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  • Writer's pictureJoan Medlen

More! All Done! No Way!

Choices! Choices! Choices!

The choices we make drive the direction of our lives and our health.  Coaching people with intellectual and developmental disabilities (IDD) is driven by the choices people make. All sorts of people: the person with IDD, the people who provide support, the people they live with,  family members, health care professionals, their friends.

As with any sort of coaching for people with IDD, all these extra people means that there are layers to the process of coaching. Each one is making a choice all the time. But the choice that matters is the one made by the person with IDD. That’s why it’s called person-centered thinking and person-centered supports.

The First Food Choices

When building choice-making skills, here’s where we begin: The first choices we make are simply,



All done

No Way!

Many families use sign language as a bridge to communication as their child with IDD learns. Of course, we typically start with “more.” It’s powerful, fun, and an easy sign to pick up. I think most parents will agree….it is also the sign regretted most! For children with IDD, “more” is something like  most 2-year-olds “no.” It’s the only thing that comes out, no matter what. “More!”  “More!” “More!”

The real question is, when do people with IDD begin making them?

We assume this is something that is part of typical development. We also tend to assume if a person who is older (even just in school) has not developed these skills, it is due to a communication delay or not understanding how to answer.

But, is it?

Yes. Its’ a part of developing communication skills. But here’s the glitch: I’ve witnessed a number of children develop great choice-making skills at this level at home just to be thwarted by the environment in school. Too often the educational and support focus is on “compliance” rather than learning.  (See: Redefining Synonyms: “Submit and Comply”)

With that in mind, learning these first choices may be something you are teaching at any age of life.  Here are a few tips for teaching these fist choices:

Choose an appropriate method for making the choice.

There are many ways to make communication clear. Often, for people with IDD it is important to offer more than a verbal presentation.l Some ideas include sign language, communication boards, or voice output devices. Sometimes you have to try more than one to find the right combination.

Act on the choice made immediately.

How do we teach the meaning of these choices? We follow through!  For example, if a person signs they want “more” asparagus, I immediately provide asparagus. Two things will happen. They will be happy, or they will be confused.

This is when I like using visual tools such as photos. If they are confused, I can use the tool to say, “You told me you wanted ‘more.’  You meant to say, ‘all done.'” I show the photo or icon as I talk about it. Then I confirm, “Do you mean you are ‘all done’?”  And I offer the icons for choosing again.

Key to this method is this: do not offer anything you are not willing to provide.

Listen with the intent to hear.

Be careful to be open to any and all choices. It does not matter if you think the choice is reasonable or healthy. Your goal is to teach that no matter the choice,  you will act on it. School-aged children, teens, and adults may test your resolve and make some really interesting choices! Your job is to listen and act. Not to make the choice for them. This is your chance to prove you are a trustworthy communication partner. By respecting what they choose, you show that you listen and that they have the power to change their environment and their life.

Watch for subtle indications of a choice.

Sometimes when people are learning to make choices, or when they are not convinced their choice will be honored, they  are very subtle about telling you.  A few years ago I was working with a young man with Down syndrome on this concept. I had picture icons for “more” and “all done” available. When his plate was empty, I asked him using sign language and pointing at the icons, “do you want more or are you all done?”   And then I waited.

As I watched, he glanced quickly at the “more” icon. I wasn’t sure, however, because it was a very fleeting glance.  And then, after 20 seconds or so, I saw it. The hand closest to the more icon was tapping a finger very slowly and quietly.

I said, “I think you are telling me you want more.” I held up the icon, put it down in front of him, and gave him more.

He smiled from ear-to-ear.

from that moment forward, his choices became more deliberate and clear. He trusted that I was listening.

Be still and wait.

The hardest part about teaching choices is the waiting.  Especially for us as parents!  Remember that it takes time for what you say to be “received,” understood, organize the answer, and to deliver the message.  Wait 30 seconds or longer before you assume a choice has not been made.

Pass the test.

At some point, your child or the person you support will likely test your resolve t listening. This is especially true if you are making a switch from a very controlled environment to a self-determined one. For example, a young man I worked with was moving from his home to an apartment setting. At home his parents (and siblings!) kept a close eye on everything he ate. One time I watched as his parent threw away his food when he left the table, knowing he would want it back. When he moved to his apartment, he did what anyone would do. He pushed on all the boundaries. I coached the staff to ignore all choices, good and bad. When he ate a salad, we talked about football. When he waltzed out of the kitchen with a half gallon of ice cream and a spoon to announce he as going to eat all of it for dessert, we talked about football. After a few bites, the ice cream went back to the freezer.

This young man was accustomed to people making all the choices whether he liked them or not. By ignoring him, we were showing that he was in charge of what he chose to eat. And in a short time, he was making very healthy choices.

These are some quick tips on teaching those first choices. It is a very important skill and essential to a person’s ability to know they are in charge of their health. When they know they can make ANY decision, they will likely choose to make better ones.

Remember, it’s our job to provide the tools. When a person is in control of their choices, they are in control of their health.

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