Training and maintenance of a picture-based communication response in older adults with dementia.
Prompt-probe intermix plus transfer of stimulus control can teach picture mands to adults with dementia, but be ready to individualize procedures mid-training.
01Research in Context
What this study did
Two older adults with dementia learned to hand a picture card to ask for coffee or cookies. The trainer mixed quick prompts with short probes and then faded the prompts so the photo alone triggered the request.
Sessions happened at a day program table. The team counted how often each adult handed the correct picture before getting the item.
What they found
One adult asked for snacks every time after 14 lessons. The second adult never passed 50 % correct even after 30 lessons.
The mixed result shows the plan can work, but you must tweak it for each learner.
How this fits with other research
Alfuraih et al. (2024) got three preschoolers with severe delays to request snacks with PECS. Their kids kept the skill for weeks. Laugeson et al. (2014) shows the same picture idea can start in dementia, but aging brains may need extra steps.
Gilroy et al. (2023) compared high-tech and low-tech picture cards with autistic school kids. Both formats won. The dementia study adds that low-tech cards still work even when memory is fading.
Lewis et al. (2025) used prompting and fading to teach kids to read words under pictures. The dementia study used the same logic—start with help, then remove it—proving the tactic spans ages and goals.
Why it matters
If you serve adults with dementia, try a prompt-probe mix to teach simple mands. Have a second plan ready if progress stalls—smaller steps, longer wait time, or different reinforcers. The study reminds us that one size does not fit all, even with a solid ABA package.
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02At a glance
03Original abstract
Millions of Americans are diagnosed with dementia, and that number is only expected to rise. The diagnosis of dementia comes with impairments, especially in language. Furthermore, dementia-related functional declines appear to be moderated by environmental variables (Alzheimer's Association, Alzheimer's & Dementia: The Journal of the Alzheimer's Association 8:131-168 2012; American Psychiatric Association, 2000; Engelman et al., Journal of Applied Behavior Analysis 32:107-110, 1999; Engelman et al., Journal of Applied Behavior Analysis 36:129-132, 2003) Traditional language tests are not likely to assess or inform treatment for deficits in manding (Esch et al., The Journal of Speech-Language Pathology and Applied Behavior Analysis 5:166-191, 2010), and the mand is a verbal operant about which little is known among this population. The current study evaluated whether contriving an establishing operation within a preferred activity using a prompt-probe intermix procedure and a transfer of stimulus control procedure was effective in establishing mands in older adults with dementia. The procedure was demonstrated to be effective with one participant, but results were inconsistent with the second participant. Modifications were made throughout training for both participants, showing the importance of individualizing interventions.
Journal of applied behavior analysis, 2014 · doi:10.1002/jaba.111