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Teaching people with communication impairments to respond to Yes/No questions requires a level of knowledge and understanding from the person(s) posing the question.  The person being a family member, a therapist, relevant person, or community provider. Therapists’ working on Yes/No with clients, should understand that there are different levels of comprehension and thinking from clients that require increased levels of cognitive and language processing.

There are five levels of yes/no question comprehension and cognitive thinking.  To be clear, each level should have a mastery of 90% inclusive of fluency.  Fluency is the response rate the client must answer the question.  Fluency is important because typical brain developer communication is rapid and requires answers rapidly.  While situational patience is provided sometimes, therapists’ should not depend on this when pushing our clients toward Independence.  As a therapist, my benchmark is the typical developer and typical peer social communciation, cognitive, and language skills.  After all, inclusion is real and in order to prepare our clients, we must teach them the knowledge along with the verbal fluency the world requires.

So again, 90% mastery inclusive of fluency to increase levels of learning of the concept of Yes/No.

The first level of Yes/No is the Mand, Choice making level: The Sd or prompt is typically ‘Do you want ____”.

In level one the clinician is asking the question plainly.  There is no addition of the word “or”.  You are not saying Do you want the ____ or the ___?  The reason is for clean data and clean teaching.  So often, I meet children who have splinter skills.  This does not mean that the teaching was totally in error, but the science behind the teaching was not present.  The one thing I can attribute to my learning and knowledge in applied behavior analysis, is the scientifically segment the actual skill so that the skill is learned.  My influence as a speech-language pathologist has allowed me to always make sure that programs have included reasoning, thinking, and social connectedness.    In the first level of Yes/No, the client is learning to answer a simple yes/no question related to something that he wants. When teaching the concept of yes and no, the client is tasked to learn to give an answer…then we work on fluency (Fast and Accurate).  The actual stimuli should be visually present.  Another challenge level to expose the client to answering the question without the presence of the visual stimuli.  This is real life in the treatment room.  Parents ask their children “Do you want McDondalds” before arriving to the restaurant just to name a few scenarios.   Here is what your data sheet should look like

The second level of Yes/No is the Mand, Choice making with “or”.  The Sd or prompt is now ” Do you want the ____ or the ____?”

Or is a different concept to learn.  We wait to include this exclusionary concept because the comprehension or lack of comprehension of this one word “or”, can disrupt the clients acquisiton of the concept.  By completing the first level with 90% accuracy, your are ensuring that concept of answering Yes/No for manding is present.  The clients performance here shows that as a therapist we need to be teaching the understandign of “or”, not the comprehension of yes/no.

The third level is Knowledge based Yes/No- item Name.  The Sd is now “Is this a _(item name___?”

In this skill set, its not really yes/no that the clinician is after.  Here we are asking clients to cognitively refer to their knowledge bank to answer questions.  This level of teaching should be reflective of the known knowledge.  The collaboration with other professionals who may also be working with your client is necessary especially here.  This program setlist should be reflective of the mastered receptive ID programs.  For example, if a child can identify “dog”, then I can now add to his Yes/No program by asking “Is this a dog?” But he must already know the concept of the tact-label of the item before I add this to my new level of Yes/No programming.

The fourth level of Yes/No is Knowledge Based- Category Label.  The Sd is now “Is this a _(item label)___?”

In the fourth level.  The client must have knowledge of labels.  Their receptive language programs should now be moving to ” A dog is an animal, A dog barks. A dog has four legs. A dog is a pet”.  Only when data shows clients firmly have this information, do we add this level to the Yes/No programming.  Yes no is still relevant here because classroom teachers, community, and typical developers ask questions like this all the time.

The fifth level of Yes No is Knowledge and Reasoning. 
The concepts can be related to safety, daily living, and reasoning about general knowledge.  The Sd will vary, but should be documented so that identification of difficult question forms and concepts can be tracked and taught.  An example here is “Do you touch a hot stove?  Is fire hot? “

Based upon where I am going with this, readers can probably guess that I have had or overheard one too many conversations about a child’s inability to answer “yes/no” questions.  And quite frankly, that’s not enough information.  As clinicians we should be framing statements about what our clients are not able to do at the present moment with specific statements rather than generalities.  When the statements are general, I can assure you that the data collection and teaching are not specific enough.  Further, each teaching should have an error correction procedure that outlines how the clinican is correcting the error AFTER each trial.  This necessary, because we do not want clients to attend therapy getting many many trials and opportunities to NOT LEARN.  Therapy is an unplanned expense for families, yet they come with copays, coinsurance, and private fees.  We must SLPs, ABA therapist, and all those in between (with a license :-)….should be providing specific data collection and correction procedures.

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