Supporting Individuals to Make Choices and Share Views

By Dr Freya Spicer-White, Chief Clinical Officer

The Ask, Accept, Develop strategy works to prioritise asking autistic individuals and those with other neurodivergent profiles. This is because every individual has the right to express their ideas, thoughts, feelings, wishes and perspective about all matters which affect them and for these to be heard and respected.

Individuals learn to make decisions by being offered choices. Being able to choose allows us to feel in control, to learn about ourselves and to develop problem solving and self-advocacy skills. Like everyone else, autistic individuals and those with neurodivergent profiles should be offered choices throughout the day and supported to reflect and share information about the things that are important to them, their needs and opinions. Giving choices helps them to feel heard and that their voice is valued.

Believing an individual is able to make choices and share their views regardless of the differences, traits and needs is essential. It is working together to find ways to allow them to have a voice which must be prioritised.

Many autistic individuals and those with other neurodivergent profiles have differences and needs when it comes to understanding and using communication. There may also have other additional needs. All of these have to be taken into consideration when giving support.

How can we support individuals to make choices and share their views?

Be inclusive.

This means making sure that those individuals who are non-speaking or who elect not to speak have the necessary Augmentative and Alternative Communication (AAC) place.

Augmentative and Alternative Communication (AAC) is a term which refers to any technique, system or approach used to support or replace spoken language.  It might include the use of a signing system, objects, photos / symbols of reference, or the use of electronic equipment.

Types of AAC fall into two categories: Unaided and Aided. Unaided AAC systems do not require the use of resources or equipment. The use of Makaton as a signing system is an unaided form of AAC.  Aided Communication can be further divided into two groups, low and high-tech. Low-tech AAC does not need a battery or power source to function. Examples include the use of objects or communication books and/or boards with photos and symbols. High-tech AAC refers to an electronic device with communication software, for example an iPad with an APP; Clicker Communicator, Proloquo2go and Grid 3 are a few examples. Some AAC systems available have both low and high-tech versions, for example PODD (Pragmatic Organisation Dynamic Display).

Research shows that having access to AAC has a positive impact on the communication of non-speaking individuals of all ages and that those who elect not to speak or who can use some spoken language benefit too.

Assessment should take place before making decisions about the best form of AAC for an individual. In our services this is carried out by a Speech and Language Therapist and they might involve external agencies and organisations who are specialists in the field of AAC.

Studies show that when individuals have multiple modes of communication at their disposal it reduces breakdowns in communication. This is why, in the context of the AAD strategy, it is essential that we follow an individual’s lead when they initiate interaction and that we acknowledge and respond to all forms of communication.

Across our schools an individual’s Communication Profile summarises their communication strengths, differences, traits, needs and preferences. If AAC is recommended this will be described in the individual’s Communication Profile.

Offer choices throughout the day.

Offering choices is a way of allowing individuals to select their preference and supports them to make decisions, for example what they would like to eat, what activity they would like to do or which piece of work they would like to complete first. Offering choices develops an individual’s sense of autonomy and can promote meaningful engagement in any activity.

Choices can be offered using objects, pictures/symbols or written language. The medium and the number of choices should always take into account the individual’s communication, sensory and learning profiles. For example, some individuals may be overwhelmed when presented with too many choices and some may need choices in the form of objects rather than words or pictures/symbols.

A choice board, which in the classroom is sometimes called a learning menu, represents choices graphically often in a grid design using photos / symbols and words. Symbols are a visual representation of an object, action, concept, or idea. There are many symbol sets and Widgit is the symbol set of choice in our schools, but if an individual needs images which are more pictographic then they would be used instead.

There are different ways to make a choice, for example with eye gaze, by pointing, by exchanging, using gesture or signs, by tapping a single message or high tech AAC device, verbally or by writing things down. All methods of making a choice should be acknowledged and respected.

It is important to be non-directive and ensure that an appropriate amount and range of choices are presented. This is because too many, too few or those not relevant to the context may unintentionally direct their choice. Individuals should be offered and encouraged to make a choice but they should never be forced. They must also be allowed to make the same choice if that is their preference at that time.

Support problem solving and sharing of views and opinions.

Using a Talking Mat is one approach which can support problem solving and the sharing information. A Talking Mat is a visual way of helping individuals to express their needs, feelings and views in a structured way. It is an approach which supports them to communicate these within a specified topic, for example: places, people, activities, learning needs, sensory needs. The selected topic is represented as a symbol with words or just in words, and this is placed at the bottom of the mat in the centre. The individual is given visual options on cards one at a time within the topic and asked to group them on the mat under headings (visual scale) represented in symbols and words left to right, for example 1/ “like / yes / happy”, 2/ “not sure / don’t know”, 3/ dislike / no / sad. It is important that there is no leading on the part of the facilitator, the placing of the options is the individual’s choice and they must be given the opportunity to change their mind and add other information.

Having the information represented in this way can support further discussion around the topic and choices made. If a photo of the mat is taken it provides a visual record of the conversation which if shared will allow others to take on board and respect the individual’s needs, views and wishes.

Talking mats can be used with individuals with specific communication needs, but it is an effective tool for anyone to help with sorting information, connecting ideas and problem solving.

A physical mat and cards can be used, but there is also a Talking Mats App which can be used on an electronic device.

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