How to Shape Choice-making in Children with Complex Communication Needs 101

By Andrea Song, M.Ed., CCC-SLP

Think about your own experience at the local diner. You go in on a Saturday morning for breakfast. The waiter approaches you to take your order, and you say that you would like eggs and toast. The waiter asks you how you like your eggs: scrambled, sunny side up, over easy (these are really only a few of many choices). Then you are asked about what kind of bread you would like for your toast: wheat, white, sourdough, English muffin, and on and on.

What does it take for you to make a choice that is reliable and true to what you really want? How are you able to communicate your preferences to others? It helps us to think about our own experiences with choice-making in order to understand what it takes to shape the skill of genuine, reliable choice-making in our students with complex communication needs.

Discover Enjoyment

At its core, reliable choice-making is finding enjoyment and pleasure in that preferred selection. Before we can begin to shape choice-making in our students, we need to learn what motivates them. What makes them happy? Clearly, one way we can discover this information is through family and caregiver interviews, but use your own observations too. Give your student access to varied, colorful experiences and open them up to the sensory-rich world that surrounds them. Utilize every sensory mode they have available in order to uncover what gets them to express enjoyment, such as olfactory (smell), gustatory (taste), tactile, kinesthetic (movement), auditory, visual, and even vestibular (movement in space).

As you expose them to various experiences, observe their natural behaviors in response to motivating stimuli. Does the child smile? Vocalize with pleasure? Extend or flex a particular area of their body, like their arms or legs? Do they fix their gaze on the desired object? Keep a close watch and observe what natural behaviors they demonstrate most consistently when interacting with preferred items. Later on, this natural behavior can be shaped into an intentional signal during choice-making opportunities.

Build Intentionality

After we discover what motivates them, we need to teach them that there is power in their natural behaviors--the power to change their environment. The ability to use behaviors in an intentional, functional way is an important prerequisite to making meaningful choices. One of the primary ways of shaping a natural movement into an intentional signal is through pairing a communicative function with the movement. Which communicative function do we teach first? Requesting “more”, as it is one of the earliest communicative functions that develop. How do we pair the function with the movement? Allow the child to experience and interact with the highly motivating stimulus; gently remove it from them; then, respond to whatever natural behaviors they provide by bringing back the motivating stimulus.

Depending on what’s appropriate for the student, you can also use other teaching strategies like modeling (as appropriate), explicit verbal instruction (e.g., “Use your voice”), providing ample processing/wait time, and other multimodal cues (e.g., movement of the object, tapping their hand) to elicit the targeted behavior. Hopefully, through implementing these strategies, the child will learn that their behaviors have rewarding consequences and can positively affect their world around them.

Preferences: What Do They Like AND Dislike?

To be able to make a reliable choice that reflects your true preferences, you have to be able to not only know what you want but also know what you do NOT want. In addition to discovering what the child enjoys, we need to collect an inventory of what they seem to dislike or to be uninterested in. Of course, the first choices we provide need to be concrete and familiar. But, we can provide additional support by including either nonpreferred choices or meaningless choices alongside the highly preferred choice. For example, if a child shows consistent enjoyment for goldfish and shows a disinterest in strawberries, we can present both of these choices to the child as they learn the system and method of choice-making. This also helps us, the facilitators, know whether the child has truly learned to communicate what they want.

How to Present Choices

There are many ways to present choices. “Do you want crackers or juice?” “Crackers?” “Juice?” We can “scan” through the choices one by one. If the choices can be represented by photo icons or real object representations, we can lay it out in an array or field. One method of presenting choices that we have found very beneficial particularly for students with physical challenges is a method called live voice scanning (LVS), also known as partner assisted scanning (PAS). As the facilitator scans through the choices, the student signals with a ‘yes’ response (e.g., smile, vocalization) to indicate his or her selection.

Remember to start by providing smaller arrays of choices. Consider the cognitive abilities of each child when determining how many choices in an array they can handle. Even for typical adults, having too many choices can be intimidating and a communication breakdown can occur.

The ‘Yes’ Signal

For typical communicators, some of the methods we use to signal our choice are with speech, head nods/shakes, or gestures. If we were to use our speech, we would label that particular choice or we would say “yes” or “no”. If we were to gesture our choice, we would point to the particular item.

For students with complex communication needs, they may need an alternative way of signaling their choice, and the signal will depend on their physical, cognitive and sensory abilities and needs. Consider what the most natural signal would be to an unfamiliar partner communicating with them. What is most conspicuous and obvious? What is easiest and efficient to use? For instance, an arm raise is more conspicuous than a smile, but a smile is more natural. Consider and outweigh all the possibilities before landing on a signal, and keep in mind that a child may have more than one way of signaling.

All in all, choice-making may look different for each child. It may also look different depending on the setting and the communication partners involved. We need to remember that the strategies and systems we develop must be individualized and catered to each child’s abilities and needs.