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Choice & Meltdowns

April 22, 2013

We read a lot these days in the social care field about choice and flexibility. Every new iniative tends to get framed in these terms and the presentation is that it is always a good thing. Who could argue that having a choice over aspects of the care package is bad? Who could argue that having a flexible care package is not good? For this post, I’ll gloss over the reality for many people that what is presented as a choice turns out not to be a choice at all. Or turns out to be a choice of having shit on toast or vomit on toast for lunch. And we’ll also gloss over many people’s experience of flexibility as feeling less in control of the care package then ever.

No, the point of this post is that for some people, choice and flexibility, even when it is genuine, is not necessarily a good thing for them. For Steven, and many autistic people I know, their foundations have to be routine and predictability. Too much flexibility can be overwhelming. Too many choices can trigger a terrible anxiety meltdown.

Yesterday, ITV2 screened a back to back double bill of Toy Story 1 and Toy Story 2. Steven saw the trailers and immediately was dead excited. However, as the total viewing time was nearly four hours, I knew that something in the normal Sunday routine would have to give: we just wouldn’t have the time to fit in four hours of Toy Story and the usual stuff. So, I gave Steven a choice of what we miss: the swim at the Mencap Pool or the Sunday afternoon 2 hour Take That session. It set off a meltdown. It was stupid of me to offer a choice; it would have been better if I had made the choice. In the end, Steven settled on going swimming but was unsettled all day about missing the music session. Trying to be flexible, I suggested we did the Take That session today instead. That didn’t help the meltdown at all – Sunday is Take That day, not Monday.

This week we are trying out two new swimming pools with the intention that whichever one Steven likes best, we’ll take out a membership for. But I know that if I ask him to make a choice between the two, it will be problematic. Therefore, it feels better to gauge his responses whilst he’s there and select the one he seems to prefer.

Making a simple yes or no choice doesn’t seem to prompt an anxiety (unless it involves intruding on the normal routine). So, a question like: “Shall I get the Hootenanny Singers CD?” is okay because the answer is yes or no. However, if I said: “Would you like either the Hootenanny Singers CD or The Hep Stars CD?”, that would not be okay.

It’s funny, when in a climate of personalisation and person centred plans, the escence of those concepts can be very problematic for the person they are meant to be liberating.


From → Social Care

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