Assisting older adults with severe disabilities in expressing leisure preferences: a protocol for determining choice-making skills.

We evaluated a protocol involving two types of choice presentations for assessing leisure choice-making skills of seven older adults with severe disabilities. Initially when presented with pairs of objects representing choices, choice making was validated through demonstration of an object preference. A more complex choice-presentation format was then employed, involving pictures to represent choices. If the preference identified with objects was not demonstrated using pictures, a replication of the object format occurred to ensure changes in choice making using pictures was not due to a preference change. Five participants demonstrated choice-making skills using objects and two demonstrated choices using pictures. These results reflect the importance of assessing choice-making skills prior to presenting choice opportunities. Suggestions for future research focus on expanding the assessment protocol to include a wider array of choice-making skills and training staff to provide choices in a format commensurate with an individual's skill level.