Offering choices

Also called Choice-making, Offering a choice of two, Forced choice

Two real options, shown as well as said, and whichever one is picked, that's what happens. Even when you'd have chosen the other.

What it is

Offering a choice means holding out two things and letting the person decide between them. Not "Do you want a drink?", which needs a yes or no that may not be reliable yet, but "Juice, or milk?", with the juice in one hand and the milk in the other.

It's the smallest possible act of control, and it's often the first one a person is ever given. That makes it a communication strategy and a dignity strategy at the same time.

Who it can help

Anyone beginning to communicate on purpose: young children, people with a learning disability, people with dementia who can no longer manage open questions, people recovering from a stroke with aphasia. It suits people at the objects of reference stage as much as people who use a device.

It is not a substitute for a real vocabulary. A person whose whole communication life is choosing between two things you've picked is being managed, not heard. Choices are a doorway, and the room beyond it is creating opportunities to say something new.

How it works

Show both options, hold them apart, and name each one as you show it. Wait (wait time, properly). Watch for any reliable signal: a reach, a look, a lean, a vocalisation, a touch on a symbol. Then give the chosen thing straight away and name it: "Juice. You chose juice."

Two things make or break it. The first is that both options have to be real. Offering "Bath, or bed?" when both are happening isn't a choice. The second is that the choice has to be honoured, including when the person picks the one you didn't want. Override it once and the person learns the choosing was decorative.

Start with a preferred item against a non-preferred one, so you can see whether the person is choosing or just reaching. Once the pattern is reliable, offer two preferred things, where the choice is harder and more meaningful.

Getting started

Build three real choices into every day. Which cup. Which cardigan. Which song. Hold the objects up; don't just say the words.

If the person uses symbols, use a choice board with two cards, or two cards from the Talk board side by side: the food and drink set covers most kitchen choices already.

Keep a note for a week of which hand or side the person picks. If it's always the right, you've found a positioning issue, not a preference, and you need to swap sides.

Where to get help

A speech and language therapist can help you find the person's reliable choosing signal and build up from two options. Mencap has plain guidance on supporting adults with a learning disability to make choices. For people who may lack capacity for larger decisions, the Mental Capacity Act requires that they're still supported to make every choice they can, and supported decision-making starts with exactly these small ones.