Daily Excerpt: Choice and Structure for Children with Autism (McNeil)
excerpt from Choice and Structure for Children with Autism -
Structured
Choice
Presenting two to four choices to
children multiple times throughout each activity will help them to be
cooperative, focused and engaged. Further the presentation of choices gives
children an opportunity to share their thoughts and interests helping them to
feel worthwhile and significant. These feelings raise the level of a child’s
self-confidence. Self-confidence feels good, improving the child’s mood and
relationships. In the following sections, insights to the details of Structured
Choice are provided. It may seem like quite-a-bit of information, yet once
processed the act of utilizing Structure Choice is quick, easy and empowering
for both children and adults.
How Many Choices to Offer?
Here are some tips for deciding how many choices to offer:
Two choices:
·
Two choices are good during natural conversation
where two options are easy and frequently offered.
·
Two choices are good in a pinch where you are
trying to influence cooperation or engagement with particular activities. Giving
two choices when you can’t quickly think of a third will, at minimum, give the
child an opportunity to make a choice. Giving any opportunity to make a choice
is better than no choice at all.
·
Make your choice a “This or That” question. Do
not make the choice a “yes or no” variety. Yes/No questions are too abstract or
meaningless for many autistic children and may cause more harm than good. Abstract
concepts are those with no physical form, action, or picture to attach meaning.
These are very difficult for autistic children to understand. Further, yes/no
questions open the door to an accept/refuse conflict that may prompt a power
struggle. A “This or That” choice has a concrete form to see and is more productive.
If deciding between “this or that” the child’s focus is on accepting an offer.
When focusing on accepting something there is a mental shift away from a
want/don’t-want power struggle. “This or That,” is a choice that can be
cooperatively achieved.
·
Limit your words. When in a situation where you
are only giving the choices through spoken instruction there is no item for the
child to see. In this instance two choices may be the most information the
child can process. Try to structure your spoken language so that the choice offered
is only one or two words long. This will allow the autistic child plenty of head
space to process the information heard. Ask your child questions such as, Do
you choose to drink milk or juice? Would you like to paint or color?” The
choices “Milk/Juice,” or, “Paint/Color,” can be repeated independently of the
entire sentence. This repetition will act to highlight the important spoken
information. Using your right and left hand to represent the choices may also
help the child focus the subject on a physical spot. This provides 2 small pieces
of spoken information, “Milk/Juice, or, Paint/Color,” and a visual spot to
imagine physically placing the items. As a result, communication and
comprehension are assisted allowing the child to make a clear and quick choice.
Three choices:
·
Three choices are ideal as it is not simply an
either/or of the two-choice variety.
·
Three choices are few enough so that decisions
can be quickly made.
·
Three choices are less likely to overwhelmed the
child than larger numbers.
·
Three Choices require visual supports: Visual
supports are anything the child can see that helps provide information about
the choices being offered. Visual supports are always a good idea when
presenting information to children with autism. Even if just a single item is being
offered such as showing a cup while asking, “do you want a drink?” a visual
support helps. The more pieces of important information that is presented, the
more essential visual supports become. Once three or more options are offered
it becomes vital to use visual supports to aide in comprehension. These
supports also assist in the ability respond and clearly communicate the desired
selection. More information on visual supports will be presented in Chapter 6,
Comprehension and Communication.
Four choices:
·
Four choices can work if there is good reason
for that many choices and visual supports are easily managed.
·
It all depends on the circumstances:
o
if the box of popsicles comes in four flavors
then, ok, let the children pick from all four flavors.
o
If all the other kids get to pick from four
types of stickers then, ok, allow your child to pick from the same four.
·
Remember, visual supports and limiting your
words will be even more important with more choices.
Five or more choices:
Too many choices are counterproductive.
Plenty of children struggle when the choices become too abundant because they
can’t focus on so much information at once. Children with autism are even more
distracted by such high levels of information. Autistic children may take a
long time deciding, or become overwhelmed by many choices and be unable to
choose anything. Or, in a situation of free-for-all choices many children with
autism will repeatedly only choose items on which they are fixated. Providing a
smaller selection of choices during each opportunity and limiting access to
fixation items will help the child to expand their engagement with other
activities. Keep your choice options simple. Shoot for three choices as the
norm and adjust down to two or up to four as the situation requires.
How to Offer a 3-Item Choice?
Here I offer you an example of how
to walk through offering a 3-item choice using naturally occurring items.
·
Present the item while speaking your offer: When
asking a child to choose from 3 items such as milk, juice and water, if
possible, hold or place all three items at equal distance apart.
·
Ask, “would you like milk,” (gesture toward or
push forward the milk), “juice,” (gesture to or push forward the juice), “or
water?” (gesture toward or push forward the water)?”
·
Pause a few seconds to allow the child to
respond.
·
If no response: Quickly repeat the offer a
second time reducing your verbal language. Only speak the item name and repeat
the indication of the item. “Milk, (gesture), Juice (gesture), Water
(gesture)?”
·
Here it is important to pause and wait for the
child’s response for at least 10 seconds.
·
If no response, repeat the offer again using the
reduced verbal language.
·
Allow the child to make his/her preference known
through whatever means is most independent.
·
Immediately give the child the chosen
item/activity!
·
Voila you are done. See? Quick, easy, and
empowering!
One Last Tip on Structured Choices
It is important to allow the child
to respond and indicate their choice through whatever means the child is best
able to communicate. If it is simply taking the preferred item, that’s great! If
it is pointing or words, that’s awesome, too! While it is often good practice
to teach new expressive communication skills throughout the normal activities
of the day, be careful not to make every choice a challenging communication
lesson. The choosing exchange itself is the focus here, not necessarily working
on the child’s speech and language goal. Practice these occasionally, yes, but if
you spend too much time practicing new challenging speech and language skills,
then your focus is in the wrong place. Structured Choice is not meant to frustrate
and discourage children. If it is too hard to make choices, children will avoid
doing so. Structured Choice is designed to be a quick and easy way to support
children’s cooperative interactions.
In Practice
Breakfast with Kiaan
Kiaan wanders sleepily into the
kitchen and finds his mother standing at the stove. “Good morning, Kiaan,” Mom
engages her precious 7-year old. “Look, I am making omelets, I know you love
omelets.”
Kiaan turns away and goes to the
cupboard to pull out some cereal. When he gets there, he finds a lock on the cupboard
door. Over the past weeks of school vacation, Kiaan has developed a routine of
pulling several boxes of cereal out of the cupboard and eating from them as he paces
around the living room. This habit seemed to form quickly and has started to
concern his mother. As Kiaan wanders the living room, he often drops pieces of
cereal and smashes the food into a big mess while traipsing across the same
area over and over. Further, Kiaan is eating from several boxes at a time, and
he becomes anxious and quarrelsome if his siblings try to take a box for their
own breakfast.
Kiaan’s mother would prefer he
and his siblings ate more of the healthy foods that she usually serves. During
school days, Kiaan’s mother regularly cooked breakfast for the family, and they
ate sitting together at the table. Cereal was only served on the weekends to
give Mom a break and support the sleep-in as late as you wish Saturday
schedule. Now that the kids are staying home from school, every day has become
Saturday, and Mom realizes that she is not happy with the habits the family is
developing. So, this Monday morning Mom is determined to set the routine back
to normal at least as far as meals are concerned.
Kiaan pulls Mom by the hand as a
way of asking her to open the door so he can get the cereal. Mom discusses the
locked cupboard with Kiaan, then says, “Today is Monday, and we are eating omelets
for breakfast, come see what we have.”
Kiaan doesn’t follow his mother and
instead keeps trying to open the door where the cereal is stored. Knowing Kiaan
loves bacon, his mother shows him a selection of bacon pieces, crumbled sausage,
and quinoa, then asks, “what would you like in your omelet?”
Kiaan predictively chooses the
bacon pieces, and Mom gives him a tiny bite to taste as she puts the plate on
the counter. Then, showing him tomatoes, broccoli, and sprouts asks, “which one
would you like in your omelet?”
Kiaan chooses the tomatoes, and Mom again gives him a tiny portion to taste. Kiaan gives up on opening the cupboard, wanders into the living room, and begins to pace.
When the omelet is done cooking Mom calls Kiaan into the kitchen to sit at the table and eat breakfast. Kiaan ignores his mother and continues pacing. Mom tries again, and Kiaan is more direct in his protest. He begins whining and running to the other side of the room.
Placing his food on the table, Mom asks, which fruit would he like: strawberries, apples, or cantaloupe? Strawberries are his favorite fruit, and he comes over to the table to make a choice. Kiaan reaches for a strawberry while simultaneously turning to run back into the living room with it in hand. Mom pulls the bowl of strawberries back from his reach, and when he misses the grasp, he stops and looks back at where the bowl was.
Immediately Mom asks, “Would you like to sit in your chair with a pillow under your bottom, a blanket on your lap, or all alone.” Placing items briefly on the chair she reemphasizes the choices, “Pillow, blanket,” and indicating an empty chair, “alone.” Kiaan loves his little blue blanket and agrees to sit on the chair with his blanket in his lap. Mom arranges his food in front of him and offers him a choice of drinks. Kiaan has now settled into his old breakfast routine of eating at the table and is happy and cooperative with his mother.
Discussion
Providing structured choices to children with autism
accomplishes the benefit of focused attention, a sense of personal control, and
a base for pleasant interaction between caregiver and child. In the above story,
Kiaan’s mom has a good grasp on providing structured choices to help Kiaan feel
good and remain cooperative even when his expectations are, at first, unmet.
The following sections will explore the important pieces weaved throughout the
story that show the benefits of providing an abundance of structured choice
opportunities daily.
Winner, Pinnacle Book Achievement Award, Category: Parenting
Edition 1: Winner of Readers' Views Gold Award for Education
Edition 1: Winner of Readers' Views Silver Award for Parenting
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