Photographs or symbols

Also called Photos vs symbols, Symbol hierarchy, Iconicity, Real pictures or symbols

Whether to use photographs, coloured symbols or plain line drawings, for whom, and why the right answer changes as the person does.

What it is

This is the decision that comes up in every first conversation about pictures: should the board show a photograph of the person's actual cup, a coloured drawing of a cup, or a plain black-and-white line? The textbook answer is a hierarchy from real to abstract: the object itself, then a photograph, then a coloured symbol, then a line drawing, then the written word. The idea is that the more a picture resembles the thing, the easier it is to understand, and that a person moves up the ladder as their understanding grows.

That hierarchy is useful and it is also where a lot of people get stuck, because it is sometimes read as a rule that a person must prove they understand photographs before being allowed symbols. There is no evidence for that gate, and plenty of people who never passed a photo-matching test use symbols daily.

The honest answer is that photographs and symbols do different jobs. A photograph is precise and a symbol is general, and the question is which the person needs to say what they want to say.

Who it can help

Photographs help when the exact thing matters: this person, this place, this toy, this brand of crisps. They suit someone at the very beginning, who has not yet grasped that a picture stands for something and needs the picture to look like the thing, and they suit anyone for people and places, where a symbol of a generic man is a poor way to say Dad. People with dementia often respond to photographs of their own life long after symbols have stopped meaning anything.

Symbols help as soon as the person needs a word rather than a thing. A photograph of one drink cannot ask for a different one; a symbol for drink can. They are essential for verbs, feelings and the small words, which cannot be photographed at all. A core vocabulary is made of symbols because most of it cannot be made of anything else.

The person it does not help to agonise over is the fluent reader, for whom text beats both.

How it works

The practical approach is to mix. Use photographs for the person's own people, places and prized objects, and symbols for everything else, on the same board, in the same size cells. A child's board can carry a photograph of Mum next to a symbol for want and a symbol for more, and that is a three-word sentence.

Watch what the person looks at and reaches for. Some people find photographs too busy, because a photograph contains a table, a window and a shadow as well as the cup; a symbol contains only the cup. Others find a symbol meaningless and a photograph obvious. The AAC assessment tests this directly by offering the same word in several forms.

As understanding grows, the photograph can be replaced with the symbol for that word, and the symbol can eventually carry the word beneath it. Nobody has to wait at any rung.

Getting started

This week, take photographs of the six people and four places the person cares most about, print them at the same size as the symbol cards, and put them on the board alongside symbols for want, more, go, stop, help and finished. Say the words as you point.

Do not remove the symbols while you wait for the photographs to be understood. Model both, and let the person show you which they use.

If the person uses a device or the Talk board, keep the photographs of people on a printed sheet or in a communication book beside it, so the precise and the general are both in reach.

Where to get help

Communication Matters for the principles, and the ACE Centre for assessment and its free resources on symbol choice. CALL Scotland publishes comparisons of symbol sets that show the same word in each. Your speech and language therapist, reached through referring to speech and language therapy, can run the comparison with the person present.