Q&A with the Expert: Decision Making with Children who have Social and Communication needs

This Q&A is with Sarah. She has over ten years experience as a special educational needs coordinator in a mainstream nursery, and now works as an early years practitioner in a specialist setting. In this Q&A, she talks with us about encouraging the communication needed to make decisions, and how even children with high levels of need can communicate what they want.

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Q: Can you tell us about your role?

A: I work in a specialist provision attached to a mainstream nursery where we support children who have been identified as having social and communication needs, including autism. The unit provides a communication-centred environment that supports the children in all areas of their learning.

Q: What sort of approach do you take?

A: Firstly, we like to have fun! We provide ‘irresistible invitations’ to join in, communicate and have fun together!

It’s important that children enjoy coming along to their sessions!

We also encourage communication and decision-making in whatever way works best for the child. We always give lots of opportunity for looking, listening and choosing within a highly structured session. The session being predictable helps the children to manage this communication and know what to expect.

Q: You mentioned there that you encourage children to make decisions. I imagine that can be difficult with a child who struggles to communicate. How do you manage that?

A: It is a challenge!

Some of our children are able to use single words to make a choice, while others are preverbal so we take our lead from where the children are.

With our children who have no words, we might first look at eye gaze, offering just two visual choices and seeing which way they are looking. We interpret that eye gaze as a request and honour it, repeating the word as we give them the item. When we start this process we make sure that we are using highly motivating items – food often works well or favourite toys.

The next stage might be to encourage them to use a pointing finger to make a choice between several items. We could be doing that for some time, and again we take our lead from what the child is ready to do.

As they progress we can use objects of reference, for example showing a ball to represent the ball pond or a light spinner to represent the sensory room. The children can then show us their preferred activity! They first do his with eye gaze, then pointing finger towards the objects. Depending on what works for the child we can go on to use photos and/or symbols of the activities for them to use.

We make sure we are able give them what they have chosen initially so that they learn that communicating their decision is worth it – it helps them get that toy they really want or a favourite snack or go to the place they have chosen!

We slowly help them to move towards being able to communicate what they want in a way that other people can understand too, such as using picture exchange communication systems (PECS), photos or signing if they are not yet verbal communicators. However many of our children do begin to use speech to make requests once they have worked out that it can help them get their needs met.

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Q: That’s so important isn’t it, so that the children can make decisions as they grow older and move on to other places.

A: Yes, we want to use techniques that the child can transfer to other settings so that they always have a way to communicate

Q: You said earlier you often only offer two choices. Why is that? Why not ten choices?

A: Well actually we sometimes start off with just one highly motivating thing, so that the child learns that there is a way to get that one item they really want.

Q: That’s really interesting. I guess it’s a way of setting the child up for the decision and showing them how they can communicate what they want

A: Yes, I remember having a child who loved music on the CD player so we gave him a photo of it on his communication book. Every time he gave us that photo, the CD player went on and he got the music he loved. Once he got the hang of that we could introduce one other thing, and he could choose between two options. Then even when the CD player was not an option, he had learnt how to make and communicate a decision about other things.

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Q: So how come you start with one thing, and then two, and then three? Surely more choice is better?

A: Not necessarily. Once children are used to using a communication method it is possible to offer lots of choices of course. At first though children can get overwhelmed if there are too many options. They tend to give symbols of things they don’t really want and make random choices. That just leads to frustration all round! It is easier to make a choice from a limited range initially but once they have the skill they can move on to a wider range of options. With practice they become able to tell us what they want without needing prompts from us.

Q: What about telling you what they don’t want?

A: Yes, it’s really important that they can tell us what they don’t want too. We use the same set of visual cues and phrases when we communicate with them. So if they don’t want a certain snack, we model saying ‘no’ and signing this in the same way each time. After a while they learn that this is ok and become able to use the phrase or sign to tell us they don’t want something, This skill then becomes generalizable, so that they can tell others when there is something they don’t want in other settings.

Q:So, are there any challenges when you have to make a decision as an adult and you need the child to go along with that?

A: That’s often an issue, because when the child is having a nice time they may not want to stop and move on to something else! However, there will be times when they need to sit and listen, or come in from outside and do something they don’t want to do. That is never fun and we all appreciate that.

The thing that we find helps is giving a warning that an activity is coming to an end and also using pictures to show ‘Now, we are doing this; Next, we will do that’.

It helps them understand what is happening. If the ‘Now’ is something I want them  to do, it always helps if the ‘Next” is something I know they want to do!

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Q: That’s something we hear a lot at Open Talk. Understanding what is happening and what will happen next is so important for helping children feel in control. We often think about it with older children understanding complex decisions about their mental health. It’s interesting to think about it with younger children who have additional needs. No one wants to feel that they have to go and do a horrible thing they don’t want to do with no understanding that it will end, or that there is a fun thing to follow!

A: Yes, it can help them to engage in the activities too, because they know what is happening and what’s happening afterwards.

Q: I think I’m the same! So much easier to go to work if you know you’re going down to the pub afterwards!  Maybe that’s a good place to leave it! Thanks so much for talking to us and sharing what works for you, we really appreciate it.

A: You are very welcome.