Adults with ID and the Importance of Everyday Choices

Image saying don't let predictability prevent possibility

Routines are great.  Until they’re not. Many of us rely on routines.  They help reduce anxiety and make our days predictable.  Everyone needs some measure of predictability. The problem comes when predictability prevents possibility.  We all deserve the opportunity to make decisions, even little ones, throughout the day, every day.

This includes people with intellectual disabilities, no exceptions.  As human beings, no one should take that away from us.

There are ways in which we can handle a little unpredictability within the scope of structured routines.  No surprise, this involves increasing opportunities for communication. First,we can begin by offering choices.  We don’t need to wait for an AAC evaluation to make this happen. When people are given choices, they retain some measure of control over their routines. This may introduce change without adding anxiety. For adults living in community living arrangements (CLAs), choices can be offered in some of the following contexts:

  • What to wear
  • What foods to eat
  • Where to go on community outings
  • What type of recreation to engage in, at home or in the community
  • What to do first (during household tasks)
  • Who to socialize with and when to be alone


The question may arise, “What if they ask for something that they can’t have?”  My response would be, how would you handle this if they were using speech to communicate?  You might say, “We don’t have (name of preferred food), but you could have (choice #1), or (choice #2)”.  Or, “We can’t go to the park right now, but would you like to help me do the grocery shopping?” For all of us, some choices may not always be possible.  You can’t leave the window open on a frigid winter’s day. You may not be able to skip going to the dentist (believe me, I would rather skip this, too). We should still be responsive to the content and context of the communication.

Image of People with ID need Voices and Choices

We know that everyone communicates.  Communication may occur through the use of multiple modalities, such as eye gaze, gestures, facial expression, body language, or words. In order to make communication effective with a variety of partners, we need to offer access to language.

We all need high frequency, everyday words that can be used in a variety of settings.  These high frequency words, often called core vocabulary, include verbs, such as do, make, want, go, stop, eat.  The list of the top two hundred high frequency words does not contain a lot of nouns.   Nouns are important, too, but you can’t make a sentence with only nouns.

At, you can print core vocabulary boards that can be used to provide access to these building blocks for language. Click the image below to see these boards and print!

Image of a core vocabulary board

They can be used for modeling language. It would be great to see laminated core vocabulary boards in every CLA (if you don’t have a laminator, use clear contact paper). At the bottom of each board, caregivers can velcro on the pictures from the individual’s daily routines, places, and preferences (use copies of these same pictures to create a visual schedule for each day).  

Teaching Communication

We teach the use of any AAC system (or visual schedule) by modeling . Modeling doesn’t have to be complicated, but it should be infused across the day.  We can talk about what to do, where to go, when to stop, what we like (and what we don’t like).  We point to the pictures, say the words, and use this as a vehicle for language.  By combining words into phrases, and eventually sentences, we lay the foundation for SNUG; spontaneous novel utterance generation.  This is just a fancy way of saying that we all need to be able to say new things.

Here is a link to a great video on modeling!

Modeling and AAC

If the person you work with uses single words, try modeling two-word phrases; “Go…work”, “Eat…breakfast.” Stay one step ahead. You don’t have to be an expert to start modeling. You just have to believe the journey is worth it, and take the first step.

Image of a decorative sunrise

Kathryn Helland

Kathryn is a certified speech-language pathologist and works with children and adults with complex communication needs. She has been with the TechOWL team since 2015 and is currently working on her doctorate. She would like to examine how to best support AAC users in higher education.

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