Communication Disorders

Quarterly
Volume 31 Number 1
November 2009 53-64
Use of Picture Dictionaries to Promote © 2009 Hammill Institute
on Disabilities

Functional Communication in Students 10.1177/1525740108327078

http://cdq.sagepub.com
hosted at
With Deafness and Intellectual Disabilities http://online.sagepub.com

Margaret Highnote Allgood

Kathryn Wolff Heller
Susan R. Easterbrooks
Laura D. Fredrick
Georgia State University, Atlanta

A mismatch of communication modalities can occur between students who communicate using sign language and cowork-
ers at community-based vocational sites who do not use sign language. This study investigated the use of picture dictionar-
ies to facilitate note writing as a form of expressive communication for students who were deaf and had mild to moderate
intellectual disabilities. Students were systematically taught to use their picture dictionaries to initiate requests using the
system of least prompts and the environmental arrangement strategy. A multiple baseline probe design was used. All
students were able to successfully use the picture dictionaries to promote communication initiations. Implications regard-
ing using the picture dictionaries for communication and for improving spelling of target vocabulary are discussed.

Keywords: communication; deaf; intellectual disabilities; community; vocational site

I ndividuals who are deaf often use augmentative and

alternative communication (AAC) such as sign lan-
guage, written communication, and/or speech reading
(Moore, 2001). Effective communication can be difficult
when intellectual disabilities are also present (although
most individuals with hearing loss do not have intellec-
tual disabilities, as supported by an 8.2% prevalence
figure; Gallaudet Research Institute, 2005). When indi-
viduals are deaf and have intellectual disabilities, they
may encounter a mismatch in communication modalities
when they participate in work and community settings.
Because community and work contexts are largely
dependent on the ability to recognize and respond to
speech (Ross & Lyon, 2007), mismatches may occur
when individuals who are deaf use sign language in work
settings when their coworkers use speech.
Individuals with deafness and intellectual disabilities
may encounter several challenges in work settings, such
as interactions with coworkers, communication with cus-
tomers, and understanding instructions, which are often
due to communication mismatches (Lott, Easterbrooks,
O’Rourke, & Heller, 2001). Even when familiar commu-
nication partners (e.g., coworkers) learn sign language to
improve communication, difficulty often occurs when
individuals with deafness and intellectual disabilities
attempt to communicate with unfamiliar communication
partners in community settings (e.g., customers; Knoors
& Vervloed, 2003). Communication difficulties have
been found to contribute to the failure of individuals with
disabilities to maintain their jobs (Hanely-Maxwell,
Rusch, Chadsey-Rush, & Renzaglia, 1986; Light, Stoltz,
& McNaughton, 1996). Students’ development of effec-
tive communication skills with coworkers and others in
the community is critical in order to gain greater accep-
tance, achievement, and social interaction on the work
site (Alberto, Elliot, Taber, Houser, & Andrews, 1993).
Individuals who are deaf may use several different
forms of communication, such as speech reading, sign
language, and writing. However, many individuals with
deafness and intellectual disabilities are unable to com-
municate with others through speech, and deaf children
who are poor readers are likely to be poor speech read-
ers (Harris & Moreno, 2006). In addition, sign language
may only serve to convey basic needs in this population
Authors’ Note: Please address correspondence to Kathryn Wolff
Heller, Georgia State University, Dept. EPSE, Room 822, 30 Pryor
Street, Atlanta, GA 30303; e-mail: kheller@gsu.edu.

53
54 Communication Disorders Quarterly
(Long, Ouellette, Long, & Dolan, 1993). When a more
extensive knowledge of sign language is present, an indi-
vidual who is deaf may use a sign language interpreter
on occasion (e.g., during orientation or important safety
meetings). However, interpreters are typically not feasi-
ble in the day-to-day interactions with coworkers, super-
visors, or customers (Dowler & Walls, 1996).
The practice of writing messages is commonly used as
a form of communication when others do not understand
sign language. This may take the form of writing a quick
message on a piece of paper, using a computer, text mes-
saging, or other devices (Power, Power, & Horstmanshof,
2006). The ability to write messages depends heavily on
literacy skills, including the ability to spell words.
Students who are deaf are often poor readers and often
have different types of spelling errors than those that typ-
ically occur with hearing peers (Kaderavek & Pakulski,
2007; Wakefiled, 2006). Systematic instructional strate-
gies such as constant time delay, cover-copy-compare,
and computer-based teaching have been used success-
fully to improve spelling in individuals who are deaf
(Cates et al., 2006; Stromer, Mackay, Howell, & McVay,
1996). While deafness in and of itself does not preclude
the ability to write (Antia, Reed, & Kreimeyer, 2005),
other factors can have a negative influence on literacy
skills (e.g., obstructed access to the phonological code,
limited fluency at the onset of schooling, inadequate lit-
eracy experiences in early childhood, lower level skills,
delayed vocabulary acquisition; Luckner, Sebald, Cooney,
Young, & Muir, 2005-2006). For students with deafness
and intellectual disabilities, their writing skills are often
insufficient to communicate with individuals who use
English as their primary language (Long et al., 1993).
Students with deafness and intellectual disabilities can
successfully communicate with coworkers and customers on
community-based vocational sites using symbol-based com-
munication devices for job-related topics (Heller, Allgood,
Ware, Arnold, & Castelle, 1996; Heller, Ware, Allgood, &
Castelle, 1994, 1996). Despite the success indicated in these
studies, students may not want to use symbol-based systems
because they are not a typical form of communication for
students who are deaf. In addition, the concern may exist that
others may misperceive those who use these systems as hav-
ing mental retardation (King, 1999).
A form of communication that approximates a more
typical communicative interaction for individuals who
are deaf is the use of picture dictionaries to assist with
note writing for expressive communication (Beeson,
1999; Cumley & Swanson, 1999; Heller, 2001). In one
study (Cohen, Allgood, Heller, & Castelle, 2001),
students who were deaf and had mild to borderline
intellectual disabilities communicated using picture
dictionaries that consisted of a notepad that had pictures
attached to the inside flap. When the students wanted to
communicate job-specific information to coworkers or job
coaches, they found the desired picture in the notepad,
wrote down the accompanying written word(s) on the
notepad paper, and gave the message to the coworker or
job coach. The coworker or job coach replied by gesturing
or by showing the student the requested item or task.
Because the pictures in the picture dictionaries were only
seen by the students, the stigma of using pictures to com-
municate with others was avoided. Also, using written
messages is more in line with communication methods
used among the deaf and hearing population (Lane,
Hoffmeister, & Bahan, 1996; McGrath, 1997–1998).
Although the Cohen et al. (2001) study appears promis-
ing, replication is needed to determine its feasibility with
students who are deaf and have more significant intellec-
tual disabilities (i.e., mild to moderate intellectual disabil-
ities). In addition, there is no research examining whether
or not the use of picture dictionaries could improve a
student’s ability to spell the words contained in the picture
dictionary when the dictionary is not in use. Students may
learn to spell the words in their picture dictionaries
through the repetitive nature of seeing the written words
and writing the words in messages for expressive commu-
nication. Although repeatedly writing and seeing the same
words can help students with typical hearing learn to spell
those words, little is known about whether this type of
redundancy is helpful with students who have deafness
and intellectual disabilities (McKeown, Beck, Omanson,
& Pople, 1985; Scheuermann & Jacobs, 1994; Stewart,
Gonzalez, & Page, 1997; Winterling, 1990).
The purpose of this study was to investigate if students
with deafness and mild to moderate intellectual disabili-
ties could learn to use picture dictionaries for expressive
communication at community-based vocational sites. The
independent variable was the use of the system of least
prompts and environmental arrangement to teach the use
of picture dictionaries as a form of expressive communi-
cation. The dependent variable was the initiation of
requests for needed items or needed instruction at the
work site. This research study also investigated if the use
of picture dictionaries resulted in an improvement in the
spelling of words in the students’ picture dictionaries.
Method
Participants
The selection of participants for this study was based
on several criteria. The students must have: (a) been
enrolled in community-based vocational training for at

Table 1
Student Demographics
Student Age Hearing Loss
Amanda 18 Profound bilateral
Brian 20 Profound bilateral
Carol 17 Profound bilateral
Diana 20 Profound bilateral
Evan 17 Moderate to profound
bilateral
Note: MID = mild intellectual disability; MOID = moderate intellectual disability.
a. Woodcock Reading Mastery Test Revised–Reading Passage Comprehension.
b. Wechsler Intelligence Scale for Children 3rd Edition (WISC 3).
c. Stanford Binet 4th Edition.
least 1 year; (b) had a documented moderate, severe, or
profound hearing loss (as indicated by their audio-
grams); (c) used a formal sign language (e.g., American
Sign Language [ASL], or contact signing) as their pri-
mary form of communication; (d) had mild to moderate
intellectual disabilities (as indicated by their eligibility
reports and IQ scores); (e) had less than a second-grade
reading ability (as indicated by the Woodcock Reading
Mastery Test Revised–Reading Passage Comprehension);
(f) had limited writing skills as documented by their cur-
rent teacher (although they had to be capable of copying
written messages legibly); (g) used picture symbols for
communication at community sites; (h) had less than 40%
successful initiations using their current picture dictionar-
ies (as indicated by data documenting successful and
unsuccessful initiations that occurred during community-
based vocational training); and (i) had good visual acu-
ity that allowed identification of words and letters in
10-point Comic Sans font and picture symbols that were
quarter-inch square.
Only six students met these criteria from the entire
student population of a metropolitan day school for the
deaf. One of the six students did not give consent to par-
ticipate in the study, so five students were selected (see
Table 1). The students ranged in age from 17 years to 20
years. Based on each student’s audiogram, the students
were determined to have profound hearing losses (except
for Evan, who had moderate to profound hearing loss).
Amanda and Carol both had mild intellectual disabilities,
and the remaining three students had moderate intellec-
tual disabilities. Amanda had the highest reading score
and was on a first-grade level, whereas the remaining
Allgood et al. / Picture Dictionaries 55
Years in Community-Based
Eligibility Report Reading Scorea Vocational Training
MID 1.3 2.2
57b
60c
MOID K.4 1.5
53b
MID K.4 2.0
< 69b
MOID K.4 5.0
48 ± 4b
MOID K.4 2.0
47b
four students had reading scores in the kindergarten
level. Carol had an additional disability of congenital
cataracts, which were surgically corrected, and she wore
glasses. Despite her cataracts, she met the criteria of
being able to identify words using 10-point Comic Sans
and quarter-inch picture symbols. All students had legi-
ble handwriting but did not have the literacy skills to
write messages without assistance. All five students’
receptive form of communication was ASL, and their
expressive form of communication was a mix of ASL
and contact signing.
All five students had been previously taught to use sym-
bol- (picture) based communication systems. Four of the
students (all except Diana) had fewer than 6 months expe-
rience with picture dictionaries. However, all five students
were unsuccessful using these communication systems for
initiation of communication at community-based job sites.
These students often communicated through a combination
of ASL and contact signing, even though their coworkers
and others in the community did not know this form of
communication. This resulted in communication break-
downs between the students and coworkers.
Setting
The researcher conducted preintervention assessment
and training sessions related to symbol identification and
use of a picture dictionary at the students’ school.
Intervention occurred at three community sites used for
community-based vocational training: the grocery store,
the retail store, and the pet store. Students’ previous
community-based vocational training experiences, current
56 Communication Disorders Quarterly
transition plans, and personal requests formed the basis
for site selection. Students were new to each of these
work sites at the start of the study.
Each student was assigned to one community-based
vocational site and had specific jobs at that site. Amanda,
Carol, and Diane worked in the grocery store, but they
worked in different departments and only saw each other
during lunch in the break room. Amanda worked in the
bakery area where she cleaned the display case, replaced
clean trays, and displayed baked items. Carol bagged
groceries, maintained supplies of bags, and performed
general cleaning of the check-out lines. Diana worked in
stocking, mostly cans of fruit. The second community-
based vocational site was a large retail store. Brian
worked at that site, and his tasks included hanging items
of clothing and attaching security tags to appropriate
clothing. The third site was a pet store in which Evan pri-
marily attached security tags to such items as cat collars
and leashes.
Materials and Vocabulary
Construction of picture dictionaries. The dictionaries
consisted of a series of small communication boards fas-
tened to the inside flap of 4-inch × 6-inch pocket
notepads. The pages of the picture dictionaries were 3
inch × 5 inch and contained pictures and words arranged
in 3 × 4 grids for a total of 12 symbols, words, and
phrases per page. Each square of the grid could contain
one picture with one or two words. Picture symbols con-
sisted of picture communication symbols using Board-
Maker software (Johnson, 2000). A 10-point Comic Sans
font was used in a 1-inch grid. The students used the
pages in the notepads to write notes. After completing a
message, the page was detached and handed to the com-
munication partner.
Determining target vocabulary for the picture dictio-
naries. Before the students began vocational training, the
researcher conducted environmental inventories at the
work sites to determine vocabulary words that are typi-
cally used with each of the student’s assigned tasks
(Fried-Oken & Moore, 1992; Millikin, 1997; Mirenda,
1985). These words would be considered for inclusion in
the picture dictionaries. In addition, essential vocabulary
was recorded based on observations at the work site and
interviews with job coaches, coworkers, and site supervi-
sors. This provided a valid interface of the needs and
abilities of the student’s communication vocabulary as
well as the preferences and interactional vocabulary
needs of the communication partner (Johnston, Reichle,
& Evans, 2004).
After a pool of possible vocabulary words was com-
piled, target vocabulary words were selected based on
their frequency of use, their potential usefulness for job
completion, and the likelihood that the student might
need the word or phrase to communicate on the job.
Most of the selected vocabulary words in the picture dic-
tionaries were job specific and consisted of nouns repre-
senting the items necessary for job completion and of
directive phrases such as I need.
Words were eliminated if the students could write the
words. A spelling test consisting of the targeted vocabu-
lary was administered. The researcher asked the students
via sign language or speech reading to write the targeted
words or phrases on paper. If a student was able to spell
the words correctly, the words or phrases were not
included in the student’s picture dictionary. For example,
Amanda could write and spell the word Where and Carol
could write the words I need. These students would be
expected to use these words when writing messages, but
it was unnecessary to include them in their picture dic-
tionaries. In addition, the researcher tested the students
to see if they could read any of the words without the
symbol and if they could identify the symbol without the
words. This was done to determine if the symbol was
needed and if the students knew what the symbols meant.
On the basis of ecological inventories, interviews, and
observations, as well as the result of each student’s writ-
ing the word (spelling), word identification, and symbol
identification, the researcher selected five targeted
word(s)-symbol pairs for each student as the target
vocabulary for this study (see Figure 1). Amanda had the
ability to write basic vocabulary to request assistance or
to write I need, therefore, her picture dictionary con-
tained the main bakery item that she was working with,
rugulach, with identifying labels such as cinnamon,
chocolate, almond, and raspberry. The other students
had pictures pertaining to their job items but also had
directives or questions such as I need or What job now?
In addition to the target vocabulary, the picture dictionar-
ies contained additional words and symbols that the
students might need to perform their job.
Procedures
Preintervention training: Intent and mechanics of use.
The examiner trained students on the purpose and
mechanics of using the picture dictionaries with individ-
uals who could not communicate using sign language.
The examiner followed a system of modeling, guided
practice, and independent practice with symbol-word
pairs to teach the students to use their picture dictionar-
ies (Polloway & Patton, 1993). The students were taught
 Allgood et al. / Picture Dictionaries 57

Figure 1 Intervention procedure. The examiner taught each of

Target Vocabulary for Each Student With Matching the students to initiate communication using the picture
Symbols Used in Picture Dictionaries dictionaries through environmental arrangement strate-
gies and the system of least prompts. Environmental
Amanda Brian Carol Diana Evan arrangement strategies (Kaiser, 2000) included: (a) giving
Grocery Department Store Grocery Grocery Pet Store
the student a task that required some assistance or expla-
cinnamon Where put? What job now? I need cat collar
nation to complete, (b) providing inadequate materials for
task completion, or (c) having the materials needed for
task completion not available. These environmental
chocolate hanger paper bag I don’t understand What job now?
arrangement strategies were used to create situations that
would require the student to communicate with another
almond I need plastic bag of pear I need
individual to obtain assistance or material that was
needed to complete a task. The words needed for commu-
nication were among the five words or phrases that were
raspberry security tag paper towels cans security tag being targeted in the study for each student. These envi-
ronmental strategies were used to ensure that a minimum
of 10 opportunities to initiate communication per training
rugalach What job now? spray cleaner of apricot leash session occurred. The environmental arrangement strate-
gies used with this targeted the five phrases or words
selected for each participant. Each session consisted of 10
trials. Students used each word or phrase at least twice
Note: From The Picture Communication Symbols by R. Johnson, during each session. Some words occurred more often
2000, Solana Beach, CA: Mayer-Johnson. Copyright 1981-2008 by when presented in combination (e.g., I need hanger,
Mayer-Johnson LLC. Reprinted with permission. chocolate rugalach, or almond rugalach).
Systematic instruction was provided through the use of
system of least prompts because it provides the opportu-
nity for the students to perform at their highest level of
using a four-step approach: (a) Locate an appropriate independence on each trial prior to increasing assistance
symbol or word in response to specific situations that (Doyle, Wolery, Ault, & Gast, 1988). In this strategy, a
may occur on their work site, (b) correctly copy the series of more intrusive prompts are given until the target
words associated with each symbol in a legible handwrit- behavior is reached. The prompt levels for the participants
ing, (c) remove the message from the notepad, and (d) in this study were independent, gesture, sign, and model.
hand the message to another person. The examiner mod- If the student did not initiate a written form of communi-
eled the four steps at least two times. The students were cation within 5 seconds, a gesture was used to indicate to
then required to engage in a situation that required them the student that the communication dictionary should
to initiate communication. Sign language was not be used. If communication was not initiated within 5
accepted as the mode of communication. If the students seconds, the examiner gave the second prompt, which
made an error, the examiner modeled the correct proce- consisted of telling the student to initiate communication
dure. To proceed in the study, the students were required via sign language. A third prompt of modeling was given
to demonstrate the four-step approach of using the pic- if signing did not initiate communication. If the student
ture dictionary with 100% accuracy over two consecu- made an error, the examiner interrupted and implemented
tive sessions. an error correction procedure, which entailed using the
most intrusive prompt, which was modeling.
Preintervention training: Symbol identification. The During each session, each student had 10 trials in
examiner taught all of the students in the study to iden- which they were expected to independently complete all
tify each symbol during this training phase. During the five parts of the picture dictionary procedure for the trial
first session, each student’s instructor signed or finger- to be scored as correct. A correct trial consisted of:
spelled the symbol name. The examiner also signed the (a) recognizing that communication should be initiated
meaning of each symbol. To complete the training ses- and pulling out the picture dictionary, (b) locating the
sion, students had to demonstrate 100% accuracy on appropriate symbol or word in response to the need for
identifying the picture symbols used in their picture dic- communication as set up by the environmental arrange-
tionary over two consecutive sessions. ment, (c) correctly copying the words associated with
58 Communication Disorders Quarterly
each symbol in a legible handwriting, (d) removing the
message from the notepad, and (e) handing the note to
the communication partner and waiting for a response.
Design
A multiple baseline probe design (Horner & Baer,
1978; Murphy & Bryan, 1980) across five students was
used to investigate the effectiveness of picture dictionar-
ies for initiating communication using environmental
arrangements and the system of least prompts. Data col-
lection occurred during baseline, baseline probes after
preintervention, and intervention.
Baseline. The examiner collected baseline data for all
students at each student’s work site. During this time, the
students had the picture dictionaries with them, but they
had not received instruction on their correct use. The pic-
ture dictionaries consisted of the words and phrases
selected for each student based on preintervention evalu-
ations. The examiner arranged the environment, but the
student did not receive instructional cues. When a stable
baseline of a minimum of five sessions occurred for the
first student, preintervention training for that student
began. For all subsequent students, additional probe base-
line data were taken. The examiner used probes rather
than continuous baseline measurement because one can
assume that the use of the picture dictionaries remained
stable without instruction (Horner & Baer, 1978).
Preintervention training. After achieving a stable baseline
for a minimum of five sessions, the first student participated
in preintervention training at school. This consisted of teach-
ing the student the intent and mechanics of using the picture
dictionary as well as student’s own targeted symbols and
associated words or phrases in the picture dictionary. The
second student received preintervention training when the
first student showed a positive trend or reached criteria dur-
ing the intervention phase. Preintervention training occurred
for the rest of the students when the previous student showed
a positive trend or reached criterion.
Baseline probes after preintervention training. After
preintervention training, two baseline probes were con-
ducted prior to intervention. This was to ascertain
whether the preintervention training had affected their
performance.
Intervention. The intervention phase occurred after
the two baseline probes following preintervention
training. The examiner taught the students to initiate
communication with the use of the picture dictionaries
through environmental arrangements and system of least
prompts. The examiner assessed each target word or
short phrase two times per session. A session consisted
of 10 opportunities for written communication on the
work site. Criterion for completion of intervention was
an accuracy rate of 80% or better for two consecutive
sessions. In the event a student had completed 15 ses-
sions without reaching criterion, the student would have
been discontinued from the study.
Pretests and posttests were administered to determine
spelling ability of the targeted words or phrases. Before
intervention began, the students were administered a
spelling test to determine the vocabulary for their picture
word dictionary. The examiner repeated the same test at the
end of intervention to determine if the students had
improved in spelling the targeted words in their dictionaries.
Interobserver Reliability and Social Validity
Trained observers (teachers and graduate students)
collected data and checked for reliability. Reliability was
assessed on 33% of baseline sessions, 20% of preinter-
vention training sessions, and 20% of intervention ses-
sions. Interobserver agreement was computed as the
number of agreements divided by the number of agree-
ments plus disagreements multiplied by 100. Reliability
was computed to be 90.66%. In addition, an observer
collected data on the ability of the evaluator to follow the
appropriate predetermined trial procedure to determine
procedural reliability. These reliability data were com-
puted to be 87.5%.
At the end of the study, students completed a social
validity questionnaire to determine their attitudes toward
the picture dictionaries and the efficacy of their use (see
Table 2). All questions were signed using ASL by the
researcher with trained observers checking that the ques-
tions were presented in an unbiased manner. The first
three questions were to ascertain how they preferred to
communicate and if they thought they needed an addi-
tional way to communicate with coworkers. The last four
questions were designed to determine their opinions
about the picture dictionaries. Responses to the last four
questions of the questionnaire were arranged in a 5-point
Likert-type scale (ranging from not at all to very much or
definitely yes; very difficult to very easy; or strongly dis-
agree to strongly agree). All potential answers were
signed using ASL and the students were encouraged to
explain their answer (by answering why or why not after
the last four questions).
 Allgood et al. / Picture Dictionaries 59

Table 2
Responses to Student Questionnaire
Questions in American Sign Language Amanda Brian Carol Diana Evan

1. How do you prefer to communicate? Sign language Sign language Writing Listening Talk
2. Do you need a different way to Yes Yes Yes No answer No answer
communicate with coworkers who do not Write to show other
know sign language? person
3. Do you need a different way to Yes Yes Do not know— No answer Yes
communicate with customers who do not Note writing show notebook.
know sign language?
4. You like using the picture dictionary at 4 (Some) 5 (Very much) 5 (Very much) 4 (Some) 5 (Very
work. Why or why not? It helped me to Writing short; much)
focus on work. show; simple
5. You would use a picture dictionary at a 5 (Definitely yes) 5 (Definitely 3 (Maybe) No answer No answer
different job. Why or why not? It helped me focus yes)
on work.
6. The picture/word dictionary was easy to use. 4 (Easy) 5 (Very easy) 5 (Very easy) 2 (Difficult) 4 (Easy)
Why or why not? For writing and Very easy—yes Easy/hard. Look
communication. 5 (Yes) around find word.
7. The picture/word dictionary helped your 5 (Strongly agree) Think yes. 5 (Strongly agree) 4 (Yes) 2 (No)
communication at work. Why or why not? To understand more. Helped work at
[store]. Help
teacher. Help write.

Data Analysis
Data were analyzed thorough visual analysis of the
graphs displaying the plotted data (Alberto & Troutman,
2003). In addition, changes in the spelling of the targeted
words were examined by comparing the results of a
pretest-posttest spelling evaluation. Data were also
examined with regard to the types of errors that the
students made (e.g., initiation of communication and
mechanics of using the picture dictionary). Mean data
were collected on student questionnaires with evaluation
of student comments in regard to picture dictionary use.
Results
The graphed data indicated that all five students met
the criteria for successfully initiating requests using pic-
ture dictionaries at community-based vocational training
sites through systematic instruction consisting of system
of least prompts and environmental arrangement. Two of
the students (Amanda and Diane) demonstrated some
increases in spelling ability as presented in pretest and
posttest results (as discussed later in this section).
Picture Dictionary Results
Amanda. During baseline, Amanda scored 0% for
each of the five sessions for accurate usage of her picture
dictionary (see Figure 2). During baseline condition she
initiated communication five times but used sign lan-
guage instead of note writing. No one responded to her
sign language and although she had her picture dictio-
nary with her, she did not use it. Next, she received
preintervention training and met criteria. After this, she
again scored 0% on the two baseline probe sessions.
During the intervention phase, Amanda reached crite-
rion in five sessions. Each session involved 10 trials, so
Amanda produced a total of 50 notes. She made contin-
ued progress in the intervention phase to exceed criterion
with 90% for two consecutive sessions. The errors that
Amanda made during intervention were no initiation for
more than 5 seconds, signed initiation, incorrect word
order, and incorrect word-symbol choice. During the
intervention phase, Amanda added additional words 51
times. She added such vocabulary as is, are, and the.
Brian. Brian demonstrated a stable baseline of 0%. He
had his picture dictionary with him but also tried to com-
municate via sign language. After meeting the preinter-
vention criteria, he again scored 0% during the two
baseline probe sessions.
During the intervention phase, Brian reached criteria
in three sessions. He reached criteria of 80% during the
last two sessions. Brian wrote only 30 notes. Brian’s ini-
tial errors were ones of signed initiation. Once he under-
stood what was required of him, he began to write notes
without prompting. Brian’s most frequent errors were
ones of incorrect vocabulary choices, such as writing
60 Communication Disorders Quarterly
Figure 2
Percentage of Accurate Usage of Picture Dictionaries Across Students
a
Baseline probe data were taken after preintervention training.
hanger instead of I need hanger. He made two errors of
word order (e.g., security tag I need). Brian did not add
any additional words in his notes.
Carol. As with the other students, Carol’s baseline and
probes taken after preintervention training were at 0%.
During intervention, Carol reached criteria of 80% and
90% in five sessions. Carol demonstrated errors of
signed initiation, inappropriate symbol-word choices,
incorrect word order, and incorrect insertion of addi-
tional vocabulary. Carol initiated communication via
sign language three times. Carol made incorrect word or
symbol choices six times. She used the word-symbol,
spray cleaner, instead of the correct vocabulary paper
towels, and plastic bag instead of paper bag. She added
the word more incorrectly for the first few times, I need
paper bags more. Once the instructor modeled the cor-
rect word order, Carol repeated the correct order in nine
additional notes that clarified items, such as more plastic
bag or more paper bag.
Diana. Diana used sign language during baseline and
during the probes after preintervention training although
she also had her picture dictionary with her, resulting in
a constant 0% accurate usage of her picture dictionary.
During intervention, Diana achieved criterion in six ses-
sions. She reached a criterion on 80% and 90%. Diana
wrote a total of 60 notes. Diana made only three types of
errors: errors of no response, initiating communication
via sign language, and omission of complete vocabulary
phrase. There were a few sessions when Diana simply
stood, waiting for instructions or cueing before initiating
communication. Her picture dictionary had the inclusion
of the phrase I don’t understand because she tended not
to initiate communication in any format in the class-
room, at home, or in the community. In the study, she
used this phrase in written communication 10 times suc-
cessfully. She also began to write this message in combi-
nation with nontargeted phrases (e.g., I don’t
understand. Where put?) that were on her picture dictio-
nary but were not targeted for this study. She also added

the word more to the statement I need more cans of apri-
cot. In the final session, she wrote I need cans of pear but
then self-corrected and wrote I need cans of apricot, the
correct response.
Evan. As with the other students, Evan’s baseline and
probes taken after preintervention training were at 0%.
Evan reached criteria in three sessions. He wrote a total
of 30 notes before reaching a criterion of 80% and 90%.
Evan made errors that included incorrect word order,
incorrect word selection, and errors of sign initiation. He
only inserted the word more once but eliminated it when
he self-corrected a message with an incorrect word.
Spelling Results
Each participant was assigned five targeted words for
spelling, which corresponded to words on their picture
dictionaries. The students did not receive any instruction
in the targeted words other than to copy the words from
their picture dictionaries onto a sheet of paper when
communicating during intervention. All of the students
took the spelling pretest and scored 0% on their five tar-
geted words.
Posttest scores ranged from 0% to 100%. Amanda
spelled all of her words correctly, even though her words
were the most difficult to spell (e.g., rugalach, cinna-
mon). There was no change in Brian’s spelling ability
during the posttest, maintaining 0% accuracy. Diane was
able to spell 40% of her words correct, but she demon-
strated a change in her spelling ability between the
pretest and posttest on words she missed. During the
pretest, Diane spelled most of the words on the pretest by
one or two apparently random letters (e.g., spelling
I don’t understand as g), while on the posttest, she
demonstrated more patterns in her spelling (e.g., spelling
apricot as appricot; spelling I don’t understand as I unti-
cat). Evan scored 0% on both the pretest and the posttest
for his five targeted spelling words, during which he
refused to attempt to spell any of the words on the pretest
and tried to spell only one word on the posttest. Carol left
the country before the posttest could be presented to her.
Social Validity Questionnaire Results
The results of the questionnaire showed that three of
the five students answered yes to the question “Do you
need a different way to communicate with coworkers
who do not know sign language?” (Evan was unclear,
and Diana would not give a response; see Table 2). When
asked if they liked using the picture dictionaries at work,
the mean response was 4.6 (out of a 5-point Likert scale
with 5 being strongly agree). When asked if they would
Allgood et al. / Picture Dictionaries 61
use the picture dictionary at a different job, Amanda and
Brian strongly agreed, Carol indicated maybe, and the
other two students indicated that they did not understand
the question. When asked if the picture dictionaries were
easy to use, the mean response was 4.0, with four of the
five students having positive responses except Diana.
The students also responded that they felt the picture dic-
tionary helped them communicate at work with a mean
of 4.4 (with all positive responses except for Evan).
When asked to explain why or why not, two students
gave brief remarks.
Discussion
This study suggests that the use of picture dictionaries
for note writing can be an effective form of expressive
communication in the workplace for students who are
deaf and have mild to moderate intellectual disabilities.
Students successfully learned to use their picture dictio-
naries for initiating requests through the system of least
prompts and environmental arrangement. In addition,
two of students had increases in correctly spelling their
targeted words at the end of the study.
Two of the students (Brian and Evan) reached crite-
rion after three sessions, and the three female students
took five to six sessions to reach criterion. Brian and
Evan may have been able to reach criteria quickly
because of their desires to please the instructor. Also,
neither student deviated from writing the exact note
except for Evan. He attempted to insert one additional
word during one trial. However, all three female students
inserted additional words ranging from 8 to 51 times.
Unlike the male students, the female students enjoyed
writing and wrote many messages in their daily journals
at school. The male students on the other hand wrote one
or two words or drew pictures in their daily journals.
The researchers did not expect the students to add
vocabulary to their messages. Four of the five students
added vocabulary to their messages, although this had
not been taught. For example, Amanda inserted addi-
tional vocabulary words that clarified her requests, such
as Where is the chocolate rugaluch? This may be con-
tributed to the fact that Amanda’s use of written language
was more developed than her peers and she was func-
tioning at a higher level in literacy prior to the investiga-
tion. Carol, Diana, and Evan also inserted additional
words, but they only added the word more. Carol and
Diana did this eight to nine times, respectively, as
opposed to Evan’s only inserting the word more once.
Another unexpected result was that students self-
corrected. Self-correcting indicates that the students rec-
ognized the importance of accurate notes and were aware
62 Communication Disorders Quarterly
of the meaning of the written words-symbols in relation
to the surrounding environment. All of the students
attempted to self-correct at least once. Carol and Diana
self-corrected six and two times, respectively. For
example, Evan incorrectly wrote I need leash more and
then self-corrected and wrote I need cat collar. This
occurred during the final session and was his only
attempt to add the word more. Had the intervention con-
tinued, perhaps Evan would have expanded his writing
skills with additional clarifying vocabulary.
Some of the students’ errors may have been due to the
similarity of symbols. For example, Diana made incor-
rect vocabulary choices six times, asking for pear instead
of apricot. Although the symbols were made to look as
different as possible and as close to appearance as their
referent, some similarity of symbols could not be
avoided because of where the students were working.
Carol made some errors between choosing plastic bag
and paper bag.
Some of the errors students made may have been due
to their fluency and skill in using ASL. Carol and
Amanda used incorrect word order on some of their mes-
sages that corresponded to the syntax used in ASL. The
syntax in ASL sometimes reverses the word order from
the spoken English. Although Evan and Brian also made
some word order errors, it is difficult to determine if the
word order errors were related to syntactic translations
from one language to another. Their word order errors
may have been related to the positions of the pictures on
the page of the picture dictionary.
The students’ use of sign language as their preferred
and primary form of communication may have initially
inhibited the use of the picture dictionary in the first ses-
sions of intervention. Some of the students continued to
initiate communication using their native language of
ASL, although the coworkers were unfamiliar with sign
and did not understand the students. It took several trials
for some of the students to initiate using the picture dic-
tionary, even though the purpose of the picture dictionar-
ies was to promote effective communication of
work-related information with individuals who did not
know sign language. In retrospect, it may have been ben-
eficial to have provided the students with more frequent
explanations and instruction on the need to use an alter-
nate form of communication.
System of least prompts and environmental arrange-
ment. Systematic instruction successfully occurred using
the system of least prompts and environmental arrange-
ment. When using the system of least prompts, most
students only needed to be prompted by a gesture to
initiate using the picture dictionary. All students in the
initial intervention sessions needed more intrusive
prompts for locating the appropriate symbol or word in
response to a specific need. The final two steps (i.e.,
removing the note; handing the message to another
person) did not require prompts during the intervention
sessions.
In this study, all students were able to initiate commu-
nication using the environmental arrangement strategy
approach. Arranging the environment to create opportu-
nities to initiate communication provided the students
with sufficient practice to initiate communication with
their coworkers using the picture dictionaries. This
approach was especially beneficial with Diana, who
would not initiate communication in any form without a
generous number of cues prior to the use of environmen-
tal arrangement. Prior to the study, the other students
either did not make requests or made them using ASL
or contact signing, which was not understood by the
general public.
Spelling accuracy. Upon examining the spelling
pretests and posttests, an increase in spelling was seen in
only two students. One factor that may have contributed
to this poor outcome is the number of times messages
were written. It was not anticipated that the students
would reach criterion so quickly in this study. It is possi-
ble that if the students continued to write messages using
the picture dictionaries for a longer period of time,
spelling could have been more positively affected. It is
also possible that the students needed systematic instruc-
tion in spelling, using a more formalized method such as
time delay or cover-copy-compare.
Considerations and Implications
The results of this study suggest that picture dictionar-
ies can successfully be used by students who are deaf
and have intellectual disabilities to facilitate writing
messages to promote communication in the work setting.
This study adds to the research on communication
modalities and instruction on initiation of communica-
tion for students who are deaf and have intellectual dis-
abilities. Given the promising nature of this research,
clinicians are encouraged to conduct further replication
studies with more students as well as with a wider vari-
ety of students.
Clinicians who decide to use picture dictionaries with
their students may obtain different acquisition rates than
what was found in this study. Students in this study had

deafness and intellectual disabilities and had previous
experience with various forms of communication and
with community-based vocational training. Students who
have less experience using alternate forms of communi-
cation at community-based vocational sites may take
much longer in learning to use the picture dictionaries
effectively. Replication studies may explore differences
in acquisition rate with students who have had varying
experiences with alternate forms of communication.
Future research on the use of picture dictionaries may
include a reexamination of the impact of picture dictionar-
ies on spelling. Because the students reached criterion so
quickly in this study, the students may not have had enough
repetition writing and seeing the words to make an impact
on spelling. Future studies may find an effect on spelling if
the students take longer to reach acquisition. In addition,
future studies may examine the word difficulty and its
impact on spelling. Some of the words in this study, such
as the word security tag, may have been a more difficult
word to learn to spell correctly than other targeted words.
Most of the students in this study added words or self-
corrected when writing their messages. Although this
was a positive occurrence, it was not expected. Future
research is needed in terms of training students to self-
correct and to write more complex sentences.
Another issue presented by this study is the student’s
willingness to use the picture dictionaries. Although
three of the students indicated that they liked using their
picture dictionary at work (and the other two students
indicated that they liked using it some), only two
students indicated on the questionnaire that they would
definitely use picture dictionaries (with one other student
being unsure, and the two remaining students being
unable to fully comprehend the question to get a reliable
response). Further training of students in situations
where nonsigners are present may be needed. Future
studies could examine the perceived importance and
stigma of using the picture dictionary to aid message
writing. Also, using this form of communication with
others in the work setting (e.g., customers) will be
important to determine feasibility across different com-
munication partners.
In summary, the purpose of this study was to investi-
gate the use of picture dictionaries for expressive com-
munication by students with deafness and intellectual
impairments at community-based vocational sites. All
five students in this study were able to use the picture
dictionaries to write messages for expressive communi-
cation and reached criteria in three to six sessions. The
researchers found the use of environmental arrangement
strategy and system of least prompts to teach the student
Allgood et al. / Picture Dictionaries 63
to use the picture dictionaries and initiate written mes-
sages as a form of expressive communication to be an
effective strategy. The effectiveness of picture dictionar-
ies to increase spelling accuracy was not supported by
the results, with only two of the students showing
increases. Although further research is needed on the use
of picture dictionaries, the results of this study indicate
that the picture dictionaries can be successfully used to
promote expressive communication of students with
deafness and intellectual impairments.
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Margaret Highnote Allgood, PhD, is a consultant in special
education whose interests include the education of students
with deafness and additional disabilities.
Kathryn Wolff Heller, PhD, is a professor of special educa-
tion at Georgia State University whose research interests
include academic instruction and health management of
students with physical and health disabilities.
Susan R. Easterbrooks, EdD, is a professor of deaf education
at Georgia State University in Atlanta. Her current interests
include language and literacy instruction of students with hear-
ing loss and technology applications that may facilitate acqui-
sition of services.
Laura D. Fredrick, PhD, is an associate professor of educa-
tional psychology at Georgia State University conducting
research in child and adult literacy and in behavior analysis
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