Making Preference Assessments More Acceptable and Effective for People with Dementia
Slowing down and watching mood makes preference tests kinder for adults with dementia without changing what they choose.
01Research in Context
What this study did
Bigwood et al. (2026) worked with the adults living with dementia in a day program.
They compared two ways to find out what each person likes: the usual quick preference test and a slower, clearer version.
The team watched for smiles, frowns, and correct choices during every trial.
What they found
Most participants smiled more and frowned less during the adapted test.
Item choices stayed the same, so the tweaks did not change what people picked.
Staff and family said the new method felt kinder and easier to follow.
How this fits with other research
MacNaul et al. (2021) showed that paired-stimulus tests give stable results when repeated every 8–30 days. Bigwood used the same format, so the dementia data fit that rule.
Rojahn et al. (1994) first proved paired tests beat group methods for people with severe disabilities. Bigwood extends that finding to dementia, showing the format still wins when you slow it down.
Enkelaar et al. (2013) found balance tests work for older adults with intellectual disability. Bigwood echoes that theme: small, thoughtful changes make standard tools usable for new groups.
Why it matters
You can keep using paired preference tests with dementia clients. Just speak slower, give extra time, and watch faces. You will get the same reinforcer list while keeping clients calm and happy.
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Add a 3-second pause between item pairs and record a quick smile or frown after each choice.
02At a glance
03Original abstract
Abstract For people with dementia, meaningful engagement with preferred activities is a vital component in maintaining quality of life. Preference assessments have been found to identify preferred and reinforcing stimuli for people with dementia. However, because they have been predominantly validated for individuals with intellectual or developmental disabilities, there are likely aspects of the assessment that need to be adapted. We implemented standard stimulus preference assessments for four people with dementia, and designed some adaptations based on objective measures of their choice, affect, verbal responding, and the input of the participants. We then compared the standard and the adapted versions in a multielement design. We found that both the standard and adapted assessments resulted in similar selections of stimuli. We observed an increase in indices of happiness and a decrease in indices of unhappiness for three out of four participants during the adapted version compared to the standard version. Family, staff, and the people with dementia reported both the standard and adapted preference assessments to be socially valid. One participant reported better understanding what they were being asked to do in the adapted assessment, and a staff member reported the adapted assessment to be more effective. We also found a decrease in the frequency of statements that were off-topic, socially polite, or about items being “sold” to them across all four participants in the adapted assessment. We further extended the work of Reid and Green (1996) by incorporating indices of confusion to capture a broader range of affect. On the basis of our results, we give some examples of how to make preference assessments more acceptable for people with dementia.
Behavior Analysis in Practice, 2026 · doi:10.1007/s40617-025-01145-x