Home Speech-Language Pathology Two Choices Are Better Than None

Two Choices Are Better Than None

by Kylie Grace Davis
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One blue and one red car

One blue and one red car

We make many little choices every day. Do I have time to stop for coffee on the way to work? Should I wash my hair today or tomorrow? Heels or flats? Ranch or vinaigrette? Imagine if someone else made all of these little choices for you. Would you be happy with their selections? Despite these being relatively small, insignificant choices, limiting them would be demoralizing and confining.

It’s important to recognize how having a choice affects our clients with communication disorders. Offering a choice between two options provides a valuable communication-partner strategy with our clients of all ages and abilities. Giving our students two choices, for example, encourages them to produce a specific response while providing a direct-language model at the same time.

Kids love the feeling of independence generated by making choices that influence their environment! Presenting them with a simple choice demonstrates the role communication plays in making requests in a concrete, immediate way: “Do you want the bear or the duck? Should we play a game or read a book?”

Giving clients choices creates opportunities to model and expand language. If a child communicates that they want to play with cars, use the opportunity to expand their concept knowledge and expressive vocabulary: “Do you want the big car or the little car? Do you want the red one or the blue one?”

Offering choices can also help set clear expectations when giving instruction. Rather than telling a child to get ready, asking them to make a choice will give them specific direction and a sense of control as they transition: “Do you want to put on your coat or shoes first? Should we walk or run in the hallway?”

These types of choice questions also help students reflect on their behavior, because the choices offered require them to be an active participant in the exchange. Choices also provide support during comprehension tasks: “Was the boy in the story happy or sad?”

In adult populations, giving two choices enables our patients to exercise immediate recall, express preferences and communicate basic needs. Some patients may struggle to respond to open-ended questions because of poor word retrieval. By presenting two options, they can provide an appropriate response while exercising recall: “Do you want to watch TV or listen to music? Do you need your toothbrush or comb?”

Asking ventilator-dependent patients yes or no questions can quickly identify a need: “Are you comfortable? Do you need suction? Do you want to sit up?” In a long-term care facility, the choices of a resident with dementia during meals and activities may get taken for granted because of a modified diet or decreased initiation. Giving residents a simple choice of two options gives them dignity and increases their quality of life: “Would you like iced tea or lemonade with dinner? Do you want ice cream or a brownie for dessert? Do you want clear or pink nail polish?”

Build in success by supplementing verbally presented choices with visuals and simple gestures, such as a yes/no board or holding out a hand for each choice. Remember to ask before assuming a client’s preference. Make sure to include wait time for your client to respond. Always respect communicated choices even if a verbal response isn’t elicited. Allowing our clients to make choices shows them we respect their desires while supporting important functions of communication.

Kylie Grace Davis, MS, CCC-SLP, works for the Montrose County School District in western Colorado. Her previous clinical experience includes skilled rehabilitation services, mobile modified barium swallow studies and tracheostomy management in long-term acute care hospitals in Denver. kylie.davis@mcsd.org


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