Teaching nonvocal communication skills to multihandicapped retarded adults.

Four adults with severe intellectual disability could not speak. None had used a communication board before.

The trainer taught them to point to pictures on a board. First they learned to match hand to picture. Then they picked the picture that named an object. Finally they used the board to tell what snack or activity they wanted.

Each step used prompts that were slowly removed. Correct picks earned praise and the chosen item. Sessions ran until each adult hit the mastery goal.

All four adults learned to use the board. They picked the right picture on most trials without help.

The skill lasted. Seven weeks later they still used the board to ask for leisure items. They also used it in new places with new staff.

Mazur (1983) got the same good result with picture cards and children. Both studies show nonvocal people can learn a picture system. The tool changed from board to loose cards, but the teaching steps stayed the same.

Alfuraih et al. (2024) and Choi et al. (2010) pushed the idea further. They used PECS and taught harder skills like asking for missing items or rejecting wrong ones. The adults in Davol et al. (1977) only pointed to request. Later work shows you can build more language once the basic picture skill is solid.

Laugeson et al. (2014) looks like a mismatch at first. Their two adults with dementia had mixed results while H et al. found clear success. The difference is diagnosis. Dementia brings memory loss that can block new learning. Adults with stable intellectual disability can still gain new communication if you give enough practice and prompts.

If you serve adults who cannot speak, start with a simple picture board. Teach them to match, then to name, then to request. Keep prompts strong at first and fade them fast. Once the skill is steady, move the board to new rooms and new people so the requesting keeps working. This old study still gives you a clear road map for first-time AAC users.