Acquisition and functional use of voice output communication by persons with profound multiple disabilities.

Three adults with profound intellectual disability and no speech joined the study.

The team used graduated guidance and a 3-second time delay to teach each person to press a voice-output device.

Sessions happened at a work table, in the lunch room, and during community trips.

All three adults learned to hit the switch and say "I want ___" through the device.

They used the VOCA to ask for juice, music, or a walk.

New listeners understood their requests a large share of the time, far better than when they pointed or made sounds.

Carr et al. (2003) later swapped the VOCA for small microswitches and still got fast learning, showing the method works across gadgets.

McGonigle et al. (2014) copied the VOCA plan with adults who have Rett syndrome and saw the same quick success, so the trick travels across diagnoses.

Howard et al. (2023) moved the whole program online; parents coached via Zoom taught the same request skill, proving you don’t have to be in the room.

If a person has no speech and scores below 25 on IQ tests, start with a single VOCA switch and graduated guidance.

Teach in real places—lunch line, van, work bench—so the request works everywhere.

One 3-second delay is enough; you’ll see a new mand in a week and strangers will finally understand.