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Early Intervention Speech Therapy

The Four S's of a Good Communication System

Published February 19, 2009 5:46 PM by Stephanie Bruno-Dowling
Today's post is an invitation to all therapists (and families!) to share the different ways they are using picture communication systems in early intervention home care. My motto for an efficient communication system is the Four S's: Simple, Sturdy and Supportive so that the child will be Successful!

I currently use a mix of several different methods to help the children I work with communicate at home. One technique incorporates the use of Mayer-Johnson Boardmaker® pictures.

Before creating the system, I collaborate with the family and we identify pictures that would be most beneficial for their child. We discuss the foods they eat throughout the day, the routines and tasks they engage in frequently, toys and activities they prefer, as well as additional words that the family would like the child to understand and use, such as "please", "more", "all done", etc. The focus of the system is to aid the child's communication throughout their day and daily routines. Activities such as mealtimes, trips to the grocery store and bedtime are the focus in order to make communication purposeful and effective for both the child and the family.  

In addition to the pictures, I use a glossy and resilient pocket folder for each family. We store the pictures inside the folder. There are several pockets inside and I use zip sandwich bags to hold additional pictures if necessary. On the outside of the folder, I place a long Velcro strip(s). This is where the communication occurs! The family can use it to give the child choices (show 2-3 pictures at a time) and/or stimulate words and build sentences (i.e. "I-Want-Juice"). I ask the family to provide a picture of the child, which serves as the "I" part of the sentence, so that the child actually sees a picture of themselves when they are sentence building and communicating. This also helps build a foundation for personal pronouns, which can often be confusing to little ones and tricky to teach!

Another method is to keep all the pictures on one laminated board and then hang it in a spot that is easily accessible to the child, such as the refrigerator, so that they can initiate communication. How to the present the pictures (one picture at a time vs. several on one board) depends upon the child's attention, focus and ability to discriminate between pictures.

Another technique I use is to take digital pictures of the child's favorite foods, toys, personal objects (i.e. spoon, toothbrush), etc. Once again, the family identifies for me the items to photograph. Of course, all the pictures, both digital and Boardmaker, are laminated after they are printed to ensure their durability.

Tune in Monday for more information regarding how to achieve the Four S's when creating and implementing communication systems in home care.

Please write in and share the communication system ideas and techniques that have worked for you!


Just like how sign language in babies is used to facilitate communication , pictures can also be used to facilitate communication.  It definitely does relieve them of their frustration when they cant convey their need.  


Manju Jacob, School Age - Speech Pathologist, Telepractice March 5, 2009 12:23 PM
Eindhoven, Netherlands

I agree with the previous comment on using the child's picture for "I". It's meaningful to the child to connect the pronoun I with themselves.

Audrea, Speech Pathologist February 27, 2009 9:07 AM
St. Louis MO has proven to be pretty successful with the kids I’ve used it with - it makes the communication more relevant for them. It has also been great for kids who do not respond to their name and present with significant cognitive delays - they seem to recognize their picture and are more willing to use the board. I think they enjoy seeing themselves! It’s empowering for them!!

stephanie, blog author February 26, 2009 10:53 PM

Stephanie, I really like your idea of using the child's picture to use for the "I" part of the sentence. Thanks!

Snipes Barb, Speech-Lang - SLP, schools February 26, 2009 7:52 PM
Winter Park FL

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About this Blog

    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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