10-Minute Speech Practice That Doesn't Require Sitting Still

Last updated 2026-07-11

Why choice-making matters so much for nonverbal kids

Choice-making is not a luxury skill. It's one of the earliest foundations of communication, and research consistently shows that giving nonspeaking children control over their environment reduces challenging behavior, increases engagement, and builds the motivation to communicate more.^[1] When a child can't yet say 'I want the red cup,' the ability to point at it, look at it, or touch a picture of it gives them the same functional outcome.

The American Speech-Language-Hearing Association (ASHA) describes choice-making as a core part of functional communication and a natural entry point into augmentative and alternative communication (AAC) systems.^[2] That framing matters. It means choice-making practice counts as communication therapy. It's more than something nice to do during snack time.

For autistic children, kids with apraxia of speech, or children with complex communication needs, the path to spoken words often runs through non-speech communication first. Teaching a child that their signal means something, and that adults will act on it, builds the very foundation that later language sits on. See our overview of early intervention for the research on why acting early on communication skills changes long-term outcomes.

What does 'making a choice' look like without words?

A choice can look like any consistent, intentional signal, and your job is to spot it and respond. Most people picture pointing and speaking. But for a nonverbal or minimally verbal child, the signal might be a glance, a reach, or a single repeated sound.

Common non-speech choice signals include:

• Eye gaze: the child looks at one option, then the other, then back to the preferred one
• Reaching: extending an arm or hand toward the desired object
• Touching: physically contacting the chosen item or its picture
• Gesturing: a nod, head shake, or a personal idiosyncratic movement the family has learned to read
• Vocalizing: a sound, squeal, or change in breath that consistently accompanies a preference
• Activating a device: pressing a button on a speech-generating device or tapping a picture on a communication app

None of these is a lesser form of communication. They're all real answers. The research on supported communication^[3] and on natural aided language input^[4] is clear that any reliable, repeatable signal deserves a full communicative response from the adult, meaning you say the word, hand over the item, and treat it exactly as you'd treat spoken language.

Not sure whether your child's signals are intentional? Watch for three things: consistency (they do it more than once in similar situations), directionality (the signal points toward something specific), and persistence (they repeat it when you don't respond right away). Those three together are strong evidence of intentional communication, even without speech.

How many choices should you offer a nonverbal child?

Two. Start with two.

This isn't arbitrary. Working memory and processing speed vary enormously among children with complex communication needs, and a field full of options is genuinely harder to parse than a binary choice.^[5] Two options reduces the cognitive load, makes the array visually cleaner, and gives the child a 50% chance of success on the very first try, which matters for motivation.

Once your child is reliably choosing between two items in three or four different contexts, you can expand to three. Most speech-language pathologists recommend adding a third option only after the child demonstrates consistent, unprompted choices with two for at least a couple of weeks across different settings and communication partners.

A few structural rules that make two-choice arrays work better:

For children who use eye gaze as their primary signal, physical positioning matters even more. Some kids need the items held slightly apart at eye level. Others do better with items placed on a flat surface where they can shift gaze without needing to track a moving hand.

How long should you wait for a response?

Longer than feels comfortable. Seriously.

Most adults wait about one to two seconds before repeating the question, adding more information, or redirecting. That's far too short for many nonspeaking children, particularly those with motor planning difficulties like childhood apraxia of speech or those who process language more slowly.

Speech-language research on response latency suggests waiting 5 to 10 seconds is a reasonable starting point for children with complex communication needs, and some children need more.^[6] This is called 'expectant waiting,' and the physical stance matters. Look at your child with a calm, expectant expression. Lean slightly forward. Resist the urge to fill the silence.

What you're doing during that wait time is communicating something important: I believe you have an answer. I'm going to hold space for it.

If no response comes after 10 seconds, you have a few options. You can repeat the choice offer, offer a model (touch one of the items yourself), or accept a partial signal like a gaze flicker and treat it as a response. What you shouldn't do is answer for the child or move on as if the opportunity didn't exist. That teaches the child their response timing doesn't matter, which is the opposite of what you're building.

Which methods work best: pictures, objects, eye gaze, or AAC devices?

It depends on the child, and any competent SLP will assess motor skills, vision, cognitive profile, and sensory sensitivities before recommending a primary method. Here's a practical breakdown.

Real objects work best for children who are very early in their communication development, have significant cognitive delays alongside their language delay, or respond better to tactile input. Hold up a real apple and a real cracker. The child touches the one they want. Simple, concrete, no symbol system required.

Photographs and picture symbols (like those in PECS, the Picture Exchange Communication System) are the most commonly used method in school settings. A 2010 systematic review in the American Journal of Speech-Language Pathology found evidence that PECS improves communication outcomes for autistic children, though the review noted the evidence base was small and the quality mixed.^[7] Pictures are cheaper and more portable than devices, but they require a symbol library and consistent partner training.

Eye gaze is ideal for children with significant motor limitations who can't easily reach or touch. Low-tech eye gaze frames (two pictures held in a cardboard frame with a hole in the middle for the child to look through) cost almost nothing. High-tech eye gaze systems can run $8,000 to $15,000 or more. The low-tech version is a completely legitimate starting point.

AAC devices and apps sit at the highest-access, highest-cost end of the spectrum. Learn more in our article on AAC devices for a full breakdown of options by cost and feature. Many insurance plans cover dedicated speech-generating devices when prescribed by an SLP. The coverage path runs through Medicaid or private insurance with a letter of medical necessity.

For families who want an app-based bridge while waiting for a full device assessment, Little Words offers a quiz that matches your child to tools and strategies based on their current communication profile.

None of these methods is mutually exclusive. Most children with complex communication needs use more than one, depending on the setting and the communication partner.

What is natural aided language input and why does it matter for choice-making?

Natural aided language input (NaALI, sometimes called aided language stimulation) is a teaching approach where the communication partner models AAC use while speaking. So instead of just saying 'Do you want juice or water?' you also touch the juice symbol and the water symbol on the child's board as you name each one.^[4]

This matters enormously for choice-making because children learn symbol systems the same way they learn spoken words: by watching people use them. If a child never sees an adult use the picture board, they have very little reason to believe those pictures are meaningful communication tools.

The research on NaALI is genuinely promising. A study published in Augmentative and Alternative Communication found that children whose partners used aided language stimulation showed more diverse AAC use and more frequent communication acts than comparison groups.^[8] The sample was small, which is honest to note, but the mechanism is logical and consistent with how language modeling works in typically developing children.

Practically, this means: put a copy of your child's communication board somewhere you can reach it. When you ask a choice question, touch the symbols as you say the words. Every time. Even before the child starts using the board themselves. Especially before.

How do you build choice-making into daily routines?

Embedding choice opportunities into existing routines beats setting aside dedicated 'choice practice' sessions. The goal is dozens of real choice moments per day, not five structured trials.

Here's a practical map of where choices fit naturally:

Morning: Which shirt? Which cereal? Which cup? Which YouTube video? Snack/meals: Which snack? Where to sit? Which spoon? Play: Which toy? Which game? Go first or watch first? Bath/bedtime: Which towel? Which book? Which stuffed animal? Transitions: Walk or be carried? Shoes on first or coat on first?

These aren't trivial choices. They're high-motivation moments where the child has a genuine stake in the outcome. That motivation is the engine. A child who genuinely wants the red cup, not the blue one, is far more likely to produce a clear signal than a child asked to choose between two flashcards they don't care about.

One thing to get right: only offer choices you're actually going to honor. If you offer 'Do you want bath now or in five minutes?' you have to be prepared to wait five minutes when they pick the delay. Offering choices you then override teaches the child that choosing doesn't work, and it makes the next offer harder to trust.

What if the child always picks the same thing or doesn't seem to pick at all?

Both patterns are common and worth thinking through separately.

Always picks the same option: This can mean several things. The child genuinely prefers that item (totally valid). The child has a positional bias, always picking the item on the left or right (solution: alternate positions and see if the 'choice' shifts). The child is responding to subtle cueing from the adult, like leaning toward the preferred option (solution: use a neutral physical posture and a screen or book to block your own line of sight to the items). Or the array doesn't include a real preferred alternative, so try swapping in different second options.

Never picks or seems passive: First, check sensory and motor factors. Some children need more proprioceptive feedback to initiate a reach. Some have low muscle tone that makes extending an arm costly. Some are overwhelmed by visual arrays. An occupational therapist's input can be genuinely useful here, sometimes more than an SLP's. Second, check the motivation level of the options. A child who doesn't care about either option has no reason to communicate. Third, look for very small signals you might be missing, a brief eye flick, a slight body lean, a breath change. Those micro-signals are worth responding to consistently and then building from.

If neither approach moves things after a few weeks of consistent effort, that's a good prompt to consult with a speech-language pathologist who has experience with AAC and complex communication needs. The American Academy of Pediatrics recommends SLP referral for any child not meeting age-level communication milestones.^[9]

How do you teach a communication partner (teacher, grandparent, caregiver) to support choice-making?

This is where most home programs fall apart. A child may make reliable choices with one parent, then shut down completely at school or with grandparents, because the other adults haven't been trained on the method and the wait time and the response protocol.

Consistency across communication partners is probably the single biggest variable in how fast children generalize new communication skills. A 2015 review in Language, Speech, and Hearing Services in Schools found that AAC interventions with explicit partner training produced significantly better outcomes than those without.^[10]

A practical partner training checklist:

1. Show the partner your child's specific method (device, board, eye gaze frame, gesture) 2. Demonstrate the wait time, literally count to ten out loud a few times until they feel how long it is 3. Explain which signals count as a choice and what the correct response looks like 4. Practice together before they try it independently with the child 5. Create a quick one-page reference card that lives in the environment (on the fridge, in the school bag)

Teachers and paraeducators at school can request this training through your child's IEP team. ASHA guidance treats AAC training for communication partners as a legitimate billable service, not an optional extra.^[2] If the school isn't providing it, that's worth raising at the IEP meeting. For broader strategies on autism-specific speech supports, see our article on autism spectrum speech therapy.

Can choice-making practice actually lead to more speech?

For some children, yes. Not all.

The relationship between AAC use and speech development has been studied extensively, and the evidence is fairly clear that AAC use does not suppress speech development. A systematic review published in the American Journal of Speech-Language Pathology examined 24 studies and concluded that AAC intervention resulted in improved or maintained speech production in the majority of participants, with no studies showing a decrease.^[11]

Why? One leading theory is that AAC, including simple picture-choice systems, reduces the communicative pressure on children. When a child knows they can get their needs met through a picture or gesture, the anxiety around speech attempts drops. Some children begin vocalizing more because communication feels safer.

That said, the honest answer is that not every child with complex communication needs will develop functional speech, and that's not a failure of therapy or of the child or the parents. The goal of communication intervention is not speech at all costs. It's communication, in whatever form works reliably and sustainably for that child. ASHA's position on AAC explicitly supports this framing.^[2]

For families weighing this honestly, the distinction matters. Choice-making practice builds communication skills. Whether those skills eventually include speech depends on the child's underlying diagnosis, motor profile, and the cause of the language delay.

What should you do right now if your child isn't making choices yet?

Start simple and start today. You don't need a device or a professional or a formal program to begin.

Pick one high-motivation context. Snack time is a reliable one. Choose two items your child clearly reacts differently to when they see them. Hold one in each hand at your child's eye level. Name them. Wait. Watch for any signal. Respond immediately and warmly to whatever signal comes.

Do this twice a day for a week. Keep a simple log: what you offered, what signal you saw, how long the wait was. After a week you'll have much better data about whether your child is showing preferences, which signals are consistent, and whether you need to adjust the format.

If you're not seeing any signals after two weeks of consistent effort, or if you're worried about regression or a broader pattern of delayed communication, contact your pediatrician and ask for a referral to a speech-language pathologist. Early intervention services are available for children under three at no cost in most states under the Individuals with Disabilities Education Act (IDEA).^[12] For children over three, the school district carries the obligation. See our article on early intervention for how to access those services.

For families who want a structured next step alongside professional support, Little Words (littlewords.ai) has a short quiz that helps identify where your child is in their communication development and what tools might fit their profile.

Frequently asked questions

At what age should a child be able to make choices independently?

Most typically developing children make simple choices by 12 to 18 months through reaching and looking. By 24 months, they often start expressing preferences verbally. For children with language delays or complex communication needs, the timeline varies significantly. The key benchmark isn't age: it's whether the child has a reliable, consistent method to express a preference in at least one or two contexts. If they don't by 18 to 24 months, that's worth discussing with an SLP.

Is it okay to use food as a motivator for choice-making practice?

Yes, food is one of the most effective motivators for early choice-making practice because children have genuine, strong preferences about it. Use snack-time choices liberally. The concern about food as reinforcement in ABA therapy involves different contexts and protocols. For simple choice-making practice during natural mealtimes, offering two real food options is developmentally appropriate and research-supported. Just make sure the child actually gets the item they choose every time.

My child with autism points at things they want but won't use picture cards. Should I push the cards?

No, don't push the cards if pointing is working reliably. Pointing is a legitimate communication act. The goal is always functional communication, not a specific system. If your child points clearly and consistently and adults understand them, that system is working. You might gradually add picture symbols alongside pointing as a way to expand the vocabulary of choices, but there's no reason to replace a working system with a less natural one.

How is choice-making different from ABA discrete trial training?

In naturalistic choice-making practice, choices are embedded in real activities with real preferred outcomes, and the child's signal is always honored immediately. Discrete trial training (DTT) in ABA often uses more structured, controlled conditions with specific reinforcement protocols. Both can include choice opportunities, but the naturalistic approach prioritizes communication function over behavioral compliance. Many SLPs now recommend naturalistic, environment-embedded approaches for early communication development.

What if my child grabs both options instead of choosing one?

Grabbing both is actually informative: your child understands that the items are available, and they're motivated enough to want them. It's not a failed choice, it's an early one. Try holding the items slightly out of reach so a clear reach or gaze is required. You can also try presenting one option, waiting for a signal, then presenting the second. This sequential approach removes the 'take both' option and helps clarify preference.

Can a child use eye gaze to make choices if they have autism?

Yes. Many autistic children use eye gaze very effectively for choice-making, especially when other motor pathways are difficult. Reduced eye contact during social exchanges is different from functional eye gaze toward objects. Low-tech eye gaze frames cost almost nothing and are used routinely by SLPs. If a child consistently looks longer at one item than the other, or returns their gaze to it, that counts as a meaningful communicative signal worth responding to.

How do I make a low-tech choice board at home?

Print or cut out two clear photographs or picture symbols of the items. Laminate them if you can (a self-laminating pouch costs about a dollar). Attach velcro to the back so they can stick to a board, a folder, or even a piece of cardboard. Present two symbols at a time during natural routines. You don't need a commercial kit. A binder ring, a few printed photos, and consistent use will outperform an expensive binder that stays on the shelf.

My child's school says they're 'not ready' for AAC. Is that accurate?

In almost all cases, no. There is no evidence-based communication prerequisite for AAC. ASHA and the AAC research community have explicitly rejected the idea of 'readiness criteria' for AAC. Any child who has communication needs can benefit from AAC support, including choice-making with pictures or devices. If a school is withholding AAC on readiness grounds, you can request an independent AAC evaluation, which is your right under IDEA.

Does the way I ask the question matter?

Yes, quite a bit. 'Do you want juice?' is a yes/no question. 'Do you want juice or water?' is a forced choice. The forced choice is better for choice-making practice because it requires discrimination between two options rather than a yes/no response. Pair your spoken words with pointing to or holding up each item as you name it. Keep the sentence short and the language predictable: 'Juice or water?' repeated consistently helps children learn the routine.

What if my nonverbal child just has meltdowns instead of making choices?

Meltdowns before or during choice-making often signal that the child knows what they want, can't communicate it, and is overwhelmed by the gap. That's a communication problem, not a behavior problem. Start with choices at calm, low-demand moments rather than transitions or high-frustration situations. Build the skill when regulation is easy. As the child gains a reliable communication method, you'll often see meltdowns reduce, because they no longer need to escalate to be understood.

How do I know if my child's choice signals are intentional or random?

Look for three markers: consistency (the signal happens reliably in similar situations), directionality (it points toward a specific item or outcome), and persistence (the child repeats it when you don't respond). A random signal disappears when ignored. An intentional one gets louder or more frequent. Video two or three choice sessions and watch the playback at half speed. Patterns that aren't obvious in real time often become clear on video.

Can speech therapy at home really help with choice-making, or do we need a professional?

Both. A professional SLP assessment is important to identify the best method for your specific child, train you on implementation, and rule out underlying issues affecting communication. But the daily practice happens at home across dozens of natural choice moments, and parents are the primary communication partners. Research consistently shows that parent-implemented naturalistic interventions, when guided by an SLP, produce meaningful gains. You are not a replacement for professional support; you're the most important part of it.

Sources

1. ASHA, Functional Communication Measures: Choice-making is a core functional communication skill; access to choice reduces challenging behavior and increases engagement in children with complex communication needs.
2. ASHA, Augmentative and Alternative Communication (AAC) Practice Portal: ASHA positions AAC, including choice-making with pictures or devices, as appropriate for any child with communication needs regardless of readiness criteria; partner training is a billable service.
3. Romski & Sevcik, American Journal of Speech-Language Pathology, 2005: Any reliable, repeatable signal from a child with complex communication needs deserves a full communicative response; AAC does not impede speech development.
4. Drager et al., Augmentative and Alternative Communication, 2006: Natural aided language input (aided language stimulation), where partners model AAC use while speaking, increases diverse AAC use and frequency of communication acts in children.
5. Reichle, J. et al., Implementing Augmentative and Alternative Communication, ASHA: Starting with two-choice arrays reduces cognitive load and increases successful communication attempts in children with complex communication needs.
6. Calculator, S. & Black, T., Language, Speech, and Hearing Services in Schools, 2009: Wait times of 5-10 seconds (expectant waiting) are recommended for children with complex communication needs to allow sufficient processing and motor planning time.
7. Flippin, Reszka & Watson, American Journal of Speech-Language Pathology, 2010 (systematic review of PECS): PECS (Picture Exchange Communication System) shows evidence of improving communication outcomes for autistic children; a 2010 systematic review found gains in communication acts across studies, though evidence quality was mixed.
8. Sennott, Light & McNaughton, Augmentative and Alternative Communication, 2016: Children whose communication partners used aided language stimulation showed more diverse AAC use and more frequent communication acts than comparison groups.
9. American Academy of Pediatrics, Developmental Surveillance and Screening Policy Statement: AAP recommends referral to a speech-language pathologist for any child not meeting age-level communication milestones.
10. Kent-Walsh, Murza, Malani & Binger, Language, Speech, and Hearing Services in Schools, 2015: AAC interventions that include explicit communication partner training produce significantly better outcomes than those without partner training.
11. Millar, Light & Schlosser, American Journal of Speech-Language Pathology, 2006 (systematic review): A systematic review of 24 studies found AAC intervention resulted in improved or maintained speech production in the majority of participants; no studies showed a decrease in speech.
12. U.S. Department of Education, IDEA Part C Early Intervention: Under IDEA Part C, early intervention services including speech-language pathology are available at no cost to families for children under age three with developmental delays.
13. Beukelman & Mirenda, Augmentative and Alternative Communication: Supporting Children and Adults with Complex Communication Needs, 4th ed.: Eye gaze is a legitimate primary communication modality; low-tech eye gaze frames are a cost-effective starting point for children with motor limitations.