Service Delivery

Offering choices to people with intellectual disabilities: an interactional study.

Antaki et al. (2008) · Journal of intellectual disability research : JIDR 2008
★ The Verdict

Small shifts in how you offer choices—using either-or wording and cutting tag questions—let adults with ID answer faster and more often.

✓ Read this if BCBAs and RBTs who support adults with intellectual disabilities in residential or day programs.
✗ Skip if Clinicians working only with verbal, grade-level clients who already initiate complex requests.

01Research in Context

01

What this study did

The team watched and coded staff talk in a group home.

They wanted to see how workers offered choices to adults with intellectual disabilities.

Six common phrases were tracked, such as “Do you want X or Y?”

02

What they found

Some friendly phrases backfired.

Tag questions like “…right?” and open-ended “What do you want?” often froze the resident.

Short either-or questions led to quicker, clearer answers.

03

How this fits with other research

Lowrey et al. (2017) saw the same wording trap in schools. General-ed teachers used flexible UDL talk but rarely linked it to students with ID, so choice stayed vague.

Bigham et al. (2013) filmed special-ed lessons and counted turns. Teachers took most of them, echoing C et al.’s finding that staff voice can dominate unless tightly cued.

Together the three studies span adults and kids, homes and classrooms, yet tell one story: whoever controls the words controls the choice.

04

Why it matters

Your phrasing can open or close a decision in seconds. Swap “What do you feel like doing?” for “Puzzle or music?” and you give a clear path to answer. Try it at the next meal, activity, or break time and see responses speed up.

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→ Action — try this Monday

Present the next daily choice as two visible options with a single question: “Toast or cereal?”

02At a glance

Intervention
not applicable
Design
qualitative
Population
intellectual disability
Finding
not reported

03Original abstract

BACKGROUND: At the level of policy recommendation, it is agreed that people with intellectual impairments ought to be given opportunities to make choices in their lives; indeed, in the UK, the Mental Capacity Act of 2005 enshrines such a right in law. However, at the level of practice, there is a dearth of evidence as to how choices are actually offered in everyday situations, which must hinder recommendations to change. METHOD: This qualitative interactional study, based on video recordings in British residential homes, combines ethnography with the fine-grained methods of Conversation Analysis. RESULTS: We identify six conversational practices that staff use to offer choices to residents with intellectual disabilities. CONCLUSIONS: We describe the unwanted consequences of some of these practices, and how the institutional imperative to solicit clear and decisive choice may sometimes succeed only in producing the opposite.

Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2008.01101.x