Examining Choice and Control for People With IDD Over Time


Choice making is an important aspect of everyone’s life in terms of fully becoming an adult within a democratic society. People with intellectual and developmental disabilities (IDD) are at risk for diminished choice making due to various factors, including guardianships; dependence on supports that are not person-centered; and, in some cases, limited capacity to express one’s desires effectively. Independent Monitoring for Quality (IM4Q) data for 9,195 and 9,817 for adult services users with IDD were analyzed across two types of choice. Repeated measures mixed regression examined choice over time after controlling for age, support needs, residence type, and community type. We found significant increases in everyday choice making among IDD service users in Pennsylvania, but not in support-related choice. This study is the first to our knowledge to consider change in choice making, an important indicator of rights and inclusion for persons with IDD. By comparing three waves of data from the state of Pennsylvania (2013, 2016, and 2019), we were able to detect changes in choice making over time among home and community-based service (HCBS) users with IDD.

Suggested Citation

Houseworth, J., Pettingell, S. L., Bershadsky, J., Tichá, R., Lemanowicz, J., Feinstein, C., & Zhang, A. (2023). Examining Choice and Control for People With IDD Over Time. American Journal on Intellectual and Developmental Disabilities, 128(6), 449–461. https://doi.org/10.1352/1944-7558-128.6.449


Peer-Reviewed Article 
Volume 128, Number 6
American Association on Intellectual and Developmental Disabilities


  • Community life
    • Self-advocacy and self-determination
  • Specific disability
    • Intellectual/developmental disability (IDD)