To Choose or Not to Choose? A Systematic Literature Review Considering the Effects of Antecedent and Consequence Choice upon On-Task and Problem Behaviour

Melanie Howell, Katerina Dounavi & Catherine Storey

Choice is a necessary social skill, due to the important effects that it has on the quality of an individual’s life and self-determination, including its impact on social interaction, problem solving and independence (Rispoli et al. 2013). Therefore, choice-making is a crucial life skill that individuals with disabilities have the right to learn. Allowing individuals to choose leads to a reduction of problem behaviour and increase of on-task behaviour, both socially valid outcomes for individuals, caregivers and professionals.

The present study examined choice, as an intervention strategy for adults and children with disabilities, including typically developing children, individuals with Autism Spectrum Disorders, emotional and behavioural disorders, learning disabilities, Attention Deficit/Hyperactivity Disorder and dementia or brain injury.

The three research questions examined in the study were (a) whether individuals show a preference for being provided with choice (antecedent or consequence choice) over being assigned or allocated a task or reinforcer, (b) whether providing individuals with antecedent or consequence choice is effective in increasing on-task behaviour, and (c) whether providing individuals with antecedent or consequence choice is effective in decreasing problem behaviour.

Choice conditions or preference of choice or choice-making is considered when an individual has the opportunity to select between two or more stimuli according to their preference at that time, as opposed to only one stimulus being available. In turn, preference for choice includes conditions that allow individuals to select a link that leads to a free choice condition, as opposed to a condition that allows no choice.

Choice as an antecedent is offered when the individual is allowed to choose which task or activity to engage in between two or more tasks, a procedure shown to reduce escape-maintained problem behaviour as a result of individuals accessing more preferred activities (Kern et al. 2001).

Choice as a consequence is offered when an individual is allowed to select one item or activity between two or more presumed reinforcers, warranting ongoing access to highly preferred stimuli as motivating operations change over time (Tiger et al. 2006).

The impact of choice has been evaluated by examining changes in on-task and problem behaviour. On-task behaviour has been defined in a number of ways, mainly including engagement with an assigned task or activity, asking for help, eyes on task and absence of problem behaviour (e.g., Parsons et al. 1990). Problem behaviour includes a variety of inadaptive responses, such as non-attendance or escapefrom a task or activity, physical aggression and self-injury (Humenik et al. 2008; Powell & Nelson 1997).

Overall, the provision of choice led to positive results for all or most participants irrespective of presence or nature of disability, producing an increase in on-task behaviour and decrease of problem behaviour. These positive results held true for both antecedent choice (i.e., selecting task or activity) and consequence choice (i.e., selecting reinforcement characteristics). When choice conditions led to the selection of stimuli that were equally reinforcing to those presented in the no choice condition, participants generally preferred the choice condition, i.e., choice per se is superior to no choice.

It is important to remember that as motivating operations change over time, choice ensures that changing preference is captured (Cannella, et al., 2005). As no studies reported choice leading to negative effects and a significant number of studies reported superior results for the choice condition, choice should be routinely incorporated in evidence-based interventions, especially for participants with ASD who showed the largest benefits.

More importantly, choice is a necessary element of interventions that respect beneficiaries’ autonomy and uniqueness and promote life-skills that can have a cascading effect on overall performance and well-being, such as communicating one’s needs (Kern et al. 1998, Bannerman et al. 1990). Clearly, choice should routinely be offered by caregivers and professionals by having beneficiaries select the tasks they engage in from a range of options, the order in which to complete activities and the reinforcers that follow completion.

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Summary by Sophia Petrogiannaki and Katerina Dounavi