YEC

Young Exceptional Children OnlineFirst, published on November 18, 2009 as doi:10.1177/1096250609351795

Supporting the Play of Preschoolers

With Autism Spectrum Disorders:
Implementation of Visual Scripts
Cal was a 5-year-old with autism who
attended an inclusive preschool class for
children with disabilities and their peers.
Cal’s teacher, Mrs. Garner, often observed
him in the dramatic play area with his
classmates. He spoke infrequently using
one-word phrases (e.g., “monkey”);
however, he appeared interested in
interacting with his peers and would often
stand close to them and put his head on
their shoulders. He often made requests
by pointing and grunting. Mrs. Garner
wanted to find a way for him to interact in
a more appropriate way with the other
5-year-olds.
Sergio, a 6-year-old with autism, was
high functioning and attended a general
education kindergarten class with periodic
support from Mr. Schwartz, an autism
specialist. Mr. Schwartz and Sergio’s
preschool teacher, Ms. Hernandez,
watched Sergio during center time and
noticed that he often chose the dramatic
play area but tended to talk to himself,
reciting lines from books and movies that
were unrelated to the current play theme.
Sergio could speak in sentences that were
approximately four to six words long and
could read fluently at approximately a
2nd-grade level. Mr. Schwartz and Ms.
Hernandez wanted to teach Sergio to use
context-appropriate phrases during
dramatic play.

step-by-step, how to implement

C
hildren with disabilities,
including autism spectrum scripts, a type of visual strategy,
disorders (ASD), are within inclusive preschool play
frequently included in classes with groups. Cal’s and Sergio’s
typically developing peers. Although examples are highlighted
these children may receive throughout the article. Although
instruction on appropriate this article focuses on children
communication skills, without with ASD, we describe several
directly targeting these skills in variations that would assist
typical activities, they may not teachers in implementing this
demonstrate these skills when they intervention with children who
are with peers. The purpose of this have a variety of disabilities across
article is to provide recommen- degrees of severity.
dations to support the novice play
skills of children such as Cal and
Sergio. This article describes Characteristics of ASD
characteristics of ASD and the
research base for use of inclusive Individuals with ASD,
preschool play groups and visual particularly, preschoolers,
scripts with children with ASD to demonstrate delays in social and
promote communication skills. communication functioning
Jennifer B. Ganz, PhD, BCBA Furthermore, this article explains, (American Psychiatric Association,
Texas A&M University
DOI: 10.1177/1096250609351795
Margaret M. Flores, PhD http://yec.sagepub.com
Auburn University © 2009 Division for Early Childhood

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 Play Groups and Visual Scripts / Ganz, Flores
“
Individuals with ASD often
learn information they can
see more easily than spo-
ken information that they
can only hear.
” Visual Strategies
2 YOUNG EXCEPTIONAL CHILDREN
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2000; Baron-Cohen, 2004).
Specifically, children with ASD often
fail to display or have delayed skills
in social interaction and building and
maintaining relationships with same-
age peers, difficulty or absence of
sharing attention and interests,
limited social reciprocity, limited use
of pretend play to the degree used by
same-age peers, and restricted use of
toys compared to peers (American
Psychiatric Association, 2000; Janzen,
2003). Furthermore, children with
ASD have delays in or an absence of
typical communication skills,
including significant speech delays or
absence of spoken language, difficulty
initiating and maintaining conversation
for several turns, poor understanding
and use of nonverbal interaction (e.g.,
pointing, facial expressions, eye
contact), and repetitive use of speech
(American Psychiatric Association,
2000; Janzen, 2003; Ogletree, 1998;
Prizant, 1988). Visual cues
implemented during playgroups that
include both children with ASD and
typically developing peers may be
effective in addressing such needs.
and Scripts
Individuals with ASD often learn
information they can see more easily
than spoken information that they
can only hear (Simpson, Myles, &
Ganz, 2008). Children with ASD
often have trouble with memory,
attention, mentally organizing
information and objects, and
language and speech skills; visual
strategies may circumvent these
problems (Hodgdon, 1995; Schopler,
Mesibov, & Hearsey, 1995).
Furthermore, the use of visual
strategies, such as written or pictorial
Vol. XX, No. X, Month XXXX
schedules, can help children with
ASD comprehend rules or
expectations and upcoming activities.
The purpose of visual scripts is
to increase the amount and quality
of appropriate phrases children with
ASD use during a variety of
activities (Ganz, Cook, & Earles-
Vollrath, 2006). Visual scripts have
been demonstrated to be effective in
addressing social and
communicative skills in individuals
with ASD (Krantz & McClannahan,
1998). Visual scripts, written and
pictorial cues to assist children with
what to say in social situations, are
designed for children with ASD,
although they may conceivably be
used to encourage typically
developing children who are shy or
who do not interact with peers often
or with children with other
communication-related disabilities.
Visual scripts may be most useful
for individuals with at least some
speech abilities, as opposed to
children who are non- or preverbal.
Visual scripts involve teaching
children to use written and pictorial
cues, usually in large font for
readability and with a large
accompanying photograph or line
drawing to remind the child of the
script phrases to be used. Although
written phrases are provided, it is
not necessary that the child is able
to read; rather, the written words
remind the adults of what phrase to
teach with the accompanying
pictures, and the children often rely
on the pictures for their cues. The
visual scripts are then displayed
during play activities to remind
children of context-appropriate
phrases they can use.
Visual scripts have been
demonstrated to be effective. In
particular, scripts have resulted in

“
Recent research has
supported the use of play
and social skill groups that
include children with ASD
and typically developing
peers to improve
interactions and
play skills.
” other disabilities. These include
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Play Groups and Visual Scripts / Ganz, Flores
increases in question answering adult-delivered verbal prompts to
(Charlop-Christy & Kelso, 2003), increase responding to comments
context-appropriate comments (Loveland & Tunali, 1991), teacher-
during dramatic play (Ganz & delivered verbal scripts to improve
Flores, 2008), scripted phrases communication during play (Neeley,
during leisure activities (Ganz, Neeley, Justen, & Tipton-Sumner,
Kaylor, Bourgeois, & Hadden, 2001; Thomas & Smith, 2004),
2008; Sarakoff, Taylor, & Poulson, peer-prompted scripts to promote
2001), unscripted phrases (Krantz & play (Goldstein & Cisar, 1992), and
McClannahan, 1993), overall use of audio-taped scripts to increase
speech (Ganz & Flores, 2008), communicative initiations (Woods
initiations toward adults (Krantz & & Poulson, 2006).
McClannahan, 1998), and
initiations to peers (Woods &
Poulson, 2006). Scripts have been
Encouraging Play in
successfully implemented during Inclusive Settings
one-on-one interactions with adults
(Charlop-Christy & Kelso, 2003), Research on playgroups that
dramatic play (Ganz & Flores, include both children with ASD and
2008; Krantz & McClannahan, their typically developing peers is
1998), and leisure activities (Ganz et limited. Recent research has
al., 2008; Krantz & McClannahan, supported the use of play and social
1993; Sarakoff et al., 2001). In skill groups that include children
some cases, new skills were with ASD and typically developing
generalized to new materials, peers, peers to improve interactions and
or adults (Charlop-Christy & Kelso, play skills. Primarily, the integrated
2003; Krantz & McClannahan, playgroup approach has proven
1993, 1998; Sarakoff et al., 2001). effective in improving social
Although a variety of other
visual cues, such as Social Stories
(Crozier & Sileo, 2005), comic strip
interactions (Lantz, Nelson, &
Loftin, 2004; Yang, Wolfberg, Wu,
& Hwu, 2003), functional and
conversations (Pierson & Glaeser, symbolic play (Wolfberg & Schuler,
2007), and visual schedules (Ganz, 1993), and language skills (Zurcher,
2007), have been used successfully Hunt, Schuler, Webster, 2001).
with children with ASD, these are Because the goal of many special
considered priming techniques. They education programs is to teach skills
prime students by providing that promote social integration, we
information prior to upcoming recommend implementing social and
events to ease transitions or communication skill training within
misunderstandings. Visual scripts inclusive settings (e.g., classrooms
are different in that they are that include children with
provided during an activity to cue disabilities and typically developing
communication skills. In addition to peers) starting at a young age.
visual scripts, other types of scripts Drawing from sociocultural
have been reported in the literature theory and characteristics of
to promote play and communication children with ASD, Wolfburg and
skills in children with ASD and Schuler (1999) provide several
recommendations regarding the
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3
 Play Groups and Visual Scripts / Ganz, Flores

implementation of inclusive without disabilities. These

“
Visual scripts are
playgroups that include children
with ASD. They suggest that
playgroups be small and meet at a
recommendations were investigated
by Ganz and Flores (2008) and are
described here in further detail.
scheduled time for a minimum of 30
implemented in a min per session at least twice a
Step 1: Choose Theme and
week. Group membership should be
natural setting in activities consistent and include both children Prepare Setting and Materials
with disabilities and “more skilled” If possible, playgroups should
during which the children players. A variety of materials
should be provided that encourage
take place in a classroom pretend-
play area and be surrounded on all
imaginative play. Finally, Wolfburg
with ASD would be and Schuler recommend that
sides by walls or child-sized furniture.
Doing so increases the chances that
participants with and without
expected to display disabilities be provided with
the children will remain in the area,
thus allowing for closer proximity to
scaffolding and supports, such as peers and increasing opportunities for
language skills. prompts or play activity suggestions, interaction. Necessary furniture
that encourage appropriate play and includes child-sized shelving, table,

” communication skills. Visual scripts

are supports that fit Wolfburg and
Schuler’s recommendations.
Implementing Visual
Scripts in Inclusive
Playgroups
Visual scripts are implemented in
a natural setting in activities during
which the children with ASD would
be expected to display language
skills as opposed to teaching in a
clinical setting, such as with a
speech therapist in a separate room.
Instruction is explicit and direct
rather than implicit. Furthermore, it
incorporates concrete, visual cues in
addition to auditory cues, which are
too transitory (i.e., here and gone)
for many children with ASD. Using
visual scripts may involve having
typically developing children model
appropriate play skills.
The following are recommen-
dations for implementing play-
groups, with the addition of visual
supports, for children with and
and chairs. Additional furniture may
be desired for particular dramatic
themes (e.g., child-sized stove and
oven for bakery theme, tent for
camping theme). When choosing
dramatic play themes, we recommend
choosing activities that are familiar to
or preferred by the children,
especially the children with ASD.
Materials will include a variety
of items befitting each theme. If
possible, have multiples of each item
to increase opportunities for
imitation (e.g., a child puts on a
cowboy hat and a peer does the
same) and decrease possible conflicts
involving preferred toys. For
example, Cal’s play theme involved
baking, so several play baking
sheets, spatulas, and plastic cookies
were available.
Step 2: Choose Learner
Objectives for Child With ASD
The teacher should choose
language and social objectives for
the child with ASD (Ganz et al.,
2006), usually based on the child’s

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 Play Groups and Visual Scripts / Ganz, Flores

Figure 1 Figure 2
Cal’s bakery script Sergio’s bowling script

It’s my turn.

Cookies, please
Let’s go bowling.

I’ll fix the pins.

A muffin

I like bowling.

“
Write the script based on
Want pretzel Let’s do it again.

the reading, language
abilities, and attention span
of the child with ASD.
Individualized Education Program
(IEP) or as a result of language or
social skills assessments. Possible
social or communication objectives
may include giving a toy to a friend,
making context-appropriate
comments, requesting items,
The scripts should be typed for
the participants in a font size
appropriate to the child’s reading
abilities. Each phrase should be
matched with a picture (e.g., line
drawing, photograph) unless the child
is a proficient and fluent reader. Each

” complimenting a friend, or
commenting on a friend’s actions.
Step 3: Write the Child’s Script
Write the script based on the
reading, language abilities, and
attention span of the child with ASD
(Ganz et al., 2006). Some children’s
scripts may include a total of 2 one-
to two-word phrases, whereas
another child’s script may include
10 phrases, each 6 to 10 words in
length. Specific phrases on the cards
should be modeled after phrases
typically developing peers use
during the dramatic play activity.
Cal’s and Sergio’s scripts are
presented in Figures 1 and 2.
script card should include only one
phrase and picture. The scripts should
be laminated or printed on cardstock
to be sturdy enough for repeated use.
When scripts are used with children
who read fluently, they may be
written on a dry-erase board or a
piece of paper and posted on the wall
within the play area. Additional
samples of scripts can be found in
Figure 3.
Step 4: Teach the Script to the
Child
The adult who teaches the script
to the child should have training in
basic behavioral techniques (e.g.,
prompting, positive reinforcement),

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 Play Groups and Visual Scripts / Ganz, Flores

Figure 3
Samples of scripts

Source: The Picture Communication Symbols ©1981–2009 by Mayer-Johnson LLC.

All Rights Reserved Worldwide. Used with permission. Boardmaker® is a trademark
of Mayer-Johnson LLC.

which is usually acquired via implementation of the scripts within

educational background (e.g.,
special education workshops,
education degree). The child should
be taught script phrases one-on-one
with an adult (Ganz et al., 2006)
prior to participation in the
playgroup. A least- to most-intrusive
prompt sequence is recommended,
pausing approximately 5 s between
steps. After the child recites the
phrase, discontinue the remaining
prompts. The recommended prompt
sequence is outlined in Table 1.
Although some experts would
recommend a most- to least-
intrusive prompt sequence (Miller &
Test, 1989), we recommend a least-
to most-intrusive sequence in this
case, so the procedure mirrors
playgroup activities. That is, the
same prompting procedure used
during instruction (i.e., first, wait to
see if the child will read the card
spontaneously prior to prompting)
should be used during playgroup
activities. By the time the scripts are
implemented during playgroups, the
children will have mastered the
ability to recite the phrases by sight
and should not require much
prompting. Murzynski and Bourret
(2007) recommend such a prompt
sequence in combination with video
modeling, another type of visual
strategy.
It is not necessary to teach the
entire script prior to the first
playgroup meeting. In fact, we

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 Play Groups and Visual Scripts / Ganz, Flores

Table 1
Prompt Sequence for Initially Teaching Scripts

1. Choose the scripted phrase that corresponds with the item with which the child is playing
and hold it approximately 1 yard (1 m) away and in view of the child.
2. Help the child point to the words or the picture on the card (this may involve using physical
assistance by taking the child’s hand).
3. Verbally model what is written on the card (e.g., “The monkey’s in the tree”).
4. If the child still does not say the phrase, tell him or her, “Say, ‘The monkey’s in the tree.’”
5. Data may be collected on the target learner objective prior to script instruction and after
implementation to ensure the skill is necessary and that implementation results in improve-
ment. This may simply be a tally of the number of context-related phrases, requests, or
responses to peers’ comments during a 5-min sample of a play group.

recommend teaching a single script Step 5: Develop Peer Instruction

card at a time with children who are Cards and Teach Them to the
not yet reading and adding a new
Typically Developing Peers
phrase following mastery of each
phrase. Mastery includes reciting the Whereas scripts give children with
phrase fluently when the card is in disabilities exact words to say, peer
view. The cards will later be placed instruction cards are used to cue
near the relevant objects that will typically developing peers when to
encourage the child to recite the engage in behaviors that promote
phrase at appropriate points in play. interactions with their friends with
Reading fluency is not required, and disabilities. The purpose of peer
some children may rely on the instruction cards is to provide
picture to remember key phrases suggestions for how to interact with
instead of reading them word for children with ASD who may not
word. New phrases are taught to the respond or communicate in traditional
child as he or she masters the use of ways. For example, because Cal spoke
each phrase. Some children may in shorter phrases compared to
master scripts quickly and will be classmates, it would be necessary to
able to incorporate the use of two demonstrate for Christina, Cal’s
new phrases prior to each playgroup typically-developing peer model, and
meeting, whereas others may help her pay attention to and respond
acquire only two phrases during a to these short phrases (see Figure 4).
few weeks of playgroup meetings. Recommended steps when developing
We recommend having the children peer instruction cards are provided in
with ASD practice each mastered Table 2.
and new phrase immediately prior These procedures should be
to each playgroup meeting. repeated prior to each playgroup
Additionally, when implementing session until the children
new dramatic play themes, new demonstrate the skill during
scripts may be developed to playgroup sessions spontaneously
incorporate phrases applicable to and frequently (e.g., three times in a
each theme. 15-min period). Peer instruction

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 Play Groups and Visual Scripts / Ganz, Flores

each child could practice being the

Figure 4
bowler, the scorekeeper, and the
Christina’s peer instruction cards
clerk. Recommended steps for
implementing the scripts during
playgroups are provided in Table
3. Although an adult is required to
be present during initial playgroup
sessions, after the children
spontaneously use the scripted
phrases and follow instructions on
the peer instruction cards, the
If Cal asks nicely, give adult may fade out support until
him what he asks for.
new phrases and instructions are
taught. See Figure 5 for a
photograph illustrating the

“
Playgroups should
implementation of a script.

Additional Notes
occur about three to
We anticipate that teachers of
five times a week to Name what Cal is holding.
young children with ASD will find
these simple visual supports useful
provide frequent in promoting communication skills
cards should be introduced one at a during activities with typically
opportunities for time, until the typically developing developing peers. The following are
recommendations for adapting this
peers are spontaneously using the
strategy for use with children who
practicing social skills. skills noted on the cards. After
multiple peer instruction cards have have a variety of abilities. Children
been introduced, each one should be with ASD who are young or at early

” reviewed before play.

Step 6: Script Implementation

During Playgroups
Ideally, playgroups should
occur about three to five times a
week to provide frequent
opportunities for practicing social
skills. Each session should last
approximately 20 to 45 min,
depending on the children’s
attention spans. Each theme should
be implemented for about 5 to 10
sessions to allow each child an
opportunity to learn a variety of
roles. For example, Sergio’s theme
was a bowling alley activity, and
stages of speech development may
require minor adaptations to the
steps of implementing scripts listed
above. Playgroups may include only
one typically developing peer and
one child with ASD in such cases.
Occasionally, when children with
ASD are placed in groups with two
or more typically developing peers,
the peers inadvertently exclude the
less verbal child and gravitate
toward the other children who
readily respond to their
communication attempts. Less
verbal children with ASD will have
more opportunities to communicate
if there are no other peers with
whom to compete for the attention

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 Play Groups and Visual Scripts / Ganz, Flores

Table 2
Steps of Developing Peer Instruction Cards

1. Choose a play or interaction skill that complements the objectives chosen for the child with
autism spectrum disorder (ASD). Possible skills to teach via peer instruction cards include
turn taking, sharing, getting a friend’s attention, and giving compliments. Peer instruction
cards for Christina are illustrated in Figure 4.
2. Write brief instructions in a large font on paper approximately 9 in. × 6 in. Include a photo-
graph or line drawing for children who are not fluent readers. The card may be laminated,
put in a page protector, or printed on cardstock for durability.
3. The peer instruction cards are introduced about 5 to 10 min prior to each playgroup session.
4. The adult explains to the peers that their friends with ASD may play or talk differently than
they do.
5. The adult provides some examples specific to the child with ASD who is participating in the
playgroup (e.g., saying that the friend with ASD may often play alone and may not know
what words to use to ask a peer for a turn).
6. The adult shows the peers the peer instruction card and reads it to the child (or children if
the group includes more than one typically developing peer). The child is asked to repeat the
phrase until he or she is able to read or recite it independently.
7. Finally, the adult and the child role-play the skill listed on the card.

Table 3
Steps of Implementing Script Cards Within Playgroup Activities

1. Place the script cards or small dry-erase boards with written scripts near context-related
materials (e.g., place the card that says, “The monkey’s in the tree,” next to the monkey pup-
pet in a zoo theme).
2. The child with autism spectrum disorder may independently see the script cards and sponta-
neously recite the phrases.
3. If approximately 1 to 2 min pass and the child has not said any scripted phrases, initiated
communication, or responded to any verbal communication with peers, the adult follows the
next steps until the child says the appropriate script phrase.
4. Help the child point to the words or the picture on the card.
5. Verbally model what is written on the card.
6. Tell the child, “Say, [the phrase on the card].”

of their playmate. In addition, In addition, adaptations may be

shorter scripted phrases (e.g., one to made regarding the typically
two words) and fewer phrases per developing peers. When working
activity may be more manageable with older children with ASD or
for younger or less verbal children those with advanced verbal abilities,
with ASD. Another possible complex play scripts with several
adaptation, implemented during roles may be developed. Each child,
initial script learning, would be to including typically developing peers,
teach the typically developing peers, may learn a number of scripted
rather than the adult, to prompt the phrases to act out complex play
child with ASD. themes. Scripts may also be used to

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 Play Groups and Visual Scripts / Ganz, Flores

Figure 5
Implementation of a script during a playgroup

Source: The Picture Communication Symbols ©1981–2009 by Mayer-Johnson LLC.

All Rights Reserved Worldwide. Used with permission. Boardmaker® is a trademark of
Mayer-Johnson LLC.

encourage increased interaction and concrete, immediate reinforcers over

initiation of communication for time.
typically developing peers who are The use of scripts has preliminary
shy or introverted. The number of research support for use with children
peer instruction cards may be reduced with ASD who have a variety of
for younger children or for those who abilities to promote communication
do not master the skills quickly. and social skills during leisure (Ganz
Reinforcement (e.g., praise, tokens, or et al., 2008; Krantz & McClannahan,
food reinforcers) may be given to 1993; Sarakoff et al., 2001), play
typically developing peers for (Ganz & Flores, 2008; Krantz &
performing actions on peer McClannahan, 1998), and
instruction cards to encourage conversation (Charlop-Christy &
participation. Reinforcers for the Kelso, 2003). We anticipate that
participants will need to be chosen teachers and parents of children with
according to the individual interests ASD will find the above guidelines,
and desires of each child. For examples, and recommendations
example, social praise may not be helpful in implementing this
effective initially for a child with ASD intervention during dramatic play
until it has been paired with more activities.

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 Play Groups and Visual Scripts / Ganz, Flores

Cal, who usually spoke in
one-word phrases, participated in a
bakery play activity with 5-year-old
Christina, who had been in his
preschool classes for the previous 2
years. This theme was chosen
because Cal enjoyed eating cookies
and breads. The bakery area
included a play oven and stove, a
variety of cooking tools (e.g.,
mixing spoons, baking sheets,
mixing bowls), several plastic
breads and pastries (e.g., cookies,
cinnamon rolls, muffins, loaves of
bread), oven mitts, breadbaskets,
and plastic plates. Cal’s teacher,
Mrs. Garner, targeted increasing
verbal interactions by making one-
to two-word requests to a peer as
his learning objective for the
activity. This was an objective
listed in his IEP and one that was
being addressed during snack time,
and she wanted to teach him to
generalize this skill to a new setting
with new materials and with a new
person. Mrs. Garner taught Cal the
first script phrase during six 5-min
sessions. Following instruction, Cal
began using the first phrase, “a
muffin,” during his playgroup with
Christina, requiring minimal
prompts. He initially said the
phrase after Mrs. Garner held the
card up or helped him point to it.
After 2 weeks, Cal spontaneously correctly read each scripted phrase.
said the phrase when he saw the Sergio’s teachers decided to teach
card, which was placed by the his playmates, Ory and Micah, to
plastic muffins. Instruction and respond to his comments by
implementation continued with the making related comments
remaining cards. Mrs. Garner back, thus providing Sergio with
decided that Christina’s instructions additional models of context-
would include responding to Cal’s appropriate comments and
requests and modeling words that providing opportunities to engage
Cal could say on the basis of what in turn taking in conversation. The
he was holding, thus increasing his peer instruction card for Ory and
vocabulary. Micah said, “When Sergio talks,
Ms. Hernandez had developed say something back.”
a dramatic play theme for Sergio As a result of implementation
based on going to the bowling of visual strategies, both Cal’s and
alley, an activity Sergio enjoyed. He Sergio’s teachers were pleased to
participated with classmates, Ory note a number of improvements in
and Micah. The bowling alley area the children’s skills. Cal spoke
included bowling balls, bowling more frequently during dramatic
pins, score sheets, play snacks, play and his peers, particularly,
plastic plates, and utensils. Mr. Christina, sought him out more
Schwartz and Ms. Hernandez often, naming items with which he
targeted making context-appropriate was playing. Sergio used many
comments to peers as the learning context-appropriate phrases,
objective. They collected data including ones that were not
during three dramatic play sessions scripted but that he had learned
(i.e., they kept a tally of how many from Ory and Micah. He also
context-related comments Sergio engaged in more turn taking in
made) and found that he made no conversation than he had
context-appropriate comments previously. Cal’s and Sergio’s
(e.g., “It’s my turn,” “Let’s go teachers continued using scripts
bowling”). Ms. Hernandez wrote and peer instruction cards in a
suggested phrases for Sergio on a variety of dramatic play themes
dry-erase board. She showed him (e.g., farm, county fair, miniature
the board and he immediately and golfing) throughout the year.

Note
You may reach Jennifer B. Ganz by e-mail at jeniganz@tamu.edu.

Acknowledgements
The authors wish to thank Sherrie Goll for providing the artwork in Figures 1 and 4.
Figures 3 and 5 are courtesy of The Picture Communication Symbols by Mayer-Johnson
LLC. Boardmaker® is a trademark of Mayer-Johnson LLC. DynaVox Mayer-Johnson,
2100 Wharton Street, Suite 400, Pittsburgh, PA 15203; e-mail: mayer-johnson.usa@mayer
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