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Initial communicative intention
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The child should have communicative intention, requesting something from the interlocutor, pointing to the pictograms I + WANT (in the communication book) + single pictogram of what they desire. The child should build the sentence in sequence, pointing to the respective pictograms, possibly accompanied by speech. To advance to the next skill, the child must be able to discriminate up to four single pictograms and independently (i.e., spontaneously, without cues) build the sentence I + WANT + pictogram. |
1. The therapist initially places a single pictogram related to an item of the child’s preference at the top of the core vocabulary page. |
| 2. The activity should be prepared to trigger in the child the desire to ask for preferred items. |
| 3. As the child shows interest in objects, the therapist uses physical and verbal cues to help them point to the pictograms that form the sentence: I + WANT + item. Visual cues are used to gradually remove physical ones. If the child has difficulty identifying I + WANT, colored adhesive tape can be used to indicate the pictograms. |
| 4. When the child is able to perform the above task, another pictogram is included; physical cues may be used again. |
| 5. The therapist uses the communication book to guide their talk with the child, pointing to pictograms in the core vocabulary page, modeling their communication – i.e., pointing to the pictograms of the words they are saying. |
| 6. Enable parents to use the book continuously, showing how to use it in the therapeutic setting, and train other relatives and professionals from various contexts. |
| 7. When the child uses up to four pictograms to build the sentence, discriminating each one by independently pointing at them, they can move on the develop the next skill. |
| 8. The therapist must instruct caregivers to promote skill acquisition, by showing how they use it with the child and then ask the caregiver to practice with the child in the therapeutic setting. The therapist must help the caregiver with feedback during practice. |
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Requesting with lexical expansion from the fringe vocabulary
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The child should be able to ask the interlocutor for something by pointing to the pictograms I + WANT + a pictogram in the fringe vocabulary from one of the two tabs with distinct lexical categories. They should build the sentence in sequence by pointing to the pictograms, possibly accompanied by speech. To advance to the next skill, the child must request with the construction “I + WANT + a pictogram in the fringe vocabulary”, independently, spontaneously, and without cues. |
1. The therapist should dismiss the single pictograms and bind with a spiral initially one or two tabs of fringe vocabulary pictograms. Each tab has a line with up to 10 pictograms in lexical categories related to the items of preference used in the previous skill. |
| 2. The activity must be planned to trigger in the child the desire to ask for some of their preferred items. |
| 3. When the child wants an object but cannot ask for it by pointing independently at it, they must be guided with physical, visual, and/or verbal cues or modeling to point to the pictograms of the sentence: I + WANT + item in one of the fringe vocabulary tabs. |
| 4. The therapist begins using the communication book by talking to the child, pointing to pictograms in the core vocabulary page and fringe vocabulary tabs, modeling their communication (i.e., pointing to the pictograms of the words they are speaking), and enabling parents to use the book continuously, as demonstrated in the therapeutic setting. They should also train other relatives and professionals from different contexts. |
| 5. The therapist can model by showing the child how to form the desired sentences. |
| 6. When the child is able to ask for up to two different items in the fringe vocabulary, pointing at them independently, they can move on to develop the next skill. |
| 7. The therapist must instruct caregivers to help the child acquire the skill, demonstrating how to do it with the child and then having the caregiver practice with the child in the therapeutic setting. Thus, they enable parents to use it continuously and train other relatives and professionals from various contexts. The therapist must help caregivers, by providing feedback during practice. |
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Requesting with lexical and morphosyntactic expansion
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The child should be able to form sentences with the pictograms: I + WANT + two pictograms from either the fringe or core vocabulary. Three or more tabs should be added. They should build the sentence in sequence by pointing to the pictograms, possibly accompanied by speech. To advance to the next skill, the child must be able to point to I + WANT + two pictograms from either the fringe or core vocabulary, independently, spontaneously, without cues. |
1. The therapist must include fringe vocabulary tabs such as foods, toys, qualities, and places, besides the ones used in the previous skill. |
| 2. The activity must be planned to trigger in the child the desire to ask for preferred items. |
| 3. When the child desires an object, action, person, or some help but has difficulty finding the desired pictogram or leafing through the tabs, they can be helped with physical, visual, and/or verbal cues or modeling to leaf through them independently and point at the pictograms of the sentence: I + WANT + two pictograms from either the fringe or core vocabulary. |
| 4. The therapist must use the communication book by speaking to the child, pointing to pictograms in the core vocabulary page and fringe vocabulary tabs, and modeling their communication. |
| 5. The therapist can model by demonstrating to the child how to form the desired sentences. |
| 6. When the child is able to ask for up to two items from different tabs, leaf through the tabs independently, and point to the pictograms of the sentence I + WANT + two pictograms from either the fringe or core vocabulary independently, they can move on to develop the next skill. |
| 7. The therapist must instruct caregivers to help acquire the skill by demonstrating how to use the book with the child and then asking them to practice with the child in the therapeutic setting. The therapist must help the caregiver with feedback during practice, enabling them to use it continuously and train other relatives and professionals from various contexts. |
| 8. The family must be encouraged to further use new words from the core and fringe vocabulary stimulated during the sessions. |
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Morphosyntactic, lexical, and communicative function expansion
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The child should be able to form sentences with three or more words, with different goals: |
1. The therapist can include new fringe vocabulary tabs, such as feelings, the notion of time, other verbs, and social greetings, besides the tabs used in the previous skill. |
| Developing communicative functions: |
2. The activity should be planned to encourage the development of communicative functions with four or more pictograms. |
| ● Informative/interrogative function, asking questions with interrogative pronouns (who, when, which, where, etc.). |
3. When the child wants to use any communicative function and has difficulties finding the desired pictogram or leafing through the tabs, they can be helped with physical, visual, and/or verbal cues or modeling to point at the four pictograms independently. |
| ● Commenting: making comments, giving spontaneous information, showing something, demonstrating pain, giving opinions, and sharing ideas. |
4. The therapist must use the communication book to speak to the child, pointing at pictograms in the core vocabulary page or fringe vocabulary tabs, and modeling their communication. |
| ● Expressing feelings, gratitude. |
5. The therapist can model by demonstrating to the child how to form the desired sentences. |
| ● Social-interactive function: greeting, saying goodbye, thanking, apologizing, and showing off. |
6. The therapist can use structured visual resources to help develop the skill. |
| They should build the sentence in sequence by pointing to the pictograms, possibly accompanied by speech. They must use them with interlocutors in various contexts to begin acquiring the next skill. |
7. When the child is able to form sentences with four or more words with different pragmatic goals, using items from different tabs, and leafing through the tabs independently, then they can move on to develop the next skill. |
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8. The therapist must instruct the caregiver to help the child acquire the skill by demonstrating how to use the book with the child and then having them practice with the child in the therapeutic setting. The therapist must help caregivers with feedback during practice, enabling them to use it continuously, and training other relatives and professionals from various contexts. |
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9. The family must be encouraged to further use new words from the core and fringe vocabulary used to stimulate the child to form new sentences during the sessions. |
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Dialog
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The child should be able to use the following communicative functions: |
1. The therapist can insert new fringe vocabulary tabs, according to the child’s and family’s demands in the child’s various social and school contexts. |
| Reporting: telling a fact or retelling a story. |
2. The activity must be free to encourage dialog using various communicative functions, maintaining conversation, creating, telling, and retelling stories, and reporting facts. |
| Imagination: creating a story or telling a joke. |
3. When the child wants to use any communicative function but has difficulties finding the desired pictogram, they can be helped by rephrasing with modeling. |
| Conversation: maintaining a conversation. |
4. The therapist must use the communication book to speak to the child, modeling their communication. |
| They should build the sentence in sequence by pointing to the pictograms, possibly accompanied by speech. They must use it with interlocutors in various contexts. |
5. The therapist can also model by demonstrating to the child how to form the desired sentences. |
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6. The therapist can use structured visual resources to help the child develop the skill. |
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8. The therapist must instruct caregivers to help the child acquire the skill by demonstrating how to use the book with the child and then including the caregiver in the conversation for them to also use the AAC book with the child and the therapist. The therapist must help the caregiver with feedback during practice enabling them to use it continuously and train other relatives and professionals from various contexts. |
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9. Acquiring this skill indicates independence to use the DHACA communication book, beginning the assisted discharge process, and allowing caregivers to insert new tabs as needed. |
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