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Choices are commonly presented to persons with developmental disabilities using one of three modes: actual objects, pictures of the objects, or by describing them vocally. Research has suggested that the ability to indicate preferences in each mode is related to the discrimination skills the person is able to perform. Twenty direct care staff members, working in a community agency serving individuals with developmental disabilities, completed a survey to indicate the types and proportions of presentation modes they used for clients. We examined the concordance between the presentation modes and the clients' discrimination skills measured by the Assessment of Basic Learning Abilities. For clients who could perform simple visual discriminations, object presentation mode was scored as concordant and this group showed high concordance (80%). For clients who could perform visual matching-to-sample, either object or picture mode was scored as concordant and this group also showed high concordance (81%), although object mode accounted for 70% of the concordance. For clients who could perform auditory-visual conditional discriminations, there was a large increase in vocal presentations relative to the other groups. The findings suggest that staff presented choices predominantly in modes that often matched their clients' discrimination skills. The apparent overuse of object mode and underuse of picture mode with clients who could perform visual matching-to-sample discriminations was surprising. Possible reasons for these findings are discussed and suggestions are made for facilitating the use of pictures in decision making for staff working with clients with developmental disabilities. [ABSTRACT FROM AUTHOR]

Choice is now recognized as a fundamental right of persons with intellectual and developmental disabilities (IDD) in the United Nations Convention on the Rights of Persons with Disabilities. In Ontario, the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act requires providers of services for adults with IDD to support them in making choices. However, efforts to implement services that promote choice have been limited by the lack of a practical understanding of choice. In this scoping review, the scientific literature on choice is contrasted to the lived experience of per- sons with IDD to both clarify the meaning of choice and identify what components of choice should be measured when evaluating IDD services. Through a review of the English-language literature published between January 1, 1991 and December 31, 2011, four components were identified as necessary for choice to occur: the availability of choice opportunities, the provision of choice options, an informed cognitive process and act of choosing, and a supportive environment. Feedback on these findings was sought from a range of stakeholders, including persons with IDD, family members, and representatives from service agencies that support persons with IDD. The results of these consultations are presented. Challenges with implementing the concept of choice at the service level is discussed. [ABSTRACT FROM AUTHOR]