A review of choice research with people with severe and profound developmental disabilities.

E et al. read every paper they could find on choice for people with severe or profound disabilities. They grouped the work into three buckets: can the person choose, how do we build choice into daily life, and does choice change behavior.

The team looked at studies from the 1970s through the mid-90s. Most used simple preference probes: show two items, note which one the person reaches for.

Even people labeled "profound" could pick preferred items when staff used brief probes. Choice moments cut problem behavior and boosted cooperation during tasks like tooth brushing or vocational work.

The review showed staff rarely offered choices. When they did, they often skipped the probe step and guessed what the person liked.

Tincani et al. (2020) later showed the same population using speech devices, but the devices were mostly used for multiply-controlled mands. E et al. had already warned that choice is more than asking for stuff; it includes picking songs, work order, or rest breaks.

Tullis et al. (2019) extended the probe idea into transition planning. They argue you should document job and leisure preferences the same way you test reinforcers, proving the 1996 logic still drives best practice today.

Drijver et al. (2025) gave us a new adaptive-behavior scale that finally works at the severe-profound level. Pair their DIAB scores with E’s quick probes and you get a full picture: what the person can do and what the person wants.

You can start tomorrow: run 90-second paired-stimulus probes before each session. Write the top two items on the data sheet and offer them at natural points—first work task, mid-break, last five minutes. You will see less agitation and faster skill acquisition without extra staff or cost.