Objects of reference

Also called OoR, Reference objects, Object cues, Tangible symbols

A flannel means bath. A spoon means dinner. Real things that stand for what's about to happen, for people who aren't using pictures yet.

What it is

An object of reference is a real, touchable thing that stands for an activity, a place or a person. A flannel is handed over before a bath, every time, until the flannel means bath. A seatbelt buckle means the car. A piece of the sponge from the swimming float means swimming. A particular bracelet means a particular carer.

They're the most concrete symbol there is. A picture asks a person to understand that a flat, small, coloured shape stands for something; an object doesn't ask for that step. You can feel it, smell it and hold it, and for a person who can't see, that's the only kind of symbol that works.

Who it can help

People with profound and multiple learning disabilities, people with deafblindness, people with a visual impairment and a learning disability, and some people with advanced dementia. Anyone at the stage before pictures make sense.

They're the wrong tool for a person who already understands photographs or symbols; for them, an object is slower and bulkier than a card. And a person with a large vocabulary of needs can't carry a bag of objects big enough to say it all, which is where tactile symbols come in as the next step.

How it works

The object is presented, named and explored a moment before the activity, every time. Consistency is everything: the same object, the same words, the same timing, from every person, in every setting. A bath flannel at home and a bath duck at respite means nothing at all.

At first the object is a cue: it tells the person what's coming, which lowers anxiety and lets them prepare. Later it becomes a choice: two objects offered, one reached for (offering choices). Later still it can be expressive: the person fetches the flannel to ask for a bath. That's the sequence, cue, then choice, then request, and it can take months or years for each step.

The objects are usually kept in a box or on a shelf in order, so a row of them can become a visual timetable for a person who can't see one. Fixed to a card, they're sometimes called tactile symbols; the line between the two is not sharp.

Getting started

Choose three activities that happen every day and one object for each: something the person already touches during that activity. Write the list down and give a copy to everyone.

Hand the object over ten seconds before the activity starts, name it, let it be held, then go straight into the activity. Do that for a month before judging anything.

Use hand-under-hand to explore the object with someone who doesn't reach out for things. Never take the object away as a punishment or an end to the activity; it has to keep meaning what it means.

Where to get help

Sense has the deepest expertise for deafblind people and publishes guidance on objects of reference. PMLD Link shares examples from families and schools. Your speech and language therapist, or a qualified teacher of multi-sensory impairment through the local sensory support service, can help choose and introduce a set. Deafblind UK supports adults.