-Nathan E. Ory, M.A. Registered Psychologist

There are subtle aspects about how we verbally interact with persons with disabilities that sometimes make a great difference in their ability to respond.

Closed choice: "Do you want to do XXXXX?" Only one option is offered. The answer is "yes" or "no".

For some people this is a perfect way to assist them to focus on the option that is available to them. There are no further concerns. For the person who is capable of coming up with their own alternative, this approach leaves them with the option to self-initiate "I'd rather do something else."

For some people this type of question or choice will always be answered with a "No!" This can lead to attempts by caregivers to attempt to persuade, bargain with or confront the person. The "automatic no" may be an answer which serves several purposes:

- If you state the question in this manner you imply that person has the option to say no. Having the control and being able to say "no" may be more important to the person than doing the offered activity.

If you do not mean to accept whatever answer the person is going to give, don't ask in this format.

- If person doesn't know what they want to do, giving an automatic "no" solves their uncertainty.

If this is the issue it often helps to "talk to the atmosphere" before you offer the choice or question to the person. This means to "talk out-loud" to yourself about what you are thinking about doing. State the positives and negatives that you think may be going through the mind of the person you are offering to make this choice. Then turn to the person and ask this question. You will have already stated and resolved the uncertainties. The person will be aware of the "right answers", and only have to recognize which of these are relevant to themselves at the moment. This makes it easier for them to be certain about whether they actually want to say "yes" or "no".

- If person has language processing problems, or does not know exactly what you mean, the automatic "no" protects person from getting into something that may be unwanted. The automatic "no" also gives person time to think.

If this is the issue, often the person will come along or participate if you simply start doing the activity yourself. The "choice" is offered non-verbally, through your own actions. The person's "decision" is whether or not they participate.

- Person may say "no" because they feel like they are not being given a real choice.

If this is the issue, it may be better to offer the person a choice between two options in the form of a "forced choice."

Forced choice: "Do you want to do this or that?" Two options are offered. The answer is one or the other.

For some people this is the perfect way to offer choices or questions. The options are defined by the question. The person only needs to recognize which is their preferred option. Whichever option the person chooses will be the "right" choice. For the person who is capable of coming up with their own alternative, this approach leaves them with the option to self-initiate "I'd rather do something else."

For some people, forced choices may cause them great anxiety. They may not know which choice they want, or they may want both choices and be unable to resolve their own conflict.

It is better to use "closed", single-option questions and choices for people with difficulty resolving conflict, who are unable to recognize what they want, or who are unwilling to make the "wrong" choice.

Some people will refuse any idea that was not their own idea.

If this is the case it may be better to offer an "open-ended" choice.

Open-ended choice: "What do you want to do? Person is offered the choice to come up with their own option.

For some people this is the perfect way to offer a choice. It gives them a sense of being in control, being responsible and being expected to think and decide for themselves.

For some people this causes great anxiety. They may have no idea what they want to do. They may have no idea what you mean. They may be unable to sort out their own confusion or conflict about what they want to do.

If this is the case the person may become unable to orient, may "freeze", may become agitated, angry or aggressive towards the person who has asked a question or given a choice in this manner. Person experiences this type of question as "pressure".

If you see that person has difficulty with "open-ended" choice, it may be better to offer "closed choice" or "forced choice" type questions.

For some people, who intepret language literally, offering "open-ended" choice ("What do you want to do?") may be interpreted by them as licence and permission to do anything that comes into their mind at that moment. They may not understand that the question was a request for them to state their preferences, rather than an obligation assumed by their caregiver to immediately do whatever was requested.

They may become quite angry that the choice they made (now it is in their mind) is not able to happen at the immediate moment they make it.

If you see that a person interprets open ended choices in a manner that results in frustration and conflict it may be better to offer "forced-choice" or "closed choice" type questions where the caregiver defines the context. This way "the customer is always right" and can pick either choice and have whichever one they asked for.

Nathan E. Ory, M.A.

Registered Psychologist

23 November 2000

Island Mental Health Support Team