Teaching Yes/No

Why is answering yes or no to a yes/no question so challenging for some children?  There are many reasons.  A child with complex communication needs may have any combination of speech, language cognitive, motor, hearing and/or vision challenges.  How do we teach this skill?  Let’s start by considering when yes/no responding develops typically. Most 12 months old can stop doing what they are doing when they hear the word no.  By 30 months or 2 ½ years of age, most children can say yes or no to simple questions.  To teach a child how to respond to a yes/no question, there are two elements. 
 
First, they have to understand the question.  So, the solution to start is to make the question very simple with visuals.  For example, you hold up a toy and say “do you want this?”.  I often think about the concept that researcher Cynthia Cress PhD calls “too many hard things” (https://cehs.unl.edu/secd/faculty/cynthia-cress/). For some children, actually have both a visual and an auditory prompt can be “too many hard things” and so you may need to use only one prompt, either hold up the toy and gaze at it with a questioning look or ask a question “do you want x” without a visual. 
 
Second, the child has to have a way to respond.  Again, thinking about the concept of “too many hard things, I never start with yes/no symbols because this adds a layer of complexity.  I try to start with the child’s own natural responses, such as a smile for yes or a pout or look away for no.  When working with children with cerebral palsy who are developing cognitively at age level, I often see that these children have figured out what motor responses they can do consistently, extending the body for yes or dropping the head for no, as an example.  For another group of young children with mild-moderate motor delays, I sometimes see a trunk movement up/down for yes (as if they can’t get their head to isolate but can get their whole body to move up/down) or a very subtle head shake.   For eye gaze responses, a child can look at you for yes or look away for no.  The recommendation is to try and find one consistent and reliable natural response that the child can perform.
 
A few extra thoughts. 
 
I often recommend communication partners model BIG motions for yes (head up/down) and no (head side to side).  For some children, the silliness of this is enough of a motivator to help them imitate what they see.
 
I encourage families and the team to agree on a single response for yes and a single response for no.  This sets up the expectation that the child will respond in the same way across settings. 
 
Pay attention to the environment.  One of my patients with a vision impairment is so tuned into the auditory environment, that responding is best when the environment is absolutely quiet (no small feat in a busy classroom or home setting).
 
Teaching yes/no to children on the autism spectrum requires some additional thoughts as these children sometimes struggle with sensory challenges that interfere with their ability to listen and understand a yes/no question as well as to orchestrate a response.  Additionally, I believe there is a social communication element that is challenging yes/no responses.  For children with ASD, they may need to develop sensory integration strategies to be able to listen and respond.  They may need to learn the social communication rules regarding yes/no responding before they can accurately answer yes/no questions. 
 
In summary, once the child is showing a consistent natural gesture or response to being asked “do you want x”, then bringing in symbols, switches or attempting harder questions can be pursued.