness of any POLE, we need to ensure that we make use of all of the senses in all of the ways detailed above. However, as we are working with Individuals Experiencing PMLD it is very likely that there will be issues with one or more areas of sensory awareness. Obviously, a Learner who has severe problems of visual acuity is unlikely to learn to discriminate a POLE based on visual information alone; we need to play to an Individual's known strengths and ensure that we we are trying to build awareness we make use of every sense available. Even with a Learner who has good visual acuity, we must not only show the POLE but consistently use the other senses to build Learner cognition. When using the senses it is important that we maintain a consistent approach even in different locations and with the involvement of different Significant Others. Think about how might we best reduce the potential for confusion in the Learner's mind with each encounter with a POLE.

Which: Which items should form the selection from which the Learner develops a preference? It would seem less than sensible to introduce POLEs into a Learner's life with which s/he is not going interact on a regular basis. Thus, the 'which' question is answered in part by the equation 'Which = daily POLEs': that is, items the Learner is likely to be meeting on at least a daily basis. Of course, this will change over time, as the Learner gets older and as a Learner moves from one establishment to another. Complexity is almost certainly going to lead to confusion and so, especially at early stages of development, Significant Others need to keep things simple.

Where: Where = Everywhere. That is both at school (or college or day centre) and at home. What things does the Learner encounter daily? Can these encounters be made to be as consistent as possible given the differing venues and the differing people in those venues?

Who: Who = Significant Others. Significant Others include family, friends, teachers, therapists, carers and any other person whom the Learner will encounter on a daily basis. While it will not be easy to get all Significant others working consistently together using the same approach it will pay dividends for the Learner in reduce confusion and increased comprehension.

When: What does 'when' mean in this situation? Does it mean at what time of day or how frequently or for how long others should attempt the promotion of awareness of a particular POLE? Actually, all three need to be taken into account:

time of day: awareness is greater when we are alert. I can be watching the TV at one moment and then, although the TV is still on and at the same volume be completely unaware of what is happening as I begin to doze. At what times of day is the Learner most alert? Does this vary? If so, how and why? Can we try and build awareness at times when the Learner is more likely to be alert?
Frequency: We need to build awareness on at least a daily basis. Things that happen less frequently are less likely to be understood by Individuals Experiencing PMLD. Continuity and consistency are very important.
How Long: Processing time is important for all of us. Too much information in too short a time period is overwhelming for all but the most gifted of individuals. Thus, for those Individuals who have issues with cognition, others need to slow things down and allow extra processing time. Not only do we need to make the action memorable (how) but we need to give the Learner more time to process it.

Choose to Teach

Click to Enlarge

"Individuals who are deaf-blind and have a cognitive disability may not effectively communicate their desires and choices even when provided with the opportunity to do so, in part because of their frequently limited communication skills. The ability of these individuals to make choices may be further constrained by instructional staff and caregivers, who anticipate their wishes and make choices for them. These caregivers and instructional staff may be acting with only the best intentions for these individuals, perhaps in the belief that they are unable to make a meaningful choice. Often, however, these individuals have not been taught how to make a choice."
Gothelf, Crimmins, Mercer, & Finocchiaro

"Perhaps more emphasis has been placed on the choice-making component as critical to a positive quality of life for people with disabilities than most of the other elements combined.
Making a choice is, quite simply, communicating a preference, and instruction in making choices focuses on one or both of these elements—either identifying a preference or communicating that preference. Except in unique circumstances, there usually is no need to "teach" choice-making, per se, although there may be a need to enable or teach children who have problems communicating new, alternative, or even more appropriate ways to indicate their preferences. By and large, educational efforts should be aimed at using choice-making opportunities to provide
experiences of control, and to teach students that not all options are available to them and that choice options are constrained for all people."
Wehmeyer & Schalock Page 9

While Wehmeyer & Schalock might suggest that there is no requirement to teach choice making skills, Wolf & Joannou state the opposite point of view:

"Often, choice making is thought of as just an opportunity that needs to be enhanced. For example, the belief is often that we need to provide individuals with significant disabilities more opportunities to make choices. While this is true, it misses a critical step: students with significant disabilities need to be taught choice-making skills."
(Wolf & Joannou 2012 page 14)

I would tend to agree with Wolf and Joannou over Wehmeyer and Schalock on this particular issue; choice making needs to be taught. While an increase in the amount of choice available to any Learner is generally a good thing, it should not be assumed that this alone is enough. Providing choices every few minutes to Learners who do not understand the options or who have not been readied to make such decisions is counterproductive. Thus, choice making skills need to be taught ...

“Choice making is a viable teaching target, to be subjected to task analysis, planning, implementation and evaluation similar to those which are characteristic of more traditional content areas” (Shevin & Klein, 1984, p.162).

Thus, in many cases, individuals experiencing significant disabilities will need to be taught the choice-making process (see Bambara, 2004; Lancioni, O’Reilly & Emerson, 1996).

Indeed, it is likely that those with the most significant physical disabilities and/or learning difficulties will have been exposed to less opportunities to make choices as Significant Others may have 'chosen on their behalf'. As such, this particular group will need more time devoted to building awareness of such skills (See Lancioni, O’Reilly & Emerson, 1996).

"Instructional emphasis during early childhood involves providing opportunities for children to make choices by offering options, assisting children to recognize alternatives, and restricting choices that are possibly harmful." (Field, Martin, Miller, Ward, & Wehmeyer 1998 page 13)

There are several aspects of teaching choice making skills that must be considered:

Cognitive Discrimination (cognisance of the items in the array which may include symbol/referent correspondence);
Affective Awareness (knowing one's likes and dislikes);
Methodological Appreciation (Learner awareness of the other's methodology employed to permit a choice);
Selection (The means by which the Learner lets another know a particular item from an array);
Generalisation (transference of skills from one location to other times and places in the 'real world').

Cognitive Discrimination
If a Learner is presented with an array of items that s/he does not recognise and asked to select one, if s/he is capable of making a selection, s/he may select on the basis of some arbitrary characteristic of one item which, at that moment in time, appealed to her/him. Having 'made a choice' in this manner, staff may draw the conclusion that the Learner is cognisant and continue to work in this way without ever testing their assumptions of understanding.

We cannot be certain, without some form of empirically verifiable evidence, a Learner is cognisant of a specific item in an array. Simply because a Learner has been given and consumed coffee every morning for three years during break does not mean that the Learner will be able to pick it out from a range of other drinks or would realise and complain if another hot drink (tea for example) were to be substituted one morning. The issue of cognitive discrimination becomes even more problematic when we substitute symbolic objects, photographs, symbols, or signs in place of the actual items in the selection process. Are we sure that the Learner recognises the symbol for tea as tea? Have we taught it? Have we assessed it?

In the example above, in which a Learner is being given a choice between three hot drinks, if we were just to use a set of cups (blue, brown, and green in colour), it would be difficult for the Learner to know the contents of each cup from sight alone. The Learner may select on the colour, shape, size, or position of the cup in the presented array (presentational preference / bias). We might use a set of containers (a jar of coffee, a tin of hot chocolate, a packet of tea) in place of the actual drinks in cups but this assumes the Learner recognises the particular style of the container and it is unchanging. We might use a set of symbols (such as those depicted above) but are we certain the Learner understands each refers to a specific drink? If we are using symbols for this purpose, we must ensure that the Learner has been taught the relationship between the symbols and the items to which they refer. Such a relationship may be taught through experience and association in context:

"These individuals, in contrast, must begin the AAC acquisition process by establishing the relationship between AAC symbols and their real-world referents, relying, perhaps almost exclusively, on contextual clues in the communicative environment to extract meaning through the visual modality" (ROMSKI M. & SEVCIK R. 1993)

Some will no doubt wish to argue that those experiencing the most severe cognitive disabilities cannot be taught to recognise and use symbols but, if pigeons can be taught to simulate communication (See Epstein, R., Lanza, R., & Skinner, B. 1980) then, there must be hope for the development of, at least, simple communication skills in Individuals Experiencing Significant Learning Difficulties. However, let's assume, for the moment, that our Learner cannot cope with symbol representations of referents at the present time: what alternatives are there? We might use real objects. Indeed, this is the likely starting point for many Learners, even those who are expected to use symbols as they will need to journey through a period of associating symbol with object. While objects might present fewer problems in their use, there are a still concerns:

size (some objects might be too large to manipulate);
availability (bringing the supermarket into the classroom might be a little problematic);
contents and containers (a choice between tea and coffee in two cups might be difficult for a Learner as cups are cups and it is not easy to tell what they contain);
portability (the requirement to carry around a range of objects from which a Learner can make a choice at any time is an almost impossible task. However, many choices can be made in real time utilising real objects found in context without the need for staff to be carrying boxes of objects for choice making activities).

Such problems may be overcome by the use of:

Sensory Selection (see section on Sensory Selection on this webpage);
Objects Of Reference (where the learner is taught the association between the Object and its referent such that the Object can be use in place of the referent when the referent is not available);
Alternatives (such as using tea bags and coffee jars to represent the drink choice instead of cups of the drinks. This assumes, of course, that the Learner understands that coffee is made via ground coffee from a coffee jar and that tea can be made by using a tea bag. Such an assumption is by no means certain.);
Photographs (assuming the Learner can make the connection between the photograph and its referent);
Symbols (with the 'problems' as detailed above).

Even recognising such issues, we will undoubtedly be starting out enabling some Learners to make choices (especially in the classroom) utilising real objects. It is essential therefore that staff ensure the Learner recognises each object to be used in any array. This skill can be assessed using the technique known as 'boxing clever' (see section below). If a Learner cannot perform under these conditions, it may be necessary to teach and reinforce the connection between an object and the Learner's typical experience of it. For example, the Learner could be involved in making lots of cups of tea using tea bags (such that s/he starts to associate a tea bag with the tea drink).

"After a new concept has been introduced, check that it has been correctly understood. It takes time to understand new meanings and ideas, and they will need to be given in context and repeated often." (Jackson & Jackson 1999 page 80)

Affective Awareness
Affective Awareness skills are those necessary for a Learner to recognise a particular preference: "I really like coke therefore I should choose coke when I am given the option". While staff may take such skills for granted it is by no means clear that all Learners possess such skills (especially those Learners who are experiencing PMLD). Staff should talk with primary Significant Others and obtain a list of the things believed to be Learner preferences. Once compiled, staff can assess the Learner's ability to select a preferred item (from the list) in a choice against one or two other non-preferred items (items not on the list). If the Learner continually selects the preferred item (even when it is presented in different positions in the array to overcome positional preference) over a number of trials, then an assumption of understanding may be made. However, if the Learner is inconsistent, staff will have to teach Affective Awareness.

It is also a possibility the Learner consistently selects a 'non-preferred' item from such an array. If this is the case, we may have to review and revise the listing produced by Significant Others and add the item to the preferred list (providing that the 'choice' were not always in the purple cup or the big cup and thus, it might be shown that the Learner was choosing on the basis of a preferred attribute of the array rather than the drink itself).

For those individuals experiencing the most significant disabilities, awareness of the world around them in general may be problematic. As such, it is unlikely that they will be able to engage in cognitive interactions with a presented array of items in order to make a conscious choice. Therefore, staff may need to engage in a program of 'awareness amelioration' from the very start. It is known that Individuals Experiencing PMLD, even while very young, can develop contingency awareness given the right environmental stimulation:

"These results suggest that from a mental age level of 2 months children are equipped to detect cause and effect relationships and build up a picture of their world based on expectancies about such relationships" (O'Brien, Y., Sheila Glenn, S., & Cunningham, C.,1994)(see also: Sterling Honig, A. 1983; Lohaus, A., Keller, H., Lissmann, I., Ball, J., Borke, J., & Lamm B. 2005; )(Please note: the topic of contingency awareness is covered further on both the contingency awareness and the history page on this website)

It is known that a Learner’s ability to influence his/her environment is both a source of growing awareness, enjoyment, and social-emotional behaviour (Fagen 1993; Tarabulsy, Tessier, & Kappas, 1996; Watson, 2001, Raab, Dunst, Wilson & Parkey 2009):

"More than 30 years of research has consistently found that infants and young children with or without disabilities or delays manifest
social–emotional behavior in response to behavior producing reinforcing consequences." (Raab, M., Dunst, C.J., Wilson, L.L., & Parkey, C. 2009)

As such contingency learning games (Dunst et al. (2008), Hodapp and Goldfield (1983), Lancioni (1980), and Watson, Hayes, and Vietze
(1982),) should form a part of all learning for those who are experiencing PMLD:

"The results have direct implications for practice. The interventions and results show that rather simple and easily implemented contingency learning games can have rather dramatic effects on child learning, which included extended benefits to both the child and his or her caregivers. Interestingly, many of the interventions used with young children with profound developmental delays and multiple disabilities do not include the promotion of child behavior competence (Dunst, Raab, Wilson, & Parkey, 2007; Winefield, 1983). Rather, the interventions typically involve noncontingent stimulation to evoke child behavior or passive manipulation of child movements. The consequences are often behavior suppression rather than enhancement." (Raab, M., Dunst, C.J., Wilson, L.L., & Parkey, C. 2009)

Thus, the implementation of a program of simple contingency awareness activities is recommended as a means of fostering the development of environmental awareness in Individuals Experiencing PMLD. Such an intervention also has additional benefits for the development of social and emotional behaviours as well as making the whole experience more pleasurable for Learner and Tutor (Significant Other) alike (Raab, Dunst, Wilson & Parkey 2009).

Note: Simple contingency awareness activities may be defined as engineering the environment (environmental engineering) such that an existing (observable) Learner behaviour is consistently paired with a particular reinforcer (toy moving, light shining, music playing, Significant Other interacting ...). The Learner can then use the behaviour to effect a response. At first, it may be an accidental movement of a Learner's body that causes the effect (reinforcing response) but, after a number of such accidental activations, the Learner may come to realise that his/her action is in some way connected to the reinforcing response. An increase in the rate at which the reinforcer is activated and also in the Learner pleasurable vocalisations and facial expressions suggest a growing awareness of the causal link.

Note: The image (right) would seem to suggest that Simple Contingency Awareness Activities (SCAA) will involve the use of switches. While the use of switches may form a part of this approach, it should not form all of it. For example, SCAA may be something as simple as a rod suspended in front of a Learner to which a set of soft toys, bells, etc are attached at which the Learner may swipe with a hand or arm. SCAA should also include situations in which a particular behaviour evokes a pleasurable response from a Significant Other such as rocking together, praising the Learner, or playing a form of pat-a-cake.

"Parents and professionals involved in the care and education/rehabilitation of persons with profound multiple disabilities and post-coma vegetative state are confronted with challenging objectives such as promoting the persons’ responding and assessing their learning. The first of these objectives may be pursued through the use of contingent reinforcement employed within microswitch-based programmes. The second objective may be pursued through the use of noncontingent reinforcement in substitution of contingent reinforcement."(Lancioni, Singh, O'Reilly, Sigafoos,& Oliva 2006).

Lancioni, Singh, O'Reilly, Sigafoos,& Oliva's article (2006) reinforces the notion that the use of simple contingency awareness activities (specifically, in their paper, those made available through micro-switch technology) support learning in those experiencing significant disabilities. As we have shown (see studies detailed above) such learning also has positive social and emotional consequences for staff and student alike. The use of a contingency awareness developmental program is but one pathway (there are others) by which we might develop affective awareness.

And finally (in this section of a section), supporting it all:

"Findings from a meta-analysis of studies investigating the use of five different assistive technology devices (switch interfaces, powered
mobility, computers, augmentative communication, weighted/pressure vests) with young children with disabilities are reported. One
hundred and nine studies including 1342 infants, toddlers, and preschoolers were the focus of analysis. Results showed that the use of all the assistive technology devices except weighted and pressure vests were related to improvements in child outcomes regardless of type of child disability or severity of child intellectual delay." (Dunst, Trivette, Hamby, & Simkus 2013)

Methodological Appreciation
There are differing methodologies staff may utilise in order to provide choice making opportunities for Learners; many are covered in alternate sections of this web page. In order that a Learner may be said to make an independent choice, it is necessary s/he understands the methodology in use by staff. Learners will not be making realistic selections if they do not comprehend the way in which choice is being presented by staff. At worse, a Learner may just sit puzzled and thus reinforce any staff assertion/notion of inability, incompetence, or unreadiness. The methodology for choice selected must be;

appropriate - matched to the needs of the Learner (for example: do NOT to use a visual selection methodology with a Learner who has severe issues with visual acuity);
taught to the Learner (in a manner that the Learner is able to comprehend);
assessed with the Learner to check if the Learner is able to cope.

It also follows, staff themselves need to understand the pitfalls of any methodology they are going to use to provide Learner choice. These include:

methodological appreciation of the Learner (as already detailed above)
positional responding/preference (The Learner always selects the object on the right of the array. Staff should ensure they change the order of the array and that they monitor the positions of items selected by a Learner from an array over time to look for any obvious patterns);
Selection on Alternate Attribute (For example choosing on the colour or shape of an object or some other attribute to which a Learner is attracted at the moment of choice. If it is known that a Learner loves blue but hates milk perhaps milk can be offered in a clear glass with a blue band while a preferred drink is offered in a clear glass without any band. Does the Learner select the milk or the preferred drink?);
'Error-Free' Arrays (All items in the array are acceptable alternatives to the Learner. Thus, what the Learner chooses will appear to be a 'correct' choice and appear to provide evidence that all is fine and there is no problem when, in reality, there may well be some significant issues);
Exit Strategies (in the best scanning systems there is always a means by which a Learner can exit a row or column selected by mistake. However, in many choice methodologies the Learner has no way of saying 'I do not want any of these' or 'I want something other than these'. While we may begin the teaching process without an exit strategy eventually a consistent approach to rejecting the choices on offer (as well as asking for another option) should be included. Again, such an approach is likely to have to be taught.
Cueing (cueing is the intentional or unintentional staff direction of a Learner to make a particular response. Learners are able to pick up on such cues and provide a response that satisfies a staff member without having to understand any other aspect of the situation. When assessing a Learner's ability all cueing must be eliminated. This aspect is covered in some depth in a following section on this web page).

Selection Technique
The selection technique refers to a Learner's method for indicating a choice. While many people make their choices via the spoken language this is not an option for the majority of Learners experiencing significant disabilities. As Learner disabilities become more significant so the selection techniques utilised have to become more creative. Among the possibilities are:

spoken language;
pointing with a finger, hand or arm;
pointing with an alternate body part;
head pointing (perhaps with a pen torch or a laser pen);
eye gaze;
scanning: Other controlled;
scanning: Learner controlled.

Spoken Language: As the majority of those with a significant disability are unlikely to have spoken language, this option, as a means of requesting a choice, can be ruled out. It may be that a Learner (one who is able to vocalise) could use a particular vocalisation / sound to indicate to a Significant Other selecting items in turn (see scanning:Other Controlled), the currently selected item is the one that s/he wants.

Pointing (finger, hand, arm): Some people with a significant disability can nevertheless still manage to indicate a choice by pointing in the traditional manner. If this is both reliable and easy for the Learner to do then it is probably the selection technique of choice.

"... are encouraged to choose their own learning activities. Students without speech who can recognise photographs are encouraged to look at a row of photos which show various activities / items around the room, ranging from the computer to the biscuits. the students can then point at a photo to indicate their choice."
(Sutcliffe 1990 page 31)

Pointing (alternate body part): Pointing does not have to be undertaken using the arm and hand, any body part sufficiently under the control of a Learner could be used. I once worked with a young man who used his big toe for all manner of things. As he could vocalise, generally we would use a particular vocalisation for an affirmative response for rapid choice making. However, when we wanted to assess his understanding accurately, we would use his big toe pointing technique to indicate an item from an array.

Pointing (head): One option for pointing is to attach a pen torch or a laser pen to a sweat band or a cap (or something similar) such that a Learner can indicate a selection by the movement of his/her head. Generally, it is good practice to begin by allowing the Learner to make selections among items (real or symbolised) displayed on areas of a nearby wall such that there was a larger target area. Over time (and usually without informing the Learner) the areas of the wall utilised may be decreased little by little (as the Learner becomes successful at targeting the previous size). After a while, most Learners will be able to cope with relatively small targeting areas as their skills in using their heads in this way improves.

Eye Gaze: Eye gaze as an option for choice has been in use as long as I can remember: certainly since the late 1970's and I would guess for many years prior to that (especially, if Significant Others allowed individuals to make choices for themselves: the rights of Individuals experiencing significant disabilities has changed a great deal over the years and it is not so very long ago that others simply may not have provided choice in the daily routine). Etran Frames are a means for an individual Learner to indicate a choice by eye gaze. The YouTube video (right) explains the use of such a system for communication purposes. Etran Frames are typically no-tech ways of using eye gaze to select from a range of symbols or photographs (the MegaBee is a high-tech version of this approach). A slightly different approach, although still (typically) no-tech, is the use of Talking Mats developed by Dr. Joan Murphy and her team at Sterling University, Scotland. Again, the Youtube video (right) explains the concept. As you will realise, Talking Mats is not just a system that could be used with eye gaze (indeed, typically, it is not) but with the other options listed as well.
There are an increasing number of eye-gaze (eye tracking) electronic systems entering the market place. Initially, these were very expensive. However, as prices continue to tumble, relatively affordable systems that can work with an iPad or a tablet are just around the corner (and, by the time you are reading this, may be commonplace!). Indeed, we may all be controlling computer systems in the future by simply looking at the screen and talking to it to make a selection! The aforementioned eye gaze systems typically are not used with real objects. Where real objects are used, eye gaze is still an effective option to allow an Individual to make a choice. The objects could be spaced out (sufficiently distal to make the direction of an individual's gaze clear although sufficiently proximal to allow the Learner to take in all options at once) on a convenient surface and the Learner asked to look at the item s/he would like to choose.

Scanning - Other Controlled: There are several forms of scanning. In scanning that is controlled by another person, the other person presents items to the Learner one by one, in some way, until the Learner indicates a selection by vocalising or facial gesture or some form of body language, etc. Other Controlled Scanning may be single item presentation (the Learner gets shown one item after another, one at a time) or a multi-item array (The Learner sees all the items in the choice set - the Other points (or otherwise indicates) to each item in the set one at a time until the Learner indicates his/her choice. If the Learner is capable of understanding the spoken word, the Other may state the options (It's tea or Coffee: which would you like?) and then run through them one at a time (Do you want tea? Do you want coffee?) until the Learner indicates a preference.

Scanning - Learner Controlled: In Learner Controlled Scanning, the other plays no real part (other than perhaps setting up the system in the first instance) - the Learner is in control. Typically this involves some form of switch (generally one or two switches) controlled technology. The technology includes a display which depicts the choice of items to the Learner. Each of these displayed items is highlighted. one at a time, for a set amount of time, as a 'scan' moves around the screen (either automatically or learner controlled) in some predictable fashion, until the Learner activates a switch to make a selection. On selection of an item, the technology involved is usually able to report the chosen item via voice synthesis. While all forms of scanning require teaching, this type of scanning is the most demanding of Learner skills and, thus, requires quite a period of preparatory effort before the Learner is ready to 'go it alone'.

Above: Eye gaze system

Above: Single Presentation Scan - Apple or Orange?

Above: Multi-Presentation Array - Apple? Orange? Strawberry?

The above depicted scanning system is a now a no-longer-available AbleNet product known as the FL4SH system. As you can see, it is set to automatic scanning: the scan moves at a set rate (which can be altered to match Learner need) and the Learner is required to stop the scan when the desired item is highlighted by activating an attached switch. You will note that there is only one item on the display - this is intentional: rather than filling all four locations initially, as a part of the teaching and assessment approach, just one is used. Is the Learner able to stop the scan at the correct moment to select a favourite reward (in this case to ask for a piece of chocolate of which the Learner is very fond and extremely motivated to achieve)? If so, we can add a second item ...

The video below is a screen capture of a Microsoft PowerPoint scan (Yes, PowerPoint can scan!) providing single switch user control (automatic scan) to a choice of three drinks. When the switch is activated, the selected drink enlarges, fills the screen, and a voices states "I want a drink of xxxx" (where xxxx is name of the selected drink). If no drink is selected, PowerPoint repeats the scan until the switch is activated and a selection is made. While such a scan is fairly straightforward to produce in PowerPoint and to access using a single switch, it is beyond the focus of this page to detail how to achieve this (you may contact Talksense via the form at the bottom of this page if you would like further details of how to produce your own scan or would like to be sent the depicted PowerPoint scan for your own non-commercial use).

There is an issue with any Learner Controlled Scanning Choice System. This issues remains the same irrespective of the methodology utilised to create the scan (whether its via PowerPoint or Clicker or a dedicated device or ...). A 'selection' of any one of the items does not necessarily indicate a conscious and purposeful Learner choice because:

the Learner may have accidentally activated the switch at the wrong moment;
the Learner may have failed to activate the switch at the right moment especially if the scan speed is set too high for the Learner to manage;
the Learner may not understand the symbols used;
the Learner may not understand the methodology;
the Learner may not understand which item s/he likes. It is an assumption on our part when we ask, "select the one you want", that the Learner understands what s/he wants;
all options are acceptable (error-free) to the Learner and therefore it does not matter where s/he stops the scan and 'selects' an item.

If the above issues have been checked and do not apply to a specific Learner then use of such a scanning system for choice might be appropriate.

It could be argued (correctly) that the final item in the above list does not apply when teaching a Learner how to make a choice because (it is hoped that) the Learner will come to realise (after repeated experiences with this process) that the drink selected is the drink staff then provide. However, as assumptions of understanding are counter-productive, a check should be made on Learner comprehension (of the choice) before progressing to other things.

Generalisation (Transfer of Skills)
We are all aware, what happens without an issue in the classroom, can sometimes be problematic when transferred to an out-of-school or out-of-college situation. Simply because a Learner seemingly has no problem with making a selection from an array in class, it does not follow that the same Learner will select from the same array in a restaurant in a shopping centre, for example. The transference of skills from one area to another should not be taken as read; Learners may need to practice such skills in a variety of situations outside the safety of the classroom.

In addition to the above listed aspects of teaching of choice making skills, Shevin and Klein (1984, p. 164) list a hierarchy of approaches that may be utilised:

Incorporating Learner choice as an early step in the instructional process;
Increasing the number of choices related to a given activity which the Learner makes;
Increasing the number of domains in which choices are made;
Raising the significance in terms of risk and long-term consequences of the choices that the Learner makes;
Clear communication with the Learner concerning areas of possible choice, and the limits within which choices can be made.

In a like manner, Brown, Appel, Corsi, and Wenig (1993) suggested seven ways to bring choice into activities in the classroom:

Choosing within an activity;
Choosing between two or more activities;
Deciding when to do an activity;
Selecting the person with whom to participate in an activity;
Deciding where to do an activity;
Refusing to participate in a planned activity;
Choosing to end an activity at a self-selected time.

Furthermore, Werner (2012) stresses a need for some increase in flexibility:

"services must be tailored to allow for true choice and self-determination. A larger workforce is needed as well as some flexibility in daily routine to fit with individuals’ choices." (page 23).

In addition, Doll, Sands, Wehmeyer, and Palmer (1996) suggested that Significant Others might:

"encourage a preschooler's emergent understanding of the links between choices and later opportunities by revisiting the choices the child has made in the very recent past, helping the child identify the consequences of these choices, and discussing plans for future choices." (Page 82)

While this and the other points may seem a little problematic for many Learners experiencing PMLD, each of the above considerations will be addressed at some point on this web page.

Sensory Selections

Choices are typically presented visually with sensory feedback being provided via characteristics of the the items in the array that are perceived by the Learner. For example, a Learner may be shown the two drinks currently available in different containers as in the illustration left. The Learner is then asked to indicate a preferred option from the two items in the array. While this is not poor practice, there are a number of concerns about such an approach that should be considered:

It should not be claimed that the Learner has chosen a specific drink nor that s/he understand (in this case) coffee and hot chocolate;
The Learner may be selecting on the basis of some characteristic of the containers and not on the drinks they contain. If the Learner likes both coffee and hot chocolate there is no way of ascertaining this.
Learners with issues of visual acuity (and, indeed, those without also) may be selecting the item that reflects the light more readily in the environment at that time.

The Learner may be selecting on positional preference (always chooses item on right, for example);
the containers must remain the same throughout the entire period of selection. As product brands tend to change their packaging over relatively short periods of time, it is important that staff keep the initial packaging used and only use it for presentations in choices (not to make the actual drink) and make the drink from another package. Thus the presentation material remains consistent throughout.
As both drinks are equally valid choices for the Learner (S/he gets a drink s/he likes every time) it does not matter which is selected. While it appears the Learner is making a choice, in reality s/he is just fly-swatting reacting to a stimuli with a conditioned response without any real cognitive engagement with the objects.

It is vitally important therefore that Significant Others demonstrate Learner comprehension of the components of the array: if there is no connection there is no selection!

For those experiencing the most significant learning difficulties (and indeed perhaps for others too) teaching and assessing Learner comprehension is a vital step in this process. The following ideas can be used to assist with this:

Supplement the sensory feedback from each option as necessary (Sensory Selections);
Work on one (assumed preferred BEST) item in the array to establish a link between item and event (drink). The Learner should always be presented with the same package (it must NOT change). As the packaging should remain consistent through out all choices for the event (in this case, a specific drink) over time, a package should be obtained that is NOT used for real (to make the drink but only used for show (to show the Learner as an item in the array). Another package can be purchased to use for making the drink (or for refilling the original container once empty);
Involve the Learner in all aspects of making the drink from the container such that s/he has an opportunity to understand that the contents are a vital part of the drink (the drink comes from the container and therefore choosing the container is choosing the drink);

Sensory support for the Learner (Sensory Selections) involves 'environmental engineering'. That is the container is 'engineered' (altered) by adding an additional sensory surface to provide extra feedback to the Learner to assist with the identification of its contents. While t is preferable the sensory surface relates in some way to the contents it is not essential: over time the Learner will come to relate the sensory feedback to that particular event (drink) providing the process is consistent over time. For example, using a template and spray mount adhesive, a circle of glue can be applied to the surface of the container at one or more appropriate points. Some of the contents of the container can then be sprinkled over the glue (if the contents are solid particles). When dry, this can be sprayed with a clear lacquer to protect it. The container now provides extra sensory feedback to the Learner when s/he interacts with it. The shape of the sensory surface can be varied for other choices to provide further sensory feedback for the Learner. Another idea would be to write the contents of the container on the container in this manner so as to provide additional sensory surface support for sensory selections even though the Learner is not actually reading it.

"You will need to be imaginative when helping someone to explore alternative options. Use all of the person's senses, if appropriate."
(Jackson and Jackson 1999 page 80)

Taking this idea one stage further, it may be appropriate to attach an Object OF Reference to the front of the container by Velcro (or some other means) such that the object is presented as the sensory surface to be explored at the same time as the container. The object can be detached and given to the Learner to explore further after making the choice and prior to the presentation of a (in this instance) particular drink such that the object becomes associated with the drink in the Learner's mind.

In the first image, the choice is provided using just the two drinks cartons. For some Learners, this might provide sufficient sensory discrimination available but, for others, the second option (the addition of a plastic fruit OOR for each drink) may give a better means of obtaining (or, at least, teaching) an informed choice.

Thinking Out Loud

click to enlarge

"Thinking out loud and encouraging a client to do the same will allow for some exploration into the logic behind a decision. It will also prompt him or her to make use of knowledge gained previously."
(Jackson & Jackson 1999 page 86)

Simple choices have limited if any consequence (what drink to have, what colour top to wear, where to sit, etc) and form a part of the early approach to building choice making skills (see later this webpage). However, at some point in the learning process, it will be necessary to take into account the consequences of choices. One strategy for introducing this is to think through any choices you have to make in the classroom (or without) aloud, so that the Learner can hear what you are doing. This can be done even before the Learner is able or ready to do the same thing him or herself to provide a model for future practice. Try to keep your thought processes simple and limit the use of language such that the Learner has some chance of comprehension of what you are doing. You may even present your choice to the Learners as a dilemma to ask their advice on the matter as to what they think that you should do:

"I can not decide whether to wear my high heels or my flat shoes to go shopping. When I wear my high heels I can reach things on higher shelves but they make my feet ache after walking for some time and I think I look nicer in them. My flat shoes are really comfortable though and I like to be comfy but I always have trouble getting to things that are on high shelves. Oh dear! I cannot decide. What do you think I should do?"

"I am going out and don't know whether to take my umbrella or not. I don't really want to carry it about all day and I am so forgetful that I might leave it somewhere. However, on the weather forecast, it said that there was a small chance that it might rain this afternoon and I don't want to get wet. What do you think I should do?"

"I am undecided whether to take the bus or the train into town this evening. I am short on money this week and the bus is a lot cheaper and the bus stop is really near to my home but the train gets there quicker and the station is nearer to where I have to go. Oh dear! What should I do?"

Choice: A Risky Business?

"Despite choice being an important humanistic concern it may be more complicated to provide full choice for people with learning disabilities because these are often vulnerable individuals who may be physically less capable of taking part in all activities and allowing free choice may put them at risk."
(Bradley 2012)

"Be it choice-making or engaging in independent living behaviors, the real barrier for many people with disabilities is that the needs of the caregiver for absolute assurance of safety often tend to lead to the prohibition of activities that have low-level risks. Certainly, behaviors that lead to a certain injury and those that have a moderate probability for harm should be cause for concern. Most behaviors, however, do not involve that level of risk and students with disabilities can be taught to assess the level of risk, and weigh the consequences of action using an effective decision-making process."
(Wehmeyer & Schalock 2012)
"There are also many risks in choice. When practitioners allow others to make their own choices, they are risking that the choices made might not be the ones they would make. At times, they might think the choices are just not appropriate, or even dangerous. Marion, a 53-year-old woman, wanted to jump up and down on a trampoline in her residential accommodation. The staff thought this might result in injury, or that there might be insurance or legl risks. They had to decide whether to respect Marion's choice." (Brown and Brown 2003 page 223)

All choices have consequences although some involve far less risk than others:

receiving an disliked beverage is a lesser short term consequence of making a choice between drinks;
a lesser quality of life may be a long term consequence of making a choice between placement provision;
personal injury may be a consequence of making a choice between varying approaches to solving a particular problem (the best place to cross a road, for example).

Significant Others are often concerned about the risks involved in allowing a Learner to make choices, believing that, in some instances, s/he will be unable to weigh the consequences and make a safe decision:

"Although young people’s level of understanding was considered, it was not always the most important factor. Other factors were important and, at times, could be considered more important by parents. The other factors were: parents’ views on the nature of the choice, protecting their child, parents’ personal attitudes/beliefs and confidence in practitioner knowledge." (Mitchell 2012)

However, unless Learners are given experience of making choices at different levels within the continuum of consequence they will not acquire the necessary skills ever to be so able to do. That is not to say that all Learners should immediately be given free access to all things without any regard to consequence and safety; that would be foolhardy. However, we can aim to teach and assess skills in this area in a progressive manner such that individual Learners are empowered to take more and more responsibility and control of their lives as time progresses and their abilities allow. To do otherwise is to deprive the Learner of some part of what it means to be human:

"There are other hidden meanings in the term “mental retardation.” For many who work with the retarded, this term triggers such action words as “protect,” “comfort,” “keep safe,” “take care,” and “watch.” Acting on these impulses, at the right time, can be benevolent, helpful, and developmental; but if they are acted upon too intensely, or if they are used exclusively without allowing for each retarded person's individuality and growth potential, the retardate becomes overprotected and emotionally smothered. In fact, such over-protection endangers the retarded person's human dignity and tends to keep him from experiencing the normal taking of risks in life which is necessary for normal human growth and development." (Perske 1972)

Therefore, It becomes something of a balancing act between 'human dignity' on the one hand and 'protection' on the other. However, it is possible to quantify the 'risk rating' of any action that might result from a specific Learner choice. Below is an example (first page of a two page Microsoft Word document) of a Risk Assessment Chart. Each item listed is given a value from 1 through 10, where 1 is 'risk is unlikely to occur' and 10 is 'risk is extremely likely to occur'. Staff use a marker to shade all the columns in a particular row to indicate the risk to give an immediate visual indication.

Even though the risk may be high, if adequate precautions are taken to minimize the danger (these should be included in any documentation) then the risk may be acceptable. The staff team evaluate the overall risk and decide if it is manageable The questions become:

Can the risk be managed?
Can the Learner be taught to manage the risk her/himself?

The complete, two-page, chart (Microsoft Word Document) may be downloaded for inspection and use by clicking on the image above.

Please note the chart is not designed to be comprehensive for all situations and therefore should be amended as necessary before use in your particular place of work.
Please note local regulations may require more extensive accompanying documentation to cover risk.

Some choices will involve risks that are not contained in the above chart. The choices may not have immediate risk but, rather, long term consequences of which the Learner is unaware or cannot comprehend For example, in choosing a new placement, a Learner might select an option which has long term consequences Significant Others might believe not to be in the Learner's best interests (social isolation, poor quality of care, bad area, ... ). If the Learner can be made aware of such consequences and is in a position to comprehend and weigh them against other factors then the choice should remain the Learner's (Supported Choice rather than Substituted Choice).

Caught between a Rock and a Hard Place

"Adam is a 26-year-old man who, because of his mobility challenges, cannot get into his local video shop, because it has many steps. He asked his case coordinator for someone to go there for him and rent adult (sex) videos once a week so he could watch them. Since it is common practice in his city, and perfectly legal, for other adults his age to rent such videos, he considered this to be a perfectly reasonable request. Adam's worker said she could not do it because of a policy in her organisation. This practitioner was pulled between the wishes of her client and the mandate of the organisation, and she readily decided in favour of the organisation."
(Brown and Brown 2003 page 220)

In some cases, choices made by an individual do not really pose a risk to the Learner (as in the instances in the above section of this webpage) but, rather, to the Significant Other(s) involved! Such Learner choices pose an ethical dilemma for Significant Others who find themselves torn between two aspects that are seemingly contradictory; they are caught between a rock and a hard place. On the one hand they want to provide support for the Learner and respect his or her wishes, on the other there are certain forces in play that would put the Significant Other at risk (maybe of losing his/her job) if they were to do as requested.

In such circumstances, and when the Significant Other decides against the choice made by the Learner (for whatever reason), it is important that the Significant Other:

informs the Learner in a way that s/he can comprehend that the decision not to act on the choice made has nothing to do with the approval or disapproval of the request.
explains the dilemma;
details why s/he decided as s/he did;
provides suggestions for an alternate source of support for the Learner (if possible); someone from outside the present establishment perhaps who will not be put in such a quandary.
checks at a later time that the Learner has found support.

In such instances, a problem shared is a problem halved unless the request was strictly a personal one and by doing so the Significant Other would be betraying a confidence. Thus, the Significant Other should take the issue to a (management team) for a ruling on the matter. Ethical issues are typically best resolved by multiple brains working together rather than a single individual acting alone.

Simply the BEST: Best Ever Stimulating Thing

Click to Enlarge

B.E.S.T = Best Ever Stimulating Thing

What motivates the Learner? Something will. For some there will be a list of BESTs; for others, a BEST may be really difficult to discover but there will be one. I find it very difficult to comprehend staff in special education settings who state that, "John isn't motivated by anything." Actually, John is motivated by something but he's not giving away that secret formula to just anyone at anytime. The staff will have to work hard to discover it. In such circumstances, staff should always say, "John's a bit of a puzzle. We haven't yet found one thing that appears to motivate him but we are still trying."

Of course, not every choice has to involve a BEST although, by definition, a selection made from a choice array will be the best of the items:

from the Learner's perspective;
at that moment in time;

unless the process was flawed in some way or the choice was made according to some attribute of the an item and not by the item itself. Choosing by which door you will enter a shop does not mean that the Learner thinks the selected entrance is the BEST: It does not follow that the Learner will select that particular entrance on the following visit, for example. Probably, the Learner made a choice from an array based on what attracted her/him at that moment. It may be the selected doorway was clear of other shoppers and, thus, the choice was based on the ease of entry. It may be that the Learner chose the doorway nearest to the sweet counter; we may never know.

Initially, an array of items involving a known Learner's BEST positioned against one or two WORST (Wretched Or Rejected Selected Things)(that is, things that are known the Learner does not like or typically rejects) may help to teach and assess the area of choice. Does the Learner select the BEST consistently no matter where in the array it is placed? If the Learner selects a WORSE then the efficacy of the methodology must be questioned:

Why did this occur?
Was it simply a mistake?
Is the Learner simply selecting the item in a particular location (positional preference)?
Is the Learner selecting on some other attribute such as colour or shape?
Are the choices too abstract for the Learner to comprehend (symbols rather than objects, for example)?
Was the Learner attracted to some aspect of the choice made?
Was the Learner distracted in some way during the selection?
Was the Learner having an off day for some reason? Is there evidence for this from other sessions?
Does the Learner understand the methodology?
Is the means by which the Learner indicates a choice faulty in some way such that it is likely to give faulty selects every now and again (for example, a scanning system set a little too fast)?
Is what we believe to be a WORST actually a BEST?
Other?

Is there any way that we can improve the efficacy by tweaking an aspect of the methodology employed to give a consistent result?

OOR: Objects Of Reference

While good practice for the introduction of choices for novice Learners should begin using real items in the array, there will be some B.E.S.T. for which the presentation of the 'real' thing might be problematic (for example, going to the park). Thus, staff might elect to use an item which represents the Person, Object, Location or Event (POLE) which would be somewhat difficult to put into a choice array otherwise. For example, going to the park might be represented by:

a symbol;
a sign;
a photograph;
an object.

What object could we use for going to the park? That depends on why the Learner likes going there: is it the flowers (we could use a plastic flower), feeding the ducks (we could use a rubber duck), the playground (we could use a toy swing or roundabout), or something else? For an object to represent a POLE, it has to become associated with it in the mind of the Learner. Placing a representative object in a choice array does not mean that the Learner will comprehend its meaning. Simply because it's obvious to staff that the riding cap stands for horse riding (for example) does not mean that it is obvious to the Learner. Do not assume, teach the connection, This aspect is covered in great depth on the Objects Of Reference page of this website and, thus, will not be addressed further here. Click on the image (above left) to go to the OOR page.

Boxing Clever

Boxing Clever refers to the practice of using ordinary cardboard boxes for a variety of selection and categorisational assessment and developmental procedures.

Cardboard boxes can be used to assess a Learner's ability to make a choice. You will need three or four (preferably identical) small cardboard boxes which should be turned on their side such that the open sections are facing the Learner. Into each of the boxes an item is placed by someone other than the person who is assessing the Learner's ability. The Assessor should not be able to see or hear the items being positioned. The Assessor stands on the blind side of the boxes such that s/he cannot see and does not know what is in each. The Learner sits on the open side of the boxes and can clearly see what is in each box. The assessor might ask a question of the Learner such as, "What did you have to drink at break today?" The Learner (if s/he is able) can then indicate which box contains the response to the question. If the Learner is not able to indicate a response directly, the assessor can perform an Other Controlled Scan, pointing to each box in turn and asking, "Is this what you had to drink at break today?"

That's a crazy idea: the Learner might assume that the Assessor is asking him to choose what he wants to drink and not what he had to drink.
That is indeed a possibility. However, as we cannot prove that a person does not know or is not understanding but it is possible prove that they do know and do understand then, the Learner's responses may be informative. If the Learner is able to tell the assessor what s/he had to drink at the previous break correctly on more than one occasion without mistake then what can we assume? Pure chance? Maybe but unlikely: it is more likely that the Learner understands the process and has correctly identified a previous choice. Of course the Learner may fail to select the correct item. What do we now know? Not very much! It may be that the Learner has:

failed to understand the question;
failed to understand the methodology;
failed to match his/her response timings to the scan of the assessor such that the wrong box was selected
failed to remember what drink s/he had at break;
decided not to co-operate or to have some fun with the Assessor.

We cannot know, we can only assume. An incorrect response or set of responses can only suggest possible rationales, however a set of correct responses tells us that the Learner is coping and is ready to make further progress. A set of incorrect responses should make us wary of moving on: we should take a step backwards and undertake further work with the Learner and the process until s/he can show us that s/he is able to cope.

We could of course provide the Learner with a drink and then ask a member of staff to enter and ask the Learner 'What are you drinking?'. Again, the Learner would indicate a particular box which this member of staff could not see inside. After a choice has been made, the staff member can check the response against the choice. As before, a failure to get this correct does not mean that the Learner is incapable of doing so. It really tells us very little other than the Learner failed to respond correctly (although continued failure is suggestive of a lack of understanding or some other such problem). However, repeated success is indicative of understanding.

I don't think that my Learner could ever do that.
That is something of a self-fulfilling prophecy! If you do not try, how do you know? Remember, this is not the starting point; you only assess after a period of teaching and learning. As such, you are assessing the quality of your teaching as much as the current ability and understanding of the Learner.

My student will always think you are asking him what she wants (future) rather than what she had (past).
OK then put something into the boxes that is not about the past and ask another question such as 'which one is the ball?' (or simply a command such as 'show me the ball'). You might argue that your Learner might still be responding by responding to the question as though the assessor had asked 'which one do you want?' Again, if the Learner does not perform in the manner we expect it tells us nothing other than the Learner did not respond in the manner we expected! However, if the Learner can do it - brilliant!! Perhaps we can attach a reward to a correct response; something that the Learner really likes. Another member of staff could model the correct (required) behaviour (selecting the ball from the boxes for example) and be rewarded with a small piece of chocolate (if chocolate is what is really motivational to the Learner) directly in front of the Learner. It would be then hoped that the Learner would imitate the modeller's behaviour and select the ball to obtain a reward. The idea is not to trick or make it hard for the Learner but rather to ensure that the Learner is performing the task without cues (unintentional or intentional) from the assessing staff member. We can start with just two boxes and really distinct items and, as the Learner achieves consistent success, step up the level of difficulty slightly.

My student can do this when there are no boxes but cannot do it consistently when the boxes are involved. I think the boxes ar distracting him.
I am not sure that you can make that assumption. Why would the presence of the boxes make any real difference? Isn't it more likely that you are providing cues to the 'correct' choice when you can see the options on which the Learner is relying and therefore consistently getting the right answer?

Free Operant Preference Assessment

A 'free operant preference assessment' is a short period of assessment of approximately five minutes in which a Learner is provided with free access to a variety of items believed to be stimulating (See, for example, Roane et al.; 1998). Several such items are placed within the Learner's reach and the Learner is free to explore or work/play with any s/he chooses. Staff record the amount of time the Learner engages with each item. The more time a Learner spends with any single item is seen as indicative of Learner preference. The set of items provided can, thus, be ranked in order. Free operant assessments therefore provides a simple and speedy means of evaluating Learner preference without:

removal or withholding of preferred items;
the presentation of speciﬁc selection opportunities that might be perceived as demands;
increasing the likelihood of problem behaviour (Roane et al.,1998);
increasing the likelihood of influence from Significant Others on Learner choice.

There are at least a couple of issues with using FOPA with Individuals Experiencing Learning Difficulties:

Physical ability may be impaired to such an extent that the Learner cannot interact with the items even if s/he wanted;
An impairment of visual acuity might mean that a Learner is unaware of all items placed close by;
It may not work with some areas of choice (such as drinks for example which could get spilled);
Who chooses the choices?
the Learner may be selecting on an attribute of an item (the colour, or it glinting in the sunlight through the window, or its position, ...) and not showing a preference for the whole item.

While the second item in the list above may be overcome using specific strategies (For example: encouraging the Learner to feel each item in turn before recording begins), the first is more problematic. While the use of switches might allow a Learner to interact with a range of objects it may be that the Learner is not yet switch aware or hasn't yet developed the necessary cause and effect skills. Indeed, preferred objects can be used to teach switch awareness and switch skills and, if we need switches to identify preferred objects, we are caught in a 'Catch -22' situation! Recording the duration of eye gaze may also address this issue in part but eye gaze may indicate a preference for a colour or a shape rather than an a specific object (list item 5). However, steps could be taken to eliminate these possibilities. The third issue might be overcome by the use of drink containers that prevent spillage but this would reduce the sensory aspect of the process considerably and could easily invalidate any resulting data. In terms of item four, Significant Others decide which items to put out based on their knowledge of the Learner. That could easily exclude something that is of even greater desirability to the Learner simply because the Significant Other(s) concerned have not considered it. However, someone has to make the 'item set' decision and Significant Others are the logical choice. A Learner's selection on an attribute must be a consideration. However, if staff are vigilant and aware of this issue, it can be assessed by repeating the FOPA removing the item but including something else of the same colour or shape to see if there is any pattern of choice emerging.

Thus, the FOPA technique may be somewhat problematic for some Learners and for some items. The ten minute video below from YouTube shows an example of FOPA in practice. Undoubtedly, you will see problems in generalising this to every individual within special education. Some of these problems have been outlined above and may be addressed (at least in part) by the routes as detailed. However, we need to embrace the philosophy of this approach if not the practice: that is, we must ensure that Learner preferences are assessed as accurately as possible and used in BEST practice. It should also be remembered that today's preference may be tomorrow's dislike: today the Learner may prefer a cheese and onion sandwich but tomorrow s/he prefers tomato and lettuce.

Standard Practice

In special education settings across the world from the USA through the UK to China, Talksense has witnessed the provision of choice to young and not so young people. While Talksense applauds such provision, the methodologies employed are sometimes questionable. I will start this section with a description of some of the methodologies witnessed. Ask yourself, if any or all of them are approaches used by you or others within your place of work, whether there are issues with such practice?

Johnny is experiencing PMLD. His teacher holds up two glasses of juice in front of him and says, "Hey Johnny. It's time for a drink. Which one would you like? Do you want the apple juice (moves the apple juice in his left hand slightly forward and then back again) or do you want the orange juice (moves the glass of orange juice slightly forward and then back again)? Johnny looks at the teacher while s/he is talking. After a while, Johnny's eyes move toward the orange juice. Johnny's teacher is delighted and says, "Ok Johnny. Well done! You want the orange juice. It's coming right up" ...

Jane is experiencing Severe Learning Difficulties. Jane's teacher is attempting to get her to choose between three options, one of which is the answer to a question that she has just set on transport. There are three model vehicles on the desk between the teacher and Jane: a minibus, a car, and a taxi. The teacher points to each in turn. She wants Jane to tell her how she comes to school each morning. The teacher knows that Jane comes by minibus. As she points and scans along the array one by one, the teacher says, "Did you come in a car?" ... "Did you come in a taxi?" ... did you come in a minibus?" ... On pointing to the minibus Jane appears to smile at the teacher. The teacher responds, "You came in a minibus? Yes, that's right. Well done Jane."

James has Cerebral Palsy. He has a set of choice communication boards. On one, are four colour coded choices of fast food meals: Subway, McDonalds, Pizza Hut, and Fish and Chips. This is taken from his bag and placed on the table in front of him by his Learning Support Assistant. She asks, "What shall we have for dinner today James"? James raises his right arm shakily with some difficulty. He brings his fist down and it rests on the 'fish and chips' option. James' LSA says, "Oh my gosh James, you certainly like your fish and chips don't you? You nearly always choose that one." James smiles at her. They head off in the direction of the fish and chip shop.

Jackie has a four location communication aid. It is operated by a single switch via a brightly coloured scan. Jackie's mother loads a new overlay depicting a choice of four leisure items: book, game, TV, and walk. The device begins to scan. Jackie's mother asks her what she would like to do. Mum looks at Jackie, then her switch and then her communication aid. After a while, Jackie moves her hand and activates the switch. The scan stops on TV and the device says very clearly, "I want to watch TV". Mum repeats what the device has said, "You want to watch TV"? and then positions Jackie in front of the TV set and turns it on. "Oh look, you're just in time for the X-Factor. You like that, don't you? I'll go and make you a drink."

The above vignettes outline four fairly typical choice making practices that can be seen almost everyday in special education settings (and beyond) around the world. A choice has been provided. Isn't that good? Yes, of course, the provision of choice is good but there are some concerns and issues with each methodology which require consideration! Each scenario is dealt with in the following sections.

Eye Pointing

In the image (left) the young girl is being given a choice between two drinks (apple and orange juice) using symbols on an Etran Frame. The girl's eye move towards the orange juice choice and rest there for a short period of time. The staff member says, "Oh you want orange Nicola? Well done, I will get you some". The staff member goes and gets an orange juice for Nicola from a nearby drinks trolley. She assists Nicola with her drinking and Nicola finishes all the orange juice from her special cup.

What can we now claim?

Nicola has made a choice?
Nicola knows what orange juice is?
NIcola likes orange juice more than apple juice?
Nicola can work with symbols?
Nicola understands how an Etran frame functions?
All the above? Some of the above? None of the above?

I would want to argue that 'none of the above' can be claimed for certain. It is correct that any of them could be true but we cannot be certain of that simply by observing Nicola's behaviour. It is not even certain that NIcola can see the symbols! Simply because her eyes move in the direction of a particular symbol and appear to rest there does not tell us that she has consciously made a choice. The eyes of a person with a severe visual impairment will move and rest in different spots especially towards light sources or reflected light. Perhaps the sun is shining through the window and reflecting off the shiny surface of the laminated symbol card and it is this that is drawing Nicola's attention (As it is morning the sun is shining in one particular direction and illuminates one symbol more than the other but, in the afternoon, the sun shines in a different direction and Nicola selects a different option. Staff might assume that Nicola is selecting a different drink because she wants a change). Perhaps Nicola is bored and likes the colour orange so she is looking at it momentarily. Perhaps Nicola is looking through the plastic frame at something beyond. We just don't know. We certainly cannot claim (from this one observation alone) that Nicola has made a conscious choice!

In the example given earlier, Johnny is given a similar choice with real drinks. They are held up in front of him and he is tasked to indicate a preference. Although Johnny appears to look at one and is given the drink, we cannot claim he has made a choice or is able to make choices, no more than we can make such a claim for Nicola. There is simply not enough evidence and our practice should be guided by evidence. So, what can we claim for certain? The only thing we can be certain of is that Johnny's eyes moved in the direction of and rested on the orange juice for a brief period of time. Anything beyond this claim is mere supposition on our part. We should not tick off an objective box which reads, 'Johnny is able to make a choice' at this point because we do not know that. Of course, Johnny may be able to make a choice but the evidence, thus far, does not enable us to reach that conclusion.

So is the above methodology poor practice? No, it isn't! It's actually ok practice (not best practice) but not for the reasons that are often cited! What we are doing with such a methodology is teaching Johnny that 'what he indicates (looks at in this instance) is what he is going to get': in other words, we are teaching him the technique involved in being able to make a choice. We cannot yet be sure he has grasped the concept but, the more we provide such 'choices' using this methodology, the more chance Johnny has to grasp the concepts involved.

There are, at least, six fundamental issues (abcde) with this type of 'indication' approach:

Assumptions of Learner Understanding: As we have seen, we cannot claim that Johnny has made a choice.
Both choices are correct: Johnny gets a drink he likes no matter where he looks. The technique does not teach him to look at a specific item. While error free choices are not an incorrect technique, there are alternative approaches. See the section on error free choice.
Cueing is a real possibility. While cueing is unlikely in a drinks choice, Johnny will not always be selecting a beverage but may be answering a question using multiple choice. Cueing is covered in a separate section on this page.
Direction of choice may be governed not by choice but, rather, by the physical abilities of the Learner (Positional Responding). For example, the Learner may be right handed and always make selections from the left and thus always indicate the left-most option.
Exclusion of 'other option': the Learner has no way of requesting other than the choices selected by the staff member. The Learner has no real way of saying 'I don't want a drink at this moment'.
Facet Focus: the Learner is selecting on some other attribute of an item at that particular moment and is not selecting the item itself.

Error Free Choices

"Everybody makes mistakes. That's why they put erasers on pencils."
Homer Simpson

"However, choice making – an important skill for all developing youngsters is even
more important for those with PMLD. Error free choices may support the
development of understanding. It is only by being offered choices on a very regular
basis that the usefulness of being able to make choices will become apparent.
Choices can vary between real object, picture or symbol depending on pupil’s
need. If objects are used consideration for accompanying the object with a picture
and/or symbol is needed in order for the pupil to get the connection and be prepared
for moving on."
SCOPE: Supporting Communication through AAC, Module 9 (bold text mine)

In the above quote from the excellent Scope publication reference is made to 'error free choices' which 'may' support the development of understanding in the individual Learner. However, the publication does not cite evidence in support of this claim.

In the 1930s, the psychologist B.F. Skinner, investigating what would make the most effective learning environment, introduced the concept of errorless learning. Skinner said:

"errors are not necessary for learning to occur. Errors are not a function of learning or vice-versa nor are they blamed on the learner. Errors are a function of poor analysis of behavior, a poorly designed shaping program, moving too fast from step to step in the program, and the lack of the prerequisite behavior necessary for success in the program."

In 1963 Herbert Terrace published a paper on errorless learning entitled Discrimination learning with and without “errors”. In it, he details how he trained pigeons to peck at a particular stimulus (peck a red key and ignore a green one) with the minimum of errors. As such, this wasn't 'errorless' rather it was a methodology (following Skinner) that produced very few errors during learning. There were also some features of Terrace's approach that would either not be ethical or practical or possible with our Learners. For example, the pigeons:

were food deprived. They were kept at 80% of their normal body weight for a period starting two weeks prior to the beginning of the experiment and continuing throughout the experiment. As the reward for 'correct' behaviour was food, they were highly motivated to make 'correct' choices. (we can, however, select highly motivating BEST items with which to work)
were isolated during the experiments within a Skinner box. (We can attempt to create a distraction free e
had not been taught anything before.
were taught only one thing. They were not taken to other 'sessions' and distracted with other things.
were played white noise during the experiment to block external sounds.
were given stimuli that could be controlled with great precision (consistency and accuracy).
were not required to perform the skill under other conditions and thus the learning may not have been generalised and transferred.

Also, Marsh and Johnson (1968) showed that, using Terrace’s method, pigeons taught to peck a red key and ignore a green one could not, even after five days, be induced to learn a new behavior of pecking the green key instead of the red.

"Observations that errors are not necessary for learning lead directly to the conclusion that errors result not from the learning process but from the teaching process; learning curves measure not learners, but teachers."
Murray Sidman 2010 (page 170)

Why would Sidman say this? He postulates that errorless learning is possible and that errors are the result of poor teaching methodologies and a lack of adequate preparation of the Learner. Gradual learning curves imply mistakes by the Learners and, as they learn to avoid errors and come to understand the task, the curve peaks into an almost smooth line with the minimum of errors. However, Sidman turns this notion around and states that the mistakes by the Learner are, in fact, errors caused by the teacher. If proper planning, preparation and procedure are in place then errors would be reduced to almost nothing and Learning could no longer be plotted as a curve.

"The simple fact that it is possible deliberately to make learning occur without errors on the part of the learner should make it obvious that we cannot conceptualize learning basically as a gradual process."
Murray Sidman 2010 (page 170)

Sidman goes on to show that B.F. Skinner's studies did not show irregular or gradual learning curves because Skinner's subjects (typically rats and pigeons) were not simply placed into the learning situation but, rather, adequately prepared for the task:

"Skinner’s original pupils did not show either irregular or gradual learning curves because he did not simply leave them to learn by themselves; he first taught them all they had to know."
Murray Sidman 2010 (page 171)

Sidman goes on to detail the prerequisites for errorless learning which Talksense has adapted as follows:

Environmental Engineering
Best Ever Stimulating Thing(s)
Item Awareness
Spatial Awareness
Temporal Awareness
Introduction of Learning (For example establishment of Cause and Effect)

Environmental Engineering

Environmental Engineering does not always mean knocking down walls and the building of new ones in different positions. Although this would be included under its umbrella it would be a rare event. Environmental Engineering concerns managing the environment in advance of any tuition to maximise the opportunity for learning to occur. Thus, such engineering would include the removal of unnecessary distractions such as outside noise or other superfluous sensory snags with which the Learner might become entangled and thus diverted from the primary goal of the session. B.F. Skinner was able to build his famous Operant Conditioning Chamber (more commonly known as a Skinner Box) with which to conduct his experiments with learning. In these he could isolate all unwanted distractions and ensure that the environment was optimal. However, staff in any special education setting do not quite have that luxury or level of control. Classrooms are likely to be noisy places and have other sensory distractions occurring during any tuition. Of course, a staff member could book the use of a more controllable area such as the multi-sensory room but this commodity may already be timetabled and being used by another.

Hi Sally, we have to engineer the environment to help you to learn and so your bedroom just has to go!

While we may not be able to engineer the environment to exclude all distractions, it does not follow that we should not do our best to ensure optimal learning conditions whenever and wherever possible. There are things that we can do to engineer the learning environment to provide the best chances of learning and understanding for our students.

BEST (Best Ever Stimulating Thing) - Revisited

In order to ensure that Learning took place both Skinner and Terrace used optimal reinforcing conditions. The positive reinforcers they typically used for the animals in their experiments were pellets of food. If the animals were well fed prior to the tests then their desire to obtain the pellet food rewards would be diminished and, as such, they would not be as motivated to engage with the apparatus of the experiment. Thus, the animals were kept healthy but hungry. The issue of the rights of our animal friends aside, we could not ethically (or, indeed, by any other standard) deny food or drink to our Learners to increase their motivation. All Learners are naturally motivated by at least one thing or another. Admittedly, sometimes in a few Learners, it is hard to find that one BEST (Best Ever Stimulating Thing) but we should nevertheless keep on searching and trying different options.

One aspect of the development of greater Learner independence is the exchange of control from the (Significant) Other into the 'hands' of individual Learners. In order to achieve this goal, we can

teach a Learner how to request the provision of a BEST from a choice of options. While it may be true that a particular Learner will always be dependent on others for help throughout her/his life, s/he can be in a position of control of others such that s/he decides what happens and when and such choices are not made on the Learners behalf.

Skinner not only had to keep his test animals hungry, he also had to teach them that the pellets he was going to provide were food. Thus, he would mix the pellets into their food in small amounts prior to the experiment and then gradually increased the proportion of pellets to other food until the food was entirely in pellet form and the animals were used to it and did not have to learn this during the experiment. While the Learner will already have a BEST, the form of that BEST may be variable and, therefore, the Learners will need to understand that the classroom version of BEST while differing in appearance form the BEST at home is nevertheless the same thing in a different package. For example (and keeping to the food topic although I would shy of using food as a motivator in the classroom), the Learner may really love chocolate and, at home, be used to this in form of a chocolate bar while at school it is provided in the form of portions of chocolate buttons. Whatever motivator we are going to be using with any Learner or groups of Learners, we need to ensure that they recognise it as a motivator prior to its use in teaching in the classroom. Thus, we might provide it for the learner without the need for a request or a choice for a period prior to the introduction of a choice activity or the teaching of a request.

Item Awareness

Let's assume we are providing a choice between tea and coffee at morning break for a Learner experiencing PMLD. How can the Learner make an informed choice if s/he has little if any awareness of what tea or coffee is? Perhaps all warm drinks are perceived in the same way and there is no discrimination. In which case, the choice is meaningless. Also, as both drinks can be held in a cup, how is the Learner to know which cup holds which drink in order to be able to make a choice? In the image right, one cup contains tea and the other coffee but as both cups are the same shape, size and colour how do we know which is which? Even if the cups were different in shape, size and colour would we in any better position to know which is the coffee? Thus there are two issues here:

Is the Learner aware of 'tea' and 'coffee'?
Can the Learner tell which is which in the presented choice?

A choice without any assessment of awareness maybe meaningless and may also lead to staff progressing onto items involving higher

levels of cognition based on assumption of Learner understanding because the Learner is seen to have made a choice.

"Students with learning difficulties should have the opportunity to experience taster days or sessions to make informed learning choices based on concrete experiences." (Sutcliffe 1990 page 45)

If switches or BIGmacks (or their alternatives) are used for choice making purposes, there is also the real danger of promoting fly-swatting (see the page on fundamentals on this website for an explanation of the concept of fly-swatting).

Presentation without a means of discrimination is also equally invalid as the Learner may be selecting an item believing it to be another.

How is it possible to assess Learner cognisance of a particular item if choosing it is not indicative of awareness? In other words, if choosing an item is not indicative of awareness then what is? If:

the Learner could speak and we gave him or her a sip of a hot drink, and;
the Learner said, "That is coffee" or "That is tea", and;
the Learner was able to do this correctly on more than one occasion without error, then

we might conclude that this particular Learner was cognisant of this particular hot drink. However, Learners Experiencing PMLD are not able to speak. Perhaps, in place of speaking, if:

the Learner could indicate a choice of symbol from two (or more), and;
the Learner could match it to a previous sip of a hot drink, and;
the Learner was consistently correct on more than one occasion without error, then

we might conclude that this particular Learner was cognisant of the choices of hot drinks presented. However, Learners Experiencing PMLD may not yet be symbol aware. Perhaps, in place of symbols, if:

the Learner could select between two BIGmacks with different sensory surfaces (one for tea and one for coffee), and;
the Learner could match the selection to the taste (or smell) of a proffered hot drink, and;
the Learner was consistently correct on more than one occasion without error, then

we might conclude that this particular Learner was cognisant of the choices of hot drinks presented. Alternately, if:

the Learner has different drinks at every break, and
the Learner was able to tell a member of staff (who did not know what drink s/he had) what s/he had after the event;

(using one of the above methodologies)

the Learner was consistently correct on more than one occasion without error, then

we might conclude that this particular Learner was cognisant of the choices of hot drinks consumed during breaks. Anecdotal evidence of Learner cognisance from staff is simply not enough. Staff might insist that 'Johnnie' knows what 'coffee' is and believe what they are saying but still be incorrect.

Spatial Awareness

As the animals in Skinner's experiments would not know where to go look for the pellet foods and this piece of learning was not a part of the set up he ensured that they knew in advance were food would be found when it was available. In order to do this, prior to the start of the experiment, he occasionally posted a food pellet into the tray in the experimental environment such that the animal learned where to find it. Thus, once the animal had performed a required action during the experiment it would know exactly where to go to obtain the reward.

In some aspects of choice making in the classroom, a Learner can decide between two or more items that are not presented but rather occupy specific positions within the room. If each item is always kept in its own unique location, a Learner can come understand where it 'lives' and can either, go and get it him/herself or eye point to the location to instruct another to get it on his or her behalf. This is an important technique in the use of Objects Of Reference for example. If a Learner is ever going to be able to use an object expressively then s/he must know where to go to get the object.

When providing a choice directly in front of a Learner (typically it will between two objects each held in the right and left hands of the staff member providing the choice: "Do you want tea or coffee?") the requirement for preparation of spatial awareness is eliminated.

Temporal Awareness

Not only did the animal need to learn where to go to get its reward, it also needed to know when to go. Skinner wanted the reward to be contingent on the successful performance of some task. He thus prepared the animal to understand that its reward would be in a specific place at a specific time immediately after a sound was played. After a short period, whenever the food dispenser made the sound, the animal immediately came to retrieve its food.

I have often defined Individuals Experiencing PMLD as trapped in the 'here and now' with little if any awareness of the aspects of time. As such, any delay in obtaining a choice might be problematic initially and should be avoided. As such, if a Learner makes a choice, s/he should receive the selected item immediately to make the choice meaningful.

Errorless learning is not therefore error free Learning. It is a method that attempts to minimise the possibility of errors (made by the Learner) by adequately preparing the Learner for the task. Error free choice making is not the same as errorless learning. While errorless learning does allow for there to be some mistakes, error free choosing does not, the Learner cannot make an incorrect choice: the only 'error' that may occur is the Learner failing to perform the choosing task (for whatever reason) and doing something else or nothing at all. Typically staff do not 'prepare' the Learner for the choice making activity, they proffer the choices and then react to a Learner behaviour.

While error free choices may be claimed to teach an individual how to make a choice (what the individual reaches for, touches or looks at is what s/he gets) the fact that anything indicated is an OK choice (there cannot be a wrong choice) maybe itself problematic. When two things are placed in front of your face you will naturally look at one of them; it is difficult not to! If both items are things that you like, it really does not matter to which your gaze is directed or why. If you have learning difficulties does such a technique really help you to figure out that you can make a choice? You might not make the connection between the thing on which your eyes focussed (or did not focus!) seconds (or minutes) before and the thing you are now being given. In the drink scenario, of course you will drink the drink (if you are thirsty) because both items were drinks that you like.

Suppose instead of providing this type of error free choice we gave another? What if we made one of the choices not wrong but rather null? A Learner selecting this choice would be indicating a lack of understanding of the process or a lack of knowledge of the non-null option. What is a null option? See the section on null options on this page.

Cueing

Individuals Experiencing Learning Difficulties (IELD) have a Ph.D. in reading contextual cues. They can learn to give staff the answer that they want without knowing anything about it at all! As David Frost used to say on the TV programme 'Through The Keyhole' ... Instructing viewers to watch carefully because 'the clues are there.' Likewise, many IELD are on the look out for 'clues' from the environment as to what is going on in the world around them. Often, such clues/cues are unintentionally provided by the staff asking the question! It's not that such cues only give answer to the question 'who done it?' but also what, where, which, why, and how.

How can staff unwittingly provide the answer to the question they happen to be asking? It's easier than you might imagine it to be. Indeed, often it is hard to prevent yourself from giving away such cues especially if you really want the Learner to succeed.

For example, look at the excerpt from the video of 'Annie's coming out' (1984), the non-fiction book Annie's Coming Out by Rosemary Crossley and Anne McDonald (Note: in some countries the film was called 'A test of love'), shown below and then answer the questions that follow:

After watching this short excerpt, see if you can answer the following questions:

- Does Annie demonstrate that she understands what her teacher wants?
- Does Annie demonstrate that she knows what the word 'ball' means?
- Can Annie make a choice between two items to indicate an answer to a question?

As Annie is seemingly able to perform the task asked of her we might assume that Annie knows what the 'ball' means and some might even go as far as to say that Annie has the concept of 'ball'. However, we need to to proceed with caution as assumptions of understanding can be counter productive. How else could Annie be selecting the 'correct' answer?

- the ball is always placed on her right side and so, her active arm moves to the ball first;
- the colour of the ball might be attracting her;
- the shape of the ball might be attracting her;

Suppose we could eliminate these objections, would we then be able to state that Annie knows what a 'ball' is? In thirty trials with different coloured balls place on her right and her left side and even when we use a rugby (American football) shaped ball, Annie still reaches out and touches the 'ball' on request. Can we now say that Annie knows the word 'ball' and can match it to an object? The answer to that question is still 'NO'!! That response might surprise you. However, take a look at the video again and watch the teacher in the clip. When she asks the question, what else does she also do?

Annie's teacher gives a cue to the 'answer' to her question: she looks directly at the ball more than once but never looks at the cup. Annie can clearly see her eyes and could be noticing where she is looking. We are naturally programmed to take notice of other people's faces and especially to notice where they are looking; indeed it is on of the techniques used my magicians for misdirection. Annie could be simply following the gaze of her teacher and selecting the object that her teacher has already selected! Of course, Annie might be a genius and she might have known what a ball is from a very early age. It's not that I am saying that Annie does not know but rather that this little experiment does not prove that she knows; we can not know that she knows by reference to her actions here.

In the earlier vignettes, Jane was tasked to indicate her mode of transport to school via selecting between three model vehicles placed on the desk in front of her. The teacher, who is standing on the other side of the desk (such that Jane can see both her and the three models) scans through the objects one by one. As she scans, she points in turn and asks, "Did you come in a ...". When the teacher gets to the minibus, Jane appears to smile which is seemingly indicative of a 'yes' response. The teacher is pleased - Jane is correct; she does indeed come to school each day in a minibus. What do we know for certain from this scenario?

- Jane knows what a minibus is?
- Jane knows how she gets to school each morning?
- Jane understands the question?
- Jane can retain the question in her memory long enough to be able to pick the correct answer?
- Jane understands the question and the answering technique?
- All of the above?
- Some of the above?
- None of the above?

I would want to argue that we know 'none of the above'. As Jane comes to school every morning in a minibus, she is likely to be more familiar with it than the other options and therefore she might just be selecting the one that she likes when the teacher points to it without any knowledge of the question itself. It also may be the case that the teacher is pausing for longer over the 'correct' response unwittingly. I have witnessed teachers tapping the correct response while just pointing to the other choices. Afterwards they state that they had no knowledge that they were doing it! Also, the tone of the teacher's voice can change when the correct response is reached or the teacher may smile at the Learner at this point. As we have seen, the teacher may have looked at the correct response more than the incorrect selections.

While it could be argued that the Learner's ability to pick up on contextual cues is a sign of intelligence (indeed, I would not want to disagree with that) it still is not demonstrating that which the staff are claiming to be true: the Learner is aware of a specific concept. The Learner may not be aware of the concept at all but still be providing a 'correct' response.

Assumptions of Understanding are counter-productive

'Assume makes an ASS out of U and ME' (attributed to Oscar Wilde)

It is easy to assume that there is a white triangle on top of three circles in the image left. In fact there is NO white triangle - it's an illusion; your brain tends to fill in the gaps and make you believe that you see a complete triangle when there is nothing there. Sometimes, it's the same in special education: we assume that something is there and we fill in the gaps and join the dots with only scant (if any) evidence). In doing so, we help no-one: not ourselves, not Significant Others and certainly not any Learner.

Throughout thirty plus years of teaching in special education, I have often asked staff how they know some fact they are claiming about the cognizance of a particular Learner to be true. More often than not they were assuming cognizance based on an interpretation of a particular situation that really did not support such a claim. As we move towards evidence based practice we should equally move towards evidence based assertions of Learner comprehension. However, this is often not the case. It is not just staff that make such claims of course, all Significant Others are capable of believing unsubstantiated claims of Learner understanding.

"He understands everything I say"
"She smiles at my jokes - I know she is intelligent"
"He understands French and German" (A claim made by a parent of teenager experiencing Profound & Multiple
Learning Difficulties)
"She can answer 'yes' to my questions"
"He can eye point to a correct object"

I am often called to question when I dispute claims of Learner cognizance: it's not that I want to destroy peoples established beliefs rather that building on unsound foundations is not a good strategy for future progress - it helps no-one, least of all the Learner. Many claims of Learner understanding are based on events that can be explained another way. For example, smiling at jokes is not a proof of understanding, it may be that the Learner is smiling because others are smiling; smiles are infectious. Of Course, there is an equal chance that the Learner is smiling because s/he has understood the pun and finds it amusing but how are we to tell the difference? I once worked with a nineteen year old student experiencing severe physical disabilities of whom a high level of intelligence was claim by his support worker who was in the employ of the student's parents. Together they had been building on 'progress' until i questioned the student's cognitive abilities to cope with the level of work being put to him. I decided to demonstrate to the staff and the support worker what I meant. I asked the support worker to write down ten questions that the student would know immediately. Really simple things like "Is your father a plumber?". All the questions could be answered by a yes or a no response or by selecting from a choice of two answers. The support worker gave me the list of questions. I cut the paper into strips and mixed the strips up randomly such that the questions were presented in a random order. I sent the support worker out of the room so that she could not hear the question being put to the student. She was called back immediately after the question had been put to ascertain the answer. Out of ten questions set by the support worker for which I was assured that the student would have no problem in understanding, there were only two correct responses. Chance alone would have allowed for a greater number. The support worker was most defensive about the result to the staff who observed the process. She claimed that it was an off day because of illness coupled with family problems. She also claimed that the student was having a 'joke' with us and not taking the process seriously.

While such claims may be true (absence of evidence is not evidence of absence) it was difficult for me because I was the 'bad guy' making counter arguments against the beliefs of the majority of the staff about the level of understanding of a particular individual. While we can never prove an individual incapable (the opposite is not true) we can prove the individual capable. In this instance, we failed to prove the student capable but had he performed on the day and proved me to be wrong I would have been very happy about it. In such circumstances I would rather be proved incorrect.

When Significant Others are involved with the performance and assessment of understanding of Learners there is a chance there might be misguided claims of cognizance and ability. The whole continuing debate on the efficacy of 'Facilitated Communication' is mostly based on such a premise - however, there is a danger of 'throwing the baby out with the bathwater' here: while there is significant evidence to suggest that facilitators are doing all of the communicative work on the Learner's behalf, it does not follow that the technique itself is flawed. Providing that Facilitators are aware of such concerns and all strive to ensure that such things cannot happen then the technique may have value to some Learners.

I once worked with a young man who was experiencing Profound and Multiple Learning Difficulties. His parents, who were both language teachers claimed that he understood both French and German. Dad proceeded to speak in French to the Learner who smiled at the end. Dad claimed that he was smiling because he was talking in French about his grandfather of whom he was very fond. I found it very difficult to put an alternate explanation. Following that assessment, I created a cartoon which is shown right in which a parent is claiming intelligence based on silence! Of course, this is over the top but it makes a real point, we can all interpret events in a way that suits our beliefs but, when it comes to the education of people with Learning difficulties it is extremely important that assessments are based on evidence of real ability and not assumptions of ability.

Below is the error-less communication chart 'proof of understanding' scenario cartoon. In the cartoon, the cat Tiggles is using a communication board to communicate with her owner. What can we state about this situation?

As we have previously seen, errorless choices may have their place but do not provide evidence of understanding. The cat's repeated use of the board may be simply because she has come to associate it with a reward of some kind: it does not follow that Tiggles can read the symbols. Of course, the cat's recognition of the connection between the board and a reward is evidence of learning that is worthy of praise but we must be careful what we claim about the cat's understanding based on her actions.

Absence of Evidence is not Evidence of Absence

"Absence of evidence is not evidence of absence" (Carl Sagan)

What does this quote by Carl Sagan mean?

In the context of this web page, it is taken to mean that, simply because a Learner does not perform as expected, it does not follow that s/he cannot perform at all. In other words, if a Learner does not do something we ask of him/her even after we have taught him/her how to do it, it does not mean that the Learner:

- cannot do the task
- has not or does not understood the task
- is cognitively incapable of coping with the task;

It may be that the Learner:

- is not in a co-operative mood today;
- is not feeling too well;
- doesn't like the staff member involved;
- is preoccupied with other matters;
- thinks we mean something else ...

However, continuing absence of evidence tends to support evidence of absence but we can never really be certain of a Learner's inability.

While we can never be certain of a Learner's inability, the opposite is not true: if a Learner performs a task and can repeat that performance on request, we can be fairly positive about Learner ability. Why do I say 'fairly' positive and not 'really' positive? The answer to that question is that there may be an alternative explanation for the Learner's success. If we can rule out alternative explanations (such as staff assistance or Learner cheating) then we can be really positive.

Many people take this concept too far! They will assume and claim an inner intelligence for a person of which there is no evidence and continues to be no evidence. Yes, there are people trapped inside vegetative frames (see video below and also here) but it does not follow that all Learners who have been classified as experiencing Profound and Multiple Learning Difficulties are in fact Ph.D. students struggling to escape.

We saw above that absence of evidence is not evidence of absence. That is, simply because a Learner does not perform as expected or as required it cannot be inferred that the Learner is incapable of undertaking the task. It maybe that the Learner is having and off day or has misunderstood the requirements of the task and is responding to a completely different set of demands. It may be that s/he just does not want to perform or any one of many other explanations. All we can legitimately state is that 'the Learner did not perform the task as we requested' but we should not make any assumptions based on that statement. However, if the Learner does perform as required and we have ensured that we are not cueing the Learner somehow unintentionally as to a correct response then we can state a positive position: this Learner understands that ...

For example: Suppose there are five choices of drink at mealtimes. After a specific meal each day for two weeks a staff member asks a Learner 'What did you have to drink with your meal today?' To enable the Learner to respond, five BIGmacks are set out in front of the Learner each containing a symbol for all the available drinks ...

So as to avoid the Learner picking on the basis of the colour of the BIGmacks they are all red. The only difference is the symbol displayed and what each says when accessed. The staff member asking the question does NOT know what the Learner had to drink with his/her meal but is able to find out later from a log that has been kept.

Scenario 1: Each day bar one the Learner chooses a drink and, when the staff member checks, she finds that the drink selected
was NOT the drink that the Learner had with lunch. On one day only, the Learner does say what s/he had to drink.

Scenario 2: Each day the Learner picks the cola drink. This is known to be the Learner's favourite.

Scenario 3: Each day the Learner picks the exact drink that s/he had for lunch without error

In Scenario One the Learner has NOT responded correctly but we cannot assume that s/he is incapable of responding correctly. It may be that the Learner thinks the staff member is asking what s/he would like to drink and not what s/he had to drink earlier. It maybe s/he is just playing a game with the staff member and does not want to cooperate...

In Scenario Two the Learner has responded correctly but it is still not possible to assume understanding as it could be that the Learner believes we are asking what s/he would like to drink and, as it's always coke, it is impossible to discriminate between the future and past responses.

In Scenario Three however different drinks were consumed each day and, when asked, the Learner was able to state the drink which was chosen to have with the meal. Can we explain this result by any other rationale other than 'the Learner understands the concept? It cannot be pure chance because it is correct every day for two weeks. It cannot be the staff member assisting the Learner because the staff member does not know the correct response.

In other words, if a Learner fails to perform we cannot assume anything (other than the Learner failed to perform). However, if a Learner does perform we can make a positive assertion. Thus, we can be positive but not negative - it's a no to negativity but a yes to positivity!

The Null Choice

The Null choice is both a means of establishing the level of comprehension of an individual and teaching awareness of a choice making system.

When presenting (for example) a choice of two drinks, we cannot realistically provide a choice between 'orange juice' and 'something really nasty' (SRN) because, if SRN was chosen we would not want to give that to a Learner. However, not to give SRN is to negate (what we see as) a communicative act. Therefore, it is much better practice to begin with a null choice. In the null choice, instead of two drinks (both of which the Learner enjoys) being presented, one of the options is null: an empty glass. The Learner is asked to indicate which of the choices s/he would like. The staff member might say something such as, "John, would you like some juice or would you like an empty glass." If the Learner selects the Null choice (the empty glass) that is what should be provided.

Hey, we can't do that. The Learner needs a drink.
The provision of the empty glass is not the end of this approach. After presenting the empty glass, the staff member moves away
temporarily. After a short while, the staff member turns and looks at the Learner, "Wow, you were thirsty, you drank that really quickly.
Perhaps you would like another drink." The staff member then repeats the same technique providing the Learner with another
opportunity to select the juice. If the Learner again indicates that s/he wants the empty glass the process is repeated until either the
juice is selected or the Learner is in danger of running out of time and a drink must be provided. At this point a choice between two
drinks should be given. However, it should be noted that this Learner may not understand the concepts involved.

Yes, but the Learner is just joking with you - he really understands, he just thinks its funny to choose the empty glass.
That indeed may be true but we have no way of knowing it for sure, it is just an assumption on our part. While, as we have seen
earlier, we can never prove that a Learner does not understand, we can , however, prove that s/he does. In other words, if the
Learner ignores the empty glass (no matter if it displayed on the Learner's left or right) on several consecutive occasions (enough
to convince you that this is unlikely to be chance alone).

Yes, but the Learner may be actually telling you that s/he does not want a drink by selecting the empty glass.
Again, you might be correct but it is an assumption on your part; you have no way of knowing that for sure. If, however, the Learner
finally selects (or just gets) the juice and drinks it then it would suggest that s/he did want a drink and that the choice of the null option
was a mistake.

Well, perhaps he was not thirsty at the start but then changed his mind.
Once again, you may indeed be correct but it is just an assumption on your part. What we require is evidence of understanding and,
if the Learner is selecting the empty glass, it is not being provided.

Perhaps the Learner is selecting on another basis; perhaps she likes the colour of the empty glass. Therefore she is making a choice, just not the choice that we are expecting.
Sure, that also may be true although both glasses should be identical if possible. However, once again, it is an assumption and, while
we can never prove a Learner does not understand, we can certainly show that s/he does. Once the Learner is selecting the non-null
option on a consistent basis which is greater than chance alone then we can start to say, 'This Learner can make a choice'.

We use cups at our school and the Learner cannot see what is inside of them so how can he tell which one has juice?
If that is the case, I could ask, 'How could the Learner make a choice between two drinks if he cannot see what is in each cup?'

We tell the Learner what is in each cup and we use different coloured cups.
How do you know that the Learner understands what you are saying? How do you know s/he is just being attracted to a particular
colour on a particular day or at a particular time? You are making assumptions of understanding that are not warranted by the
evidence.

I can't give the Learner an empty glass because she needs a straw to drink.
Give her an empty glass containing a straw.

But she needs my help to assist her to drink, I can't help her to drink from an empty glass.
Why not? It may seem silly to you but you are helping this Learner to learn and make progress. You can allow her to sip from the straw
in the empty glass once and then say, "Wow, you drank that fast! You must be thirsty. I'll get you another drink ..."

But she would find that amusing and just carry on choosing the empty glass.
You do not know that. No not laugh during the technique. Treat it always seriously. Even if the Learner laughs. Don't assume, seek
evidence of understanding.

But, if she laughs, surely that is evidence that she is finding it amusing?
Unless she can tell you that she is laughing at the whole idea then it is an assumption on your part. However, don't join in with the
laughter. Do not reinforce it. Simply continue with the technique over several days. If, initially, the Learner is finding it amusing, the
novelty will wear off.

But what if it doesn't?
Then you cannot prove that s/he understands the concepts involved by this method and claims of understanding will be an assumption
on your part. I often have staff telling me that the Learner is not performing because 'he is having a joke with you' or ' he is having an
off day' or 'she doesn't really know you' or 'She thinks this technique is silly and is refusing to cooperate with it' or ... While all of these
claims may be true we cannot prove any of them without further evidence. However, once a Learner does get it right (and consistently
does so), we can claim that the Learner does understand.

Choice Opportunities

A simple exercise for staff that promotes thinking about the provision of choice is to introduce a Matrix for Choice Opportunities for each day of the week. Staff consider each session of the day and list possible opportunities to provide some choice for the Learner in the routine. Some ideas may require small changes in the provision: for example, if you are to offer a choice of flavour of toothpaste (or brand of toothpaste) then there will need to be at least two varieties available. An example chart is detailed below. This Microsoft Word document may be downloaded by clicking on it.

Weighing Choices

The ability to 'weigh' the salience of different options in a choice array may be problematic for some Learners. If the choice is compounded by the addition of extra 'dimensions':

Do you want:

£5 now and £5 tomorrow and £5 the next day?
£10 now?

then the Learner may be completely confused. Many may not be able to weigh the choice between the £10 now and the £15 spread over three days even though they might have chosen the £15 over the £10 if it were presented as an immediate choice: "Do you want £15 or £10?"

"The ability to delay gratification comprises a number of elements, not least of which is the ability to decide to wait. Children with an intellectual disability have been reported to have difficulty with making this choice." (Cuskelly, Zhang, & Gilmore 1998)

"Using a version of the TD (Temporal Discounting) task designed for young children to use without prior training, we found that, unlike typically developing participants, almost all participants with intellectual disabilities either behaved randomly, or used only a single source of information: there was very little evidence that participants were taking both sources of information into account and ‘weighing’ them. Furthermore, when a single source of information was used, this usually took the form of impulsive responding: choosing the immediate alternative, irrespective of the pay-off." (Bailey, Willner, & Dymond 2011 Page 38)

In their study, Bailey et al (2011) note that the this seeming inability to weigh multi-dimensional choices is due to a lack of 'executive functioning' skills rather than being simply related to any IQ level.

"Taken together, these two studies suggest that executive functioning, rather than IQ, underpins reasoning abilities in people with intellectual disabilities." (Bailey, Willner, & Dymond 2011 Page 38)

Executive functioning is defined as the:

"set of cognitive processes that regulate an individual’s ability to organize thoughts and activities, prioritize tasks, manage time efﬁciently, and make decisions. They include goal setting and planning, organization of behaviour over time, response initiation, response inhibition, attention, working memory, set shifting and ﬂuency" (Bailey, Willner, & Dymond 2011 Page 38)

It might be argued that any typical person might opt for the smaller amount of money (£$€) now over the larger sum if:

the larger sum were only to be provided in what a person might consider the distant future (next day, next week, next month or next year);
the larger sum was not significantly more than the smaller amount (£10 vs £9 for example);
our present need for money was urgent;
s/he misunderstood the offer;
some combination of the above.

Generally, we would weigh the options and decide, after that time, which choice appeared the better for us. Many would opt for a larger amount even if there was some delay (providing the delay was not too long such that the value of the amount would not dwindle due to inflation) and our need was not urgent (we had immediate debts to pay for example): £10 now or £20 next week... £20 next week please! However, thinking things through and coming to some logical decision is unlikely to be an easy task for those experiencing a significant learning difficulty. In their study, Bailey et al (op.cit.) opted for a visual aid to provide additional assistance to the decision making process to make it easier for the participants to make a reasonable choice. They used squares of either green or red (based on a traffic light system: green for go/good/positive and red for stop/not good/negative) arranged in columns. More positive things that Learners valued earned more green squares. Negative things that the Learners did not value earned red squares. Putting the two columns side by side meant that they could be compared with the larger one helping to make the choice (larger green - let's do it, larger red - let's not do it). In addition to the colour scheme they also added smiling and frowning 'smiley' faces to provide additional visual cues as to the meaning.

The images below are my take on the above idea: a means to quantify the value of different aspects of a choice in a visual (and tactile) medium.

The above images may be downloaded by clicking on them.

This idea has been included in the section on 'Creating Choice Charts' (see section below this webpage) that is a method to allow a Learner to explore and evaluate choices in a more sensory medium to assist with building thinking skills for future practice.

Decide to be Indecisive!

Staff can decide to play a certain role when it comes to choice: they can decide to be indecisive and allow the Learner(s) to make the choices! For example, on a trip to a fast food restaurant:

In which one shall we eat?
Which way shall we get there? Which way do we go now?
What door shall we use (if there is more than one entrance)?
Where shall we sit?
What shall we eat/drink? I can't decide what I should drink, can you help me?
How many sugars do you want? (if tea or coffee)
Do you want milk or no milk?
Who should go and get the order?
Who is going to assist you?
Who is going to take the rubbish away?
What shall we do next? Where shall we go?

There are some points to be made here. If you give a Learner a choice and s/he makes a choice then you should respect that choice and act upon it. It is of no use providing a choice if, once a choice has been made, you say, "Hmmm, I don't think you should choose that", "I don't like that, I think that this would be best", "You cannot be serious. That's just a silly choice." ... Suppose we give the Learner the choice of route to the restaurant and the Learner chooses to go right rather than left (and you know that the restaurant is down the road to the left) then you should go left. After a while walking down the route, you might say, "Are you sure this is the right way?","Shall we carry on or turn around?", ... but always the control is in the hands of the Learner.

Yes but we may not get to the restaurant.
So what if you don't? There are consequences to actions and it's another learning experience for the Learner. As long as the
route does not put the Learner in any danger s/he should be allowed to choose it.

Yes but what if we have to get back to the bus and we are running out of time?
There are parameters to any action. Therefore, you can let the Learner know the time constraints: "We only have 40 minutes James
and then we must head back to get the bus". We can still allow James to direct the way back to the bus but as time is pressing, if he
goes seriously astray we would then have to take control.

What if the Learner chooses something to eat that they cannot have?
If the Learner is allergic to a particular item then s/he must be reminded of that fact: our objective is to give Learners choice and
not to put them in danger. If the Learner is on a particular diet and certain foods are restricted perhaps there can be a token
system in place which allows for a piece of chocolate cake but, once the tokens are gone, no more is permissible within a certain
time frame.

What if two Learners choose the same staff member to assist them?
You can decide on which Learner chooses first either by rotating the list each time you go out into the community or by some
random method (one potato, two potatoes,...). As long as all Learner get to choose first some of the time and it is fair then there
should be harmony! You can always toss a coin too ...

Choice Strategies

Listed below are some ideas for strategies that may be employed to promote an increasing understand of choice within the classroom and at home. They are not designed to be undertaken all at once but rather one at a time building on success and understand by bringing in later items from the listing. It should also be understood that the list is not intended to be totally comprehensive or unalterable; you may feel that there are items missing or that one approach may be best achieved by a slight (or major) modification. That is OK: they are just suggestions for your consideration. The listing should NOT be viewed as intending to represent some form of total curriculum for a person experiencing learning difficulties rather an aspect of curricular provision.

This listing is based on an extensive revision of work by Sands & Wehmeyer in a book on self-determination (1996) with a view to its application for the development of choice for those experiencing more significant learning difficulties while maintaining a progressive approach.

It is important to note that, in all aspects of the list presented below, Significant Others must adopt a consistent approach and response at all times. It is potentially confusing for the Learner and damaging to the process if different staff at different times of the day undertake a choice interaction with a Learner in a variant manner with one member of staff using one methodology and a further member of staff adopting another. Likewise, if Significant others utilize vastly different language during such interactions. Those overseeing the implementation of any choice system should plan for and attempt to ensure (and randomly test for) consistency throughout the approach with any Learner. Consistency is crucial to the success of any such strategy. It is equally important that the response of all significant Others to any 'choice' made by a Learner is consistent: they must provide the choice and not confound the issue by making unhelpful comments such as "Well, I don't think that is a good choice, you would look better in blue!" or emphasize one choice more than another simply because they believe it to be better. It is important to note that the entries at each stage are NOT sequentially contingent on each other; they may be introduced together during the same period of time (which, for some individuals may be months or years). All choices made should be recorded for assessment and analysis. A recording sheet for this purpose may be downloaded from the image in the section below.

STAGE ONE: EARLY EXPERIENCES

Significant Others (staff, parents, carers, etc) might provide opportunities for the Learner to:

be assessed using a 'Choice Checklist' which predicts Learner readiness for work in this area (Detailed in section below) and is covered also by some of the bulleted points below;
demonstrate awareness (of self, of others, of items in his/her environment, of change, ...);
develop a sense of self;
experience Sensory Cueing (see OOR page on this website) and Sensory Selections;
work with Objects Of Reference (see OOR page on this website);
build 'historic' awareness (see history page on this website);
begin the development of contingency awareness (provide as many opportunities for Learners to experience contingency events that are under their control/direct results of their actions). (See contingency awareness page this website.)
develop preferences (although preference is a synonym for choice what is really meant here is Learner experience/ awareness of things on which later preference can be based);
make simple choices between two alternatives as a regular feature of each part of the day. This choice would NOT assume a certain level of Learner understanding as an entry point (even though this understanding was not evident). Significant Others would respond to a particular Learner action consistently as though it were intentional: for example, if the alternatives were presented as objects held to the right and left of the Learner and the Learner was to look at one particular object with more focus than the other. At this stage, Significant Others would be responsible for the formulation of each choice such as the selection of array items ("Do you want to wear the green or the blue top today?" while holding up each top in either hand).
Make simple choices with 'Learner salient' items. Continuing from the point above, choices should begin with items that the Learner will meet on a daily basis (indeed, already have met on a daily basis) and thus be more likely to have some awareness already (although this should NOT be taken as a given).
receive positive feedback on the choices made;
make choices that are taken in appropriate environments: for example, choices of foods should be made in places where foods are normally consumed. To do otherwise may confuse the Learner.
make choices that have immediate consequences. That is the Learner gets an immediate follow up after making a choice such that s/he can come to realise a connection between the choice making activity and what happens. To delay the follow up even only by a minute might have significant consequences for a Learner's comprehension.
make selections of activity based on free operant choices. You might use the OOR for this purpose.
decide to be indecisive (see separate section above). In the next stage, we might introduce an opening closed question to allow the Learner to choose to do nothing rather than something:

"Do you want a drink?" (CLOSED)(Opportunity to say 'no')
If YES. "What do you want to drink?" (OPEN)(provide choice)
It should be noted that Individuals Experiencing Learning Difficulties are likely to respond in the affirmative to a closed question.

STAGE TWO: CASCADES

Significant Others (staff, parents, carers, etc) might provide opportunities for the Learner to:

make a choice between an item and a null option (a drink and an empty glass for example) at varying times throughout the day. A selection of a null item should not be taken to be indicative of any specific Learner intention (for example, as indicating 'I do not want that drink') or lack of ability (for example, does not understand the concepts involved) but should be referred back to the managing team for further discussion as to direction and progression. The continuing selection of the active item (as opposed to the null item in the array) is indication that a further progression may now be considered by the team. Examples of null items might be: drink vs empty glass; snack vs empty plate (would the Learner choose an empty plate over a plate that has a couple of pieces of chocolate for example?); container (containing a favourite item) vs a container that is clearly empty; coat hanger with item of clothing versus empty coat hanger; a picture of an item or place or event vs a blank image; a Known Object of Reference for a particular favourite POLE vs Object which means 'go away for one minute', etc.
make a choice between preferred items and a known non-preferred items throughout the day when items are presented such that there is no location specificity (the preferred item is not always on the right). If a known non-preferred item is selected it must be provided for a given amount of time (at least 2 minutes) before the choice is repeated.
make a decision using a 'Cascade of Choice' approach provided by a Significant Other (the available choice options are broken down into easy to manage chunks to make it more likely that the Learner will cope). For example, if there was ten minutes left of a session and the planned work was complete and staff wanted to give the control over what to do for remaining period of time to the Learner, they could use the 'cascade choice' methodology. As can be seen from the chart below, the cascade involves staff breaking down the available options into alternative choices for the individual. The first choice is between just waiting there until the session ends or doing something. The words 'Do something else' are used consistently throughout (or a simple variation on the form). Staff can decide on the form of language they deem suitable for the Learner. If the Learner chooses to wait then s/he is left in peace to watch what is going on in the room until the session ends. However, if the Learner elects to 'do something else' a further choice is offered. In each choice in the cascade, one option is always the 'something else' branch. While this might seem this could be a lengthy process, in reality it can be achieved quite speedily. Staff are typically dealing with known individuals of whom they recognise their likes and dislikes. As such, the BEST likes are those offered up early in the cascade. Once the Learner has indicated a particular choice, the cascade comes to an end and the choice is provided. The staff team involved can plan cascades for each individual drawing on their known preferences.

follow up on naturally occurring events. Sometimes something happens during the course of a session for which there are several possible pathways that might be taken. Staff empower the Learner to consider the options and make a choice of what to do. For example, while the Learner is preparing some food, an accident occurs and some liquid is spilled. The Learner could be tasked to decide what to do about the spillage (rather than staff just sorting it out there and then for him or her). For those that can communicate (via voice or some augmentative or alternative methodology), they can simply inform staff what they think might be a suitable thing to do. For other Learners, staff might provide either a simple choice option or a cascade option so as to pass the control over what happens next to an individual.
stop the delivery of 'items on a plate': that is, don't do things for (or even with) Learners but empower them to do it for themselves. As a part of this process, starting with the very simple, we can introduce some aspect of problem solving into daily routine of all individuals at this stage. The problems should be really easy to solve but, nevertheless, involve some aspect of choice and or decision-making about what to do. For example, if a preferred items is placed in front of a Learner but then put under a cardboard box does the Learner remove the box to reach the item? OK some Learners will not have the physical skills to do this but the problems set should be a match for the the Learners abilities: a preferred wireless, mobile, switch-controlled toy is placed on the table top in front of the Learner. However, a staff member then places a small screen in front of the toy! Does the Learner activate the switch to move the toy into view once again? Does the Learner communicate a need for assistance? OR does the Learner simply switch off and wait for a member of staff to provide stimulation?

STAGE THREE: REFLECTIONS & CONSEQUENCES

Significant Others (staff, parents, carers, etc) might provide opportunities for the Learner to:

consider 'what happens next'. This idea can be seen in some TV shows where they show a clip of film and then stop the action and ask the audience to state 'what happens next'. The same sort of idea can be used in the classroom. Record items from the TV or look for simple footage on YouTube and stop the action at a salient point and ask the class to consider 'what happens next'.
reflect on a recent choice. For example: "Today you chose the double cheese burger at McDonald's and then you did not eat most of it" Do you think that was a good decision? What might you have done instead? Today you chose not to take your coat when we went out and then you said you were too cold. What might you do in future?
Reflect on a recent choice to consider the reason or reasons 'why' the choice was made. Is the Learner able to communicate a reason for making a choice by choosing from a range of options? For example: You chose to spend all your money on a pot plant for your mother and thus had no money left to buy any food. Can you think back as to why you did that? a) it seemed like a good idea at the time; b) I liked the plant and did not think about dinner c) I didn't think I would be hungry at lunch time; d) I didn't think about it at all; e) I don't know f) something else

make choices for characters in a sensory or in a social story. A Significant Other can tell involve a Learner or group of Learners in a story. At certain points in the story there may be opportunities for a Learner to make a choice of what happens, or what to do, or how to do something or ... Learners may also be asked to reflect on what might happen if a character in the story was to do something: For example: "Johnny was playing with his sister Janet outside in a field behind their house. Johnny was throwing the ball high in the air and Janet had to try and catch it as it came down. Then Janet did the same thing for Johnny to catch. The field had several large trees. One time, when Johnny threw the ball up in the air, it did not come down! The ball had got stuck in the branches of a nearby tree. Janet and Johnny looked up at the ball and thought about what they could do. Johnny told Janet not to worry as he had a plan to get the ball down. Johnny said that he would climb up the tree, crawl out along the branch and then reach out to get the ball back. Janet did not like the idea and said that he should not do it but Johnny said it was OK and started to climb the tree. He got up to the branch and then crawled out along it. Janet did not like what johnny was doing."

- What things do you think might happen?
- What else could Johnny or Janet have done?
- Which choice do you think was the best?

Do the above with an available story book. Use a Bookworm, Step by Step, or PowerPoint (for example) to allow a Learner (or Learners) to tell the story. Illustrate the story further for the audience by using sensory interactions (sensory stories type of approach). Stop at particular points to discuss choices about what to do, or where to go, or just what might happen next. Compare the choices of the Learners with what happens in the story.
make a silly choice on purpose. Ask the Learner to think of the silliest choice to make / thing to do in a particular circumstance.
to decide between sensible and silly choices. Using a Talking Mats approach, you can provide fictional scenarios and ask the Learner to decide whether the solution you are going to report is 'sensible' or 'silly'. For example: a boy was playing with his ball outside his house throwing it against the wall and catching it. One time, he could not catch the ball and it went past him into the road. The boy decided to run after the ball into the road to get it back. Was that a silly choice or a sensible choice?
take an on-line fun multi-choice personality test (or some other such thing). The sort of thing that you might get in magazines... "you see a nice girl sitting at a nearby table in a cafe. You really like her and want to get her to notice you. Do you: a) go up and talk to her?; b) Knock your drink on the floor on purpose?; c) decide she is too nice for you and do nothing?; d) ask her friend out? e) pretend to leave the cafe but accidentally bump into her? There are lots of these sorts of things on line (Google teen personality quiz, etc) and in magazines. Staff can keep a bank of them. Discuss the options chosen by the members of the group.
follow a story that is in the news to its outcome. Each day discuss what might happen next. Ask the Learners to make simple decisions about what to do. The decisions could be a choice between picture cards (for example: ask for help, do nothing, something else). Compare the Learner's suggestions with what actually occurs. Emphasise consequences of real-life decisions that are made.
review and reflect on a story that has been in the news in the past or something that has happened in a Learner's life (or a friend of a Learner or to a Significant Other). Look at the consequence(s) and discuss if it was a good or a bad outcome. Review what decisions might have been made that lead to this outcome. Can the Learners think of anything that might have been done differently to give a different outcome. The stories may be complex but should be presented in as simple a manner (as dictated by the intellectual capacities of the Learners involved). Illustrate the issues graphically if possible. Show how one thing leads to another and how the final outcome was reached.
work with 'Choice Charts' to make choices and their consequence more accessible at the Learner's current level of understanding (see Choice Chart section this page).

STAGE FOUR: STRATEGIC PLANNING

Significant Others (staff, parents, carers, etc) might provide opportunities for the Learner to:

make choices about something that is going to happen in the future. For example: Planning a trip out (What clothes are you going to wear for the trip out next Friday? We'll be taking a picnic with us then; what sort of food and drink would be good to take with us on our picnic? What else will we need to take?); Planning a surprise for a relative or friend for their birthday; Planning a holiday ...
look at different strategies that might be used to work on a particular task that has been set and decide on the best way to approach it. For example, if a Learner does not know what a word means what might s/he do about it? Try and figure it out him/herself? Look it up in a dictionary? Ask a friend? Ask a member of staff? ...
look at common everyday problems and have a brain storming session on how they might be avoided as well as how they might be solved if they have already happened. For example: You have to go out very soon and you cannot find your keys or your mobile phone or your glasses. You want to watch a favourite programme on the television and you cannot find the remote control. You need to wash your hair but discover you have run out of shampoo. You are out shopping when you discover you forgotten your wallet or glasses or ...
set simple goals. Ask the Learner to consider something that s/he would like to do/get done in the next few weeks. Put that up on the board as a goal. Now consider together the steps that are necessary to reach that goal.
plan a route. Get the Learners to plan a route from one place they known to another place they know. What is the shortest route? What is the quickest route? What is the longest route? What is the silliest route they can think of?
break a large task down into smaller easier-to-manage steps. For example: you want to go and see a musical but it is on in London. What do you need to do?

STAGE FIVE: THEORY OF MIND

Significant Others (staff, parents, carers, etc) might provide opportunities for the Learner to:

make sense of another's actions. If a member of the team is wearing something different (perhaps a really smart outfit) ask the Learner(s) to speculate as to why. If a member of the group is not in class ask a Learner to consider a possible reason as to why.
understand others emotions. If a member of staff has had some sad or happy news ask the group to consider how s/he might be feeling.
consider a choice made by another person (a person in a story, a person in a film, a person in a play ...). Why do you think he made that choice? What did she think about?
consider a choice made by a person in a story and how it might affect the other characters.

Choice Checklist

The Communication Continuum

There is a communication continuum which is marked by a spontaneous remark at one end (You are walking through town and a person says "I fancy a cup of tea”) and parroting at the other (You are walking through town and you wonder if the person with you would like a cup of tea. You say "Say ‘I want a drink’ on your nice machine”). In between these extremes are two further elicited forms. The first is elicited contextually (You are walking past McDonald’s and say "I fancy a drink”) the second is elicited via a verbal prompt (You are walking through town and fancy a drink you turn to the user and ask "Would you like to take a break for a drink?”).

Parroting forms the least desirable technique:

"Speech is never an end in itself, it is always a means to an end. We use it to
convey meaning, purpose and to bring results. To attempt to teach a child
‘parrot fashion’ would be to miss the point." (Jeffree, D. & McConkey, R. 1976)

While parroting forms the least desirable technique within the communication continuum, it should be noted that it is a technique used, in certain circumstances, by parents (and others) with children. For example, if a child asks for an item and forgets his or her manners parents will say:
"When you say please.”

Although initially the child is told to say the word itself, the direct prompts soon fade:

"What’s the ‘pl’ word?”
"Haven’t you forgotten to say something?”
"When you ask properly.”

Eventually, the child may be ignored until she or he asks in a socially acceptable manner.

Meal time with the Adams Family (From the feature film ‘The Adams Family’):

Wednesday Adams: "May I have the salt?”
  Morticia Adams: "What do we say?”
  Wednesday Adams: "NOW !!”

The verbal prompt can be sub-classified into seven categories:

The first is an open ended question:

"What would you like to do?” RESPONSE "Stop for a drink”
"What would you like to drink?” RESPONSE "Tea please”

Note: The initiating question may, in fact, be closed so long as it leads to the continuum (thus 'closed' is followed by 'open'):
"Would you like a drink?" (Closed)
"What would you like to drink?" (Open)
This allows the Learner to make a choice of nothing at all ("Would you like a drink?" "No") instead of just assuming a drink is required. There is a problem with closed question formats as it has been shown that Individuals Experiencing Learning Difficulties are more likely to answer in the affirmative (see for example, Sigelman, C.K., Budd, E.C., Spanhel, C.L. & Schoenrock, C.J. 1981 a,b) and, as such, cannot be regarded as a definitive choice. However, a 'yes' response, leads us into communication continuum practice.

The second is a multi choice format in which the AAC user is active:

"What would you like to drink - tea, coffee, or a milkshake?”   RESPONSE "Milkshake please.”

The third is a variation on the second - the alternative:

"What do you want, tea or coffee?” RESPONSE "Coffee please.”

Multi-choice differs from the alternative option only in the number of choices presented. For a person with severe learning difficulties a smaller range of choices is more appropriate. The alternative option is a choice of two.

The fourth is a multi choice in which the questioner is active:

"What do you want to drink? There’s tea, coffee, or you could have milkshake."
"Do you want tea?” (Person shakes head)
"Coffee?” (Person shakes head)
"A milkshake then?” (Person nods head)

The fifth is an alternative choice in which the questioner is active:

"What do you want to drink? There’s tea or coffee? Do you want tea?” (Shakes head)
"Coffee?” (Nods head)

The sixth is a closed question:

"Do you want coffee?” (Nods head)

Finally there is Hobson’s choice. No choice at all:

"I've got you your tea just the way you like it!”   No questions asked.

One of the goals of AAC is to give the user the skills and the confidence to chat spontaneously. However, if a verbal prompt is required (and initially it is likely that there will be many) then it should begin at the left (as shown on the chart illustrated below) of the elicited verbal prompt continuum:

"What would you like to drink?”

If there is no response, it may be repeated: Gaining eye contact:

"Sam, what would you like to drink?”

If there is still no response, move one step down the continuum. List the options:

"Well there’s tea, there’s coffee, there’s milkshake, and there’s juice. Which would you like?”
(If this is an overload of choice consider the alternative option)

Still no response? Move one step down the continuum:

"There’s tea, coffee, or a milkshake. Would you like tea? Coffee? A milkshake then?”

No response? Oh dear! Then use the closed format:

"Jenny would you like a chocolate milkshake?”

No response! This is serious:

"Darn it Jenny, I’ll get you a glass of water.”

Note: the two strategies used to help promote a Learner response: the selective use of a person’s name to focus attention and gaining eye contact.

It is unlikely that you will need to move so far down the continuum. However, the option is there should any particular strategy fail. The idea is not to allow the Learner to fail but to provide the maximum amount of choice and opportunity for active communication skills. Of course, this assumes that the Learner knows about the drinks and has been taught where they are located on the AAC system.

While it is likely that, in the early stages of teaching, much use will be made of elicited verbal prompts, they should not be the only form of communication strategy used:

"... it is therefore important that the communication does not become responsive, i.e. that the individual answers only when
spoken to by others or takes the ‘initiative’ after being urged to do so. Even though it is unintentional on the part of the
person who plans the training, the teaching may reinforce a child’s dependence." (Von Tetzchner, S. & Martinsen, H. 1992)

The section above does not make reference to physical prompting. This was intentional. Verbal and physical prompts, however, may be used at any point within the communication continuum to help people to achieve a desired response. All prompts should be gradually faded (see sections on prompting on this website).

Choice Time

"Notions of a well run school, where a tight timetable laid down by the teacher is strictly adhered to and pupils have a prescribed set of activities , needs questioning in the light of of opportunities it provides for individuals to develop choice. Choice is not to be viewed as something that occurs on Friday afternoons or at milk time." (Coupe-O'Kane, Porter & Taylor 1994)(Page 19)

This section of this web page is devoted to Choice Time that is:

for: the provision of an extra time allowance to process information;
against: compartmentalising choice into a set time on a Friday afternoon.

Individuals Experiencing Learning Disabilities are likely to take longer to process information. As such the time they need to make a choice will be correspondingly greater. They are thus more likely to lack the skills required to instantly process information to make rapid choices (see Bratkovic, Bilic, Nikolic 2003).

Given this information, staff should not plan the provision of choice activities in a time restricted period such as during a short break where a transition to another session is imminent. The provision of choice should always allow sufficient time for the requirement. Furthermore, choice cannot and should not be compartmentalised as a session that occurs at a specific point within any curriculum: the development of 'choice skills' should pervade all that we do.

Video Choices

"Video recording of actual practice should be a central tool for organisations attempting to improve services for people with learning disabilities. Since an important site for the disempowerment of service-users is in everyday, mundane interactions with service staff, an approach to staff development is needed which allows workers to see what they actually do and how they might do it differently. Research illustrates that retrospective self-reports of what people habitually do cannot capture much of the important details of communicative interaction. We argue that video recordings are the best way of doing this, and provide examples from our own work of the type of benefits that can arise."
(Finlay, Antaki, & Walton 2008)

Since the early 1980s I have often used both video and cassette recordings of my classroom practice to review the quality of my sessions. Although I often cringed at watching myself on the screen and thus always did it it in isolation, it seemed a very beneficial way to improve practice and review my approach. Finlay, Antaki, & Walton (2008) also advocate such an approach although they encourage the sharing of such vignettes with others for review. Indeed, they argue that this approach is more beneficial to the improvement of practice than other means:

"We argue here that there is only so much that can be achieved by re-writing policy documents and vision statements, by changing the type and membership of meetings held in services, by redesigning the filing system, and by sending people to workshops outside of their immediate working environments. None of these expose the staff to an objective record of their own practices. Our basic argument can be simply put: if a staff member is to change their practice, then a good way to encourage the self-reflection that must be the first step to that change is to talk them through a video record of their day-to-day experience with residents" (Finlay, Antaki, & Walton 2008)

The technique is not one used to evaluate staff, criticise them or to apportion blame: indeed Finlay et al provide a set of safeguards and guidelines specifically to outlaw such uses of the captured material. The guidelines also ensure that no person is coerced to be filmed and that assurances are made and consent is freely given. I often use videos of practice in my talks. The videos are used to illustrate aspects of practice both good and not so good. However, even when the videos illustrate a not-so-good aspect of practice, I always begin by stating:

the staff involved were brave enough to volunteer to be videoed;
although performing in what might be considered less than good practice on the film snippet it was not typical of their approach;
how much I valued them.

The technique therefore is only used as a methodology to improve practice:

What is our current approach?
Can it be improved?
What needs to be changed?

Thus, videoing and reviewing the use of choice in all aspects of the daily routine is to be recommended as one effective technique for the amelioration of practice in special needs settings providing that staff are given assurances that such material will not be used to embarrass, evaluate, criticise, or blame.

Creating Choice Charts

A Choice Chart is a means by which Significant Others may make a current choice and its consequences more accessible at a level that the Learner may more readily be able to comprehend. It is an adaption by Jones (2014) of Brown and Mirenda's (2006) Contingency Mapping approach.

A Choice Chart comprises:

at least two branches;
a common origin (the choice);
a pictorial representation of each of the alternatives as a separate branch of the chart;
a pictorial representation of the consequences of selecting any branch of the chart;.

To be of any use a Choice Chart must:

be accessible at the Learner's current level of understanding;
represent each aspect of the current choice by a separate branch of the chart;
show the consequences of each available alternative objectively (without Significant Other bias);
be discussed with the Learner such that s/he may give a weighting to each of the consequences;

There is a continuum of Choice Charts beginning with the Condensed Form and progressing to the Considered Consequence form. While there maybe a few Learners who could cope with entering at the right of this continuum with the more complex Considered Consequence Choice Chart it is not a recommended strategy. It is better practice to begin very simply as detailed below and gradually , over a period of time that is dictated by the understanding of the Learner, build in more options.

You will note that a Condensed Choice Chart fails half of the above list (concerning use). However, the list refers to the Considered Consequence Choice Chart which is on the far right of the continuum.

Condensed Choice Chart

To the right is a Condensed Choice Chart for a drink of juice. As you can see it comprises a common origin that identifies the choice name (drink) and a route planner with a double branch to either orange juice or apple juice. The route planner is illustrated as a road (hence the mid road white lines) such that the learner can see s/he is able to go either way but not both. A Condensed Choice Chart is simple; it illustrates no consequence of any choice merely the choice options themselves.

Note: the images depicted to the right can be downloaded as transparent .png files by clicking on them. Although copyright Talksense, they may be be used freely within your place of work for non-commercial purposes.

A Condensed Choice Chart might be concatenated with another to bring in further choices in a form of cascade. For example, if the choice was of a drink and the options were tea or coffee (as in the illustration right) then on reaching a decision, a further choice would be with sugar or with sweeteners. Of course, these choices themselves could create further concatenations: how many sugars? If such a cascade was presented all at once, the Learner might be overwhelmed but, in presenting each aspect of the choice as an additional branching Condensed Choice Chart, the Learner should be more able to cope. Only the selected branch is expanded in this way, the non selected branch is left as it is. Furthermore, the Learner might be able to use the resulting chart to explain his/her choice options to another.

Of course, an initial choice might be between a hot or a cold drink and thus the initiating branch selects between hot and cold and then the chart would continue with either of the images (right). You might reasonably ask, "What if the Learner does not want a drink?" The solution to this would be to make the initiating Condensed Choice Chart option 'drink' or 'no drink', followed up by the 'hot'or 'cold' alternatives ... However, it would not be best practice to begin with so many cascading branches even if they were presented each in turn building to a complete choice chart. Start simply such the Learner begins to comprehend the process and gradually build in the cascade.

The image below depicts three consecutive choices concatenated to form a complete whole cascaded Condensed Choice Chart for a particular individual Learner's hot drink selection. You will note that there is no 'other' option: perhaps this Learner would have liked a drink of hot chocolate at this time, or a cold drink, or no drink at all. Other options are possible within Condensed Choice Chart but it is best to start simply so as not to confuse the Learner. Once simple Condensed Choice Charts are mastered then additional options may be included.

You might now be asking about milk options (milk, no milk, lemon, other ...). Of course, you can form another choice chart for a decision about the addition of milk. This too can be factored into the chart to make it ever more complete. However, once again, do not be tempted to make the chart too complex too soon. Learners will need time to comprehend the system and thus some aspects must be held back for the time being.

Considered Consequence Choice Chart

A Considered Consequence Choice Chart is somewhat more complex than it's Condensed sibling. However, complex is not synonymous with complicated rather it means that this type of chart as more components that have to be considered. The idea is to present a choice and its consequences in a manner in which the Learner has the greatest possible chance of comprehending. Furthermore, by considering each of the consequences sequentially and assigning plus and minus counters it is is possible for the Learner to weigh the options visually and arrive at a considered choice. For example let's continue with our drink scenario and look in particular at adding sugar or a sugar substitute to our hot drinks: which should we choose? I think that is a choice that many of us consider and many of us don't really know the answer!

We can lay out the choice as a Considered Consequence Choice Chart as depicted below.

Beginning with the common origin (in this case a cup of tea) the options are detailed (sugar or sweetener). Following this the pathway highlights each possible concern (cost per cup, health issues, side effects ...) which are again represented as pictures or symbols. The cost per cup of sugar vs sweetener is fairly easy to calculate and will depend on a person usage of one vs the other. The health benefit is not so easy to calculate: sugar contains calories while sweeteners do not but sweeteners may not provide the 'high' that is received from sugar and therefore the person may indulge in eating more sweet things as a result and actually gain weight! Let's assume that this is not so such that the sweetener has a benefit over sugar in terms of assisting with weight loss. Then there are the possible side effects to consider: sugar as we all know is bad for our teeth and is a contributory factor in tooth decay. However pretty much all sweeteners may have varying side effects. There may well be other considerations I have not considered!

Once the Considered Choice Chart has been laid out, each branching alternative must be evaluated and given a weighed value from one to five (in either red (stop, danger, bad) or green (go, safe, good) tokens. Let us suppose that assisting the Learner s/he assigns the following values

You may not agree with this Learner's evaluations of the relative weightings of each aspect but that need not concern us here as we are trying to illustrate the process.

On each branch are number of green and red counters. Greens and reds cancel each other out: thus on the sugar branch, for every green removed we must remove a red (and visa-versa). We must then do the same for the sweetener branch. If we do this, the chart then becomes:

Both branches are less than desirable but, for this particular Learner, the sugar branch is slightly less desirable (two red tokens remaining) than the sweetener branch (one red token remaining). As both are red weighted the Learner might choose to opt for neither and go with something else in tea such as lemon. However, the Learner can clearly see that, from his/her ratings, the sweetener wins by a margin of one. Thus, the sweetener is likely to be the choice made after weighing the consequences.

Thus, the process is to assist the Learner to learn to make a considered choice by helping him/her to:

visual the options: depicting the choices graphically (Condensed Choice Chart);
list the considerations / consequences of each branch of the chart;
weigh each consequence in a comprehensible manner;
evaluate the total weight of one considered branch against another;
reach a considered conclusion.

If it is to be a Learner's choice then the Learner must be at the forefront of every step: if staff are weighting choices with tokens from their perspective (for example) then the choice becomes not significantly different than what went before with staff making the decision one behalf of a Learner.

The tokens used to give weight to each consideration can simply be counters purchased from the web. Or, you might create them yourself by downloading (click on each to download) the following images, printing, cutting out, and laminating a set of each:

Or:

use a stamp set;
use sticker sets;
do your own thing!

What if the choice has three or more branches?
Then you need to create a 'map' that has the correct number of pathways as in the illustration (left). However, at least in the early stages of tuition, it is better to limit the branches to two so as not to overly complicate the issue and confuse the Learner.

Your joking, I don't have time to do all of that just to teach choice making. All you need to do is hold up two items an get the Learner to pick one.
I suggest you study this page once again as I do not agree with you. However, while I agree that time is typically an issue, an ability to make a considered choice is an important aspect in putting the Learner in control and, for me, the 'goal is control' (learner control). Therefore, it is a matter of what you believe to be important and in the best interest of your Learners.

Your Joking, that's all too complicated for my Learners they have Profound Learning Difficulties.
I am not of the opinion that once PMLD always PMLD. All individuals can learn and all can make progress providing they are conscious. While some of the items on this page relate to those at a higher level of ability, there is something for everyone. Of course, it is not advisable (indeed foolhardy) to begin a Learner experiencing PMLD at the Considered Consequences level! However, this page does not suggest this: start simply at a Learner's current level of comprehension and move on up as evidence is provided the Learner has mastered the skills being taught. Remember choose to present information at a Learner's current level of comprehension.

What does best practice choice look like for IEPMLD?

Including the work by Brown and Brown (2009), what does the best practice in choice look like for Individuals Experiencing Profound and Multiple Learning Difficulties? While some may doubt that choice is even possible for such a population of people (see for example, Guess, Benson, &
Siegel-Causey, 1985 ) research has shown that Individuals Experiencing Significant Disabilities are capable of learning to make choices in their daily life (Lancioni, O’Reilly, & Emerson, 1996). To become a chooser the Learner must first experience choice in situations where the approach is tailored to be:

Considered, Clear & Consistent;
Hasteless & Helpful;
Object Orientated;
Opportune & Optimised;
Simple, Sensory & Selective;
Empathetic;
Regular, Responsive & Real.

Each is further detailed below:

Considered, Clear and Consistent:
For choice to have any impact on the lives of Individuals Experiencing Profound and Multiple Learning Difficulties (IEPMLD) it has to undertaken by all Significant Others in a manner that is considered and consistent. Considered because the approach has to accommodate the current ability of the Learner: it is of no use offering a visual choice to those that are experiencing significant issues with visual acuity for example. Thus considered involves some aspect of clarity form a Learner's perspective: is the selected approach one with which s/he has the greatest chance of coping? Consistent because the individual will find a multiplicity of approaches confusing. Initially, it is very likely the Learner will lack understanding of the approach and only come to comprehension as a result of consistent experiences. If the approach lacks consistency, it is likely that learning will not take place as such a lack of strategy serves to stump rather than to support (leads to confusion rather than comprehension). Many of us have had experiences in our lives in which we have started a journey not really understanding all its nuances but have come to comprehension over a period of time as we join the dots and make the connections through consistent experience.

Clarity too for the Significant Others involved in the process; they must be clear what they are doing and why they are doing it in a particular way. Any lack of such clarity is certain to result in a proportional loss of consistency with inevitable Learning confusion.

Hasteless and Helpful:
"Take time for all things: great haste makes great waste." Benjamin Franklin
If we act in haste, it is generally true that we repent at leisure. Individuals Experiencing PMLD require more time than their peers to process information. Thus, the provision of any choice has to be undertaken not just in a clear, considered and consistent manner but also in situations in which Significant others are not pressured by time. Indeed, clarity is assisted by time:
"Unreasonable haste is the direct road to error." Jean Baptiste Moliere
and thus, the time to do the task correctly should be a part of our considerations. As we have seen in an earlier section on this page, time has two aspects: the first concerns not limiting choice to a specific time on a specific day and the second, the allowance of sufficient time to give consideration to the needs of the Learner.

Helpful refers to the spirit with which Significant Others make such an undertaking: It is both considered and empathetic (see below). The presentation of any object option from and array has to be undertaken in a way that is helpful: that is, for example, if the Learner has little control of his/her arms and hands, staff assist the Learner to experience the choice in a way that is meaningful and will provide the greatest sensory feedback. That may be in assisting the Learner to feel (see, smell, hear or taste) the object.

Object Orientated:
For me, an Individual experiencing PMLD is currently trapped in the present with little awareness of the future and a loss of the past. However, others can open a doorway and thus provide a route out. If that route is considered (see above) then it must necessarily begin with real objects. While some Learners will undoubtedly be able to cope with symbolic forms of objects (photographs, drawings, symbols, signs) these may presently be too abstract for the Learner currently operating at this level of understanding. Thus, the use of symbols may be ill-considered and unhelpful. Objects provide more sensory feedback to a Learner than symbols which tend to act in one medium only. A Learner may be able to feel, hear, see, smell and even taste an object that is not likely to be true of a symbol. Such sensory feedback requires time for the Learner to process and thus we return to the former section on hastelessness.

However, what if the symbol is also an object?! Objects Of Reference are, at one and the same time, both a symbol and an object. can these be used for making a choice? The answer to that is yes and no! It would be unwise to use OOR for this purpose until the Learner has reached stage four of the OOR process (please see the OOR page on this website for further details). When at this level of understanding, such a use of OOR is permissible (indeed, advisable as staff would be attempting to teach OOR as a means of control and expressive communication).

Opportune and Optimised:
For there to be any chance of the development of the necessary skills there have to be opportunities for Individuals Experiencing PMLD to make choices. Thus, choice has to become routine with staff providing choices at every opportune moment during the day. It should not be assumed that such an individual will necessarily grasp the idea immediately; indeed, that is unlikely. However, through regular exposure to optimised experiences such skills may develop.

In order for learning to take place both the environment and the process itself need to be optimised. As learning needs to be scaffolded (Vygotsky), so we need to approach choice with due diligence and consideration. Their are (at least) four ways in which such an approach may be optimised for those experiencing significant learning difficulties:

limit the choice: that is we should not provide too much choice at any one time. Indeed, it is advisable to limit the choice in the first instance to one of two. We should not introduce a higher level of choice until we are certain that the skill has been understood and mastered at this most basic of levels;
select and reinforce the optimum Learner selection technique (see S section below): How is the Learner to indicate a preference to another? How can this be optimised? Creating a Responsive Environment (see R section below) is one means to this end.
known items: the provision of choice should begin with items the Learner is believed to understand: with objects that s/he encounters daily rather than strange, previously unencountered items.
make use of BESTs: evidence based research appears to points to the idea that the use of preferred items (even when used without choice) can have very positive results. Thus choice, initially at least, should typically involve one option (from two) that is believed to be preferred. If the Learner selects the other option then either, those facilitating the choice made a mistake, the other object is not actually preferred, or the Learner does not understand the process as yet.
simple and sensory: see below

Simple, Sensory and Selective:
"Finally the participants in this study identified some key ideas on how choice can best be facilitated for people with severe and profound learning disabilities. The need to keep choices fairly simple and not overpowering individuals with too many choices was one such idea and is echoed in a study by Antaki et al (2008) who identified similar factors that can lead to confusion and this adversely affect the utility of choice opportunities." (Bradley 2012 page 79)

In order to optimise the process in order to maximise the opportunity for learning, Significant Others should approach the situation in a helpful fashion from the perspective of the Learner. That is they need to be empathetic to his/her needs (see below). Two important factors in the equation
are that it should be simple and sensory. Simple means not overly complicated an thus easier to comprehend. What makes it simple for the Learner:

limit the number of options in the array so as not to overwhelm. As has been stated, this should be two only.

"Limiting a person's choice may be used as a stage in the learning process. This can avoid frustration
and even embarrassment" (Jackson & Jackson 1999 page 83)

use known items for choice;
make the choice sensory ...

Sensory suggest that the items should be real and not symbols for items or otherwise any form of abstract choice. The Learner will require something s/he can feel, hear, see, smell, or taste; with which s/he can interact in real time.

Selective refers to the means by which the Learner will make the choice. It may be by pointing with an finger, hand or arm, it may be by looking at an item more than another, it may be by some other means. The selection technique needs to be optimised and then reinforced in a responsive environment (Ware 2003). Selection may also be through a further S word ... Scanning. As we have seen (earlier this page), scanning may be controlled by the Learner (through some sort of switching system) or via another person (other controlled). When scanning is other controlled there an indicator of Learner selection will still be required (perhaps the Learner smiles when the selected item is reached for example). Any selection technique chosen must be natural to the Learner. That is, it must be a behaviour that:

the Learner finds easy to produce and to control;
others can (be taught to) recognise.

Empathetic:
"Putting themselves in the shoes of the individuals they supported was a tool often cited by participants as a way to gain information about the best course of action. Empathy also allowed the participants to understand what it must be like for individuals with severe and profound learning disabilities who may be unable to express themselves in understandable terms." (Bradley 2012 page 68)

"Not enough emphasis can be put on getting to know the person in order to understand their response." (Jackson & Jackson 1999 page 86)

While some may believe that empathy means putting yourself in the position of the other and asking what would I want, what you want may be very different than that actually required by the Learner. However, such a view is likely to result in respect and consideration for the Learner. Rather than just asking 'what would I want?', in addition, best practice might seek to enhance empathy by:

getting to know the Learner well before presenting choices (thus new staff should not be presenting choices without guidance from others);
acting with reference to the other headings in this section;
experiencing the choice situation for yourself: while it is difficult to create conditions for a Significant Other to have such an experience it may nevertheless be valuable. If we were to blindfold, put on headphones, and forbid the use of speech and then present two options one at a time such that the other is required to make a selection, while not truly emulating the experience of the Learner, the other might gain insights into to making the process more helpful;

Regular, Responsive and Real:
Choice cannot and should not be limited to a particular session or sessions on a timetable; it needs to part of the regular routine with the provisos that it is:

undertaken by staff that are familiar with the Learner;
not done under time constraints.

Choice should therefore be an event that happens consistently (at least) several times a day. Consistently here implies both regularity in time and approach.

Responsive (see Ware 2003) means that staff respect and act upon the Learner choice made. Significant Others should not:

negate a Learner choice by selecting another option instead;
select the item arrays (choices) on the basis of the interests of themselves or another (other than the Learner);
provide an item array (choice) that they are unable to tend provide if selected;
promote one choice over another;
position item arrays in the same order every time as a Learner may be selecting via positional preference;
assume understanding on the basis of a choice made (Real);

Consistent responsiveness is a means of helping the Learner to grasp the process: when I do this ... this happens. Initially, the Learner is unlikely to comprehend the choice process. However, with time and consistent experience, a Learner can come to comprehend that an item that is in some way indicated results in its provision. Indeed, that is exactly what we are trying to teach: what is picked is what is provided. What is picked, of course, suggests that the Learner has a means of selecting from the array of options (choices presented). It may be that the Learner exhibits several ways of selecting and staff act upon any one of these but that may not be best practice for it may be the other's opinion that the Learner made a selection in this way when, in fact, no such selection was made. Best practice might be to teach a Learner to use a single primary method for indicating a selection. One strategy for teaching and reinforcing that methodology is for others to respond to it consistently. The development of such a methodology should therefore include:

the selection of an approach that is already natural to the Learner (selecting pointing when a Learner has difficulty with arm movement is not a good strategy for example);
the responsiveness of others to the selected Learner behaviour;
a lack of response to other Learner behaviours;
other?

While there may be exceptions to the above ( Learner may be able to eye point as well as finger point for example depending on the context) these should be considered with great care. Introducing more complexity into a routine can serve to compromise its effectiveness.

It should be noted, simply because a Learner appears to make a selection between two objects it does not follow that this is evidence of understanding. Learner progression requires Real comprehension. While it may be the Learner has understood the choice. others must be sure (no assumption of understanding) of this before adding further complexity to the process (for example, by offering a third choice).

R might also stand for Risk. It is unlikely that early choice making during the tuition phase will involve risk as choices will be confined and, thus, selected by others. However, risk may be a consideration at some point. When it becomes a consideration, it is evidence that we are doing a good job! The Learner must have made progress!

With the above criteria in mind and considering every portion of this webpage what can we say about the two You Tube videos of the provision of choice for these young people experiencing PMLD?

Good Practice
The videos depict mainly excellent practice by the teacher concerned with a few considerations that are listed in the section to follow. The depicted good practice includes:

the provision of choice as a part of the daily routine;
empathy for the young people involved;
awareness of positional preferences and thus, swapping of array positions;
calm approach. Time taken (lack of haste);
use of identifiable containers as representations of the drinks involved;
limited number of choices;
perseverance of staff member;
check on choice made (for example, uses etran frame);
the introductions of symbols into the routine (although this also raises some issues!);
actions on choices made (responsive environment);

Considerations
I really do not think there was any poor practice shown in the videos. However, there are a few points I would want to raise as considerations:

the use of the two different yellow containers for the food items (crisp or biscuit) presented to Callum. Perhaps Callum might select on the basis of their shape or size. This could be easily established over a few days. It would be better if both items were presented on were yellow plates or yellow bowls;
Both choices were acceptable drinks. I assume Kimmy and Callum would have liked either. Therefore there is no way of knowing whether they are comprehending the either methodology or the items involved without the staff performing other actions which we do not see in the videos (but may have been performed some time previously);
Fleeting indications of choices are open to staff interpretations and biases.
As the film snippets are short and we do not have a complete picture, it is possible that the staff are using these and similar approaches as evidence of Learner understanding. If that is the case, I would believe that to be an assumption: it might be valid or it might be a misreading of the situations. I would urge all staff to build safeguards into their practice;
The move to symbols as a means of choice or the check on choice. Are we certain that these young people can comprehend symbols? The teacher seems to know them very well and I have no reason to doubt her ability to read the situation. However, I would like to see

- the etran frame removed (such that the teacher holds the two cards);
- the two cards a little larger, non-transparent and identical from the rear;
- the teacher shuffling the two cards face down before presentation such that
she did not know on which side each of the choices was presented to the Learner.

The objects and the symbols are always separate in the videos. I would have liked to see the symbols as a part of the objects such that, as the objects are presented, so the symbols. However, it does not follow that the symbols should also not be used on their own: they should, if applicable.

Of course, the above comments are made on viewings of the two videos alone and therefore on no knowledge of prior practice. However, the purpose here is not to criticise the teacher (who appears to be doing a fabulous job) but to highlight issues around the methodologies employed by staff in the provision of choice using the videos as a medium.

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Choice Pickings

The Development of Choice Making Skills in Individuals Experiencing Significant Learning Difficulties:Theory and Practice

Too much of a good thing?

The Convention on the Rights of People with Disabilities 2008

What is choice?

The Goal is Control

Prerequisite Factors

A Continuum of Choice

A Preference for Choice: A Continuum of Consequence

No Choice

No Choice Too

Self-Determination and Choice

Self-Regulation and Choice

Choice is a Voice

Who chooses the choices?

Evidence Based Research

Areas Four Choice!

Preferential Treatment

Choose to Teach

Sensory Selections

Thinking Out Loud

Choice: ﻿A Risky Business?

Caught between a Rock and a Hard Place

Simply the BEST: Best Ever Stimulating Thing

OOR: Objects Of Reference

Boxing Clever

Free Operant Preference Assessment

Standard Practice

Eye Pointing

Error Free Choices

Cueing

Assumptions of Understanding are counter-productive

Absence of Evidence is not Evidence of Absence

The Null Choice

Choice Opportunities

Weighing Choices

Decide to be Indecisive!

Choice Strategies

Choice Checklist

The Communication Continuum

Choice Time

Video Choices

Creating Choice Charts

What does best practice choice look like for IEPMLD?

Bibliography and References

Choice Pickings

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The Development of Choice Making Skills in
Individuals Experiencing Significant Learning Difficulties:
Theory and Practice

Choice: A Risky Business?