Using Choice Outside of the Clinic

Studies have shown that giving clients the opportunity to make choices in matters regarding their treatment can actually make treatment more effective! You might be asking yourself, “What does this look like outside of the clinic? How does choice align with me getting my child to do the things they need to do, but hate to do?” When a BCBA, like those found at our clinic, encourage caregivers to incorporate choice, we are not suggesting that the child gets to do anything and everything they want. Choice can be added naturally to your caregiving, without disrupting your ability to care for your child. You may find that adding choice may actually make it easier to get your child to do the things they don’t want to do, but are important…like tooth brushing!

Some children find toothbrushing to be a particularly aversive activity, but it’s important to their health and should be done. If your child hates brushing their teeth, choice can be incorporated to increase toothbrushing and/or decrease problem behavior during toothbrushing. One way to add choice to their tooth brushing time is to allow them to pick which toothbrush they would like to use each time they brush their teeth. Provide your child with two different toothbrushes that are theirs, and allow them to pick which one they would like to use each time they brush their teeth. As the caregiver, you probably know which toothbrush they will pick each time. However, still allowing the child to pick which brush they will use will give the child some autonomy and personal investment in the activity. If you can occupy the child with deciding on a toothbrush, you may find that they spend less time flat out refusing to do the activity. It’s also important to make sure there aren’t so many options that the client becomes overwhelmed. Choice could also be incorporated to this activity by allowing the child to pick between mint toothpaste, cinnamon, or bubblegum flavored toothpaste. If you are struggling to help the child brush for long enough, try asking the child, “Would you like to brush for two minutes or two-and-a-half minutes?” These are a few small steps that any caregiver can take to increase compliance for necessary tasks, without having to significantly disrupt your normal routine.

Another example of where choice can be used is with breaks. If you see that your child is getting upset and they need to take some time away from an activity, you should to give them a choice on whether or not they take a break. You can let them choose what they want to do during their break (draw vs nap), how long they want their break to be (three minutes vs five minutes), or where they take their break (at their desk vs on the floor). For example, you can ask them if they want to be away from their toys for four or five minutes. This will not only give them some control over their environment and themselves, but will also provide them with an opportunity to evaluate what they are feeling, how they are feeling, and what they need to feel better. Caretakers tend to be familiar with the cues that precede problem behavior, something that your child might not. Gently intervening when your child begins to exhibit signs of distress and offering them a choice about what you believe they might need to feel better is a great way to teach them to be aware of when they need to pay more attention to regulating their behaviors and how to do in a healthy way.

Our team is focused on providing assistance to caregivers and clients in a way that will foster independence, autonomy, and self-advocacy in clients. Providing small choices, throughout every day, is an excellent place to start teaching clients how to be more independent while continuing to pursue their therapeutic goals. Choice is not a cure-all and will not fix every problem behavior under the sun; however, choice is a powerful tool to foster independence in your loved one and help you and your child tackle those problem behaviors more effectively and efficiently.

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