Introducing a communication board for the first time
The first contact with a communication board counts as much as the tool itself. A calm introduction, with no testing and no hurry, opens a door that well-meant habits often close again too quickly.
A communication board cannot be guessed at. For a family member, a patient or a pupil who has never seen one, the first contact with the tool counts as much as the tool itself. A clumsy introduction can create a lasting rejection, whereas a calm introduction opens a door that stays easier to walk through afterwards. The way the tool is shown often decides more about its future than the tool itself, whatever number of pictures it carries.
An attitude before a gesture
Before any gesture, the person introducing the tool does well to start from the principle that the person opposite understands more than they can currently show. ASHA, the American Speech-Language-Hearing Association, points out that no cognitive prerequisite is necessary for the use of AAC, that impaired cognitive ability does not prevent communication, and that AAC services must follow a policy of non-exclusion. This position changes the way the person is spoken to, looked at, and given a real place in the exchange, before the board is even put on the table.
Three settings, the same attention
The setting changes the way the tool can appear for the first time, without changing the attention it calls for. At home, a family member often introduces it in an ordinary moment of life, over a meal or a game, with no label of a session about it. With a patient, a member of staff has less time, but can build on an immediate, concrete need, such as pointing to a pain or expressing discomfort. With a pupil, a teacher has the benefit of a setting the classroom has already structured, provided care is taken that the board does not become one more marked exercise.
The steps, one by one
The steps follow an order, and that order has its logic: each one prepares the next.
- Choose a calm moment, with no urgency and no audience, for the first introduction.
- Put the board in sight and within reach of the person, not only of the person helping.
- Point to a picture and name it aloud, without requiring an immediate answer.
- Watch what the person looks at or points to, and name it in turn.
- Leave a silence of several seconds after each exchange before starting again.
- Take the tool up again at varied moments of daily life, rather than in a single session.
What not to do
Some habits, well meant as they are, hold back the settling in of the tool. They slip easily into a helping relationship, precisely because they come from a concern for efficiency or protection.
- Turning the introduction into a test or an assessment of the person.
- Speaking for the person as soon as a silence sets in.
- Pressing the person, or repeating the question louder and louder.
- Taking the board away at the first sign of hesitation or apparent refusal.
- Limiting exchanges to closed questions, which call only for yes or no.
Modelling rather than requiring
One method has a precise name and comes up constantly in AAC resources: aided language stimulation. It consists, for the communication partner, in pointing to the pictures on the board themselves while speaking, without asking the person to do the same straight away. AssistiveWare, a publisher of AAC tools, sums the idea up in this way: model with no expectation of a result, that is, touch a picture without requiring the person to repeat it afterwards, and model regularly, in varied settings.
A case report published in 2024 in Therapeutic Advances in Rare Disease illustrates this gradual pace. It concerns a single person, a young adult with advanced Sanfilippo syndrome, using an eye-gaze board: it is therefore not a general protocol, and we do not present it as one. What can be taken from it has to do with pace. Those supporting her are given a demonstration by a speech and language therapist specialised in AAC, then introduce only four new pictures themselves every one to two sessions, to avoid fatigue and rejection of the system. Each picture is named aloud while the board stays visible, and the tool is woven into daily activities, washing, meals or leisure, rather than into separate formal sessions.
The time left to the person to respond plays a part of its own. A specialist AAC resource notes that a wait time of up to forty-five seconds helps people to speak up more and to use more words than a hurried exchange does. That time serves three purposes: signalling that it is the person’s turn, letting them process what has just been said, and leaving them the possibility of answering.
The patience of the communication partner counts as much as the quality of the board they are holding.
This way of introducing the tool does not change according to whether you are a family member at home, a member of staff with a patient or a teacher in front of a pupil. The attitude, the gesture and the time allowed stay the same; only the setting varies, and it is that constancy which makes the tool recognisable from one place to another.
This article describes ways of doing things reported by AAC resources and published work. It is neither medical advice, nor a care protocol, nor a method validated for any particular person. Words Within Reach assesses no one and measures no progress: introducing a board is not a test, and nothing here asks anyone to check what a person can do before giving them a voice. The choice of a means of communication belongs to the person, to those close to them and to the professionals who know them.
Sources
- Augmentative and Alternative Communication (AAC), American Speech-Language-Hearing Association (ASHA).
- Successful use of an eye gaze AAC communication board by a young adult with advanced Sanfilippo Syndrome (MPS IIIA): Case report, Therapeutic Advances in Rare Disease, 2024.
- Communication partner skills for AAC learners, AssistiveWare.
- Do’s and Don’ts of AAC: Wait time, AssistiveWare.
This article is published under the CC BY 4.0 licence: copy it, translate it, republish it, crediting ODERSA.