For some non-verbal children, choosing pictures or symbols with their hands is not an option, due to conditions that make it difficult for them to reach, point to or grasp. For these children, we need to look at ways for them to select picture or symbols, without undue effort or stress, so that they can communicate in an easy, timely manner.

Children naturally look at interesting pictures placed in front of them. They may not yet have the idea that looking intentionally at a picture caused particular outcome (i.e. looking at the picture of the book results in a story being read to them) but they may gradually make this connection over time (cause and effect) if the outcome of their selection, whether intentional or not, is consistently carried out.

For both children making intentional choices and unintentional choices, eye pointing (selecting a picture or symbol by looking at it) can be a powerful way of communicating. While many children may start with eye pointing to items in their visual field, it may be necessary to formalise this system, through the use of a consistent set-up. An Etran Frame is one method of doing this.

An Etran frame is like a large square, see-through donut, with a space in the centre (see picture below). It is usually made from a plastic transparent material, such as Perspex. It sometimes has a base or is mounted on an arm, so that the facilitator does not need to hold it, and has both hands free to interact with the child and their selections. The frame should be placed in front of the child, with picture symbols attached, facing toward the child. The hole in the middle is used by the facilitator to see the child and follow their gaze, to interpret what picture or symbol the child is looking at.

Positioning

The child should be positioned well, with the Etran frame square on, in front of them. If possible it should be mounted, to prevent it moving around.

The partner should be directly opposite the child and able to make eye contact through the hole in the centre of the frame.

Using the Etran frame

Plan to use 2-3 locations initially – with the top left and bottom right being the first positions to introduce pictures.

The bottom right will always be used as an “All Done”/”Stop” indicator. The vocabulary at the top will vary according to activity.

Make it fun

The child needs to get the idea right from the start that this is a good game. Use highly motivating objects, activities or toys and stick symbols directly onto the frame.

Attaching items to the frame

Bluetack or Velcro is really the simplest and best method.  If you stick on picture symbols, make sure that you write what they are on the back, so that you can see which is which! (You cannot both read their eye movements from the front and keep popping around to see the child side of the frame and “sitting on his or her shoulder” to see what they are pointing at).

How many objects are pictures?

Not too few (boring), not too many (overwhelming). Two, then quickly onto three is good. Move up gradually.

First steps

Model the activity for so that a child knows what they’re supposed to do. Let the child see you sticking pictures/symbols to the frame.

Prompting

When the child looks at the object for 1-2 seconds, use the selection frame around the symbol s/he looked at (for visual reinforcement), and say “you looked at this. It’s a ____. Will we use/do_____?” (for auditory reinforcement). The reason for introducing the selection frame is for the future, when the child may move onto a high tech device and the selection is indicated with a colour frame around their selection.

Scanning

If the child doesn’t look at the symbols, say, “Where is the _____? Let’s look for the _____. You help me find it”.

Take your finger and slowly point the item fixed in the position that is top left (to the child- always start at this same position). Say “Is this it?” Move your finger slowly and smoothly along to the next item along the top of the frame, if a second picture is being used. Try to take the child’s eyes with you as you move your finger “Is this it?”. Keep doing this until you get to the one you want. Then say “aha, we found it, look at the _____! Here it is!”.

Take the selection frame and hold it around the symbol for 2-3 seconds, so that the child knows that this is the choice s/he has selected. For example, below shows the “Stop/All done” symbol selected.

Ideas for using the Etran Frame.

Book reading – Use a “Turn the page” symbol in conjunction with the “All done/Stop” symbol. A second symbol for “Read it again” or “new book” can be introduced later.

Blowing bubbles/listening to music/any activity the child enjoys – use a “more” or “again” symbol with the “All done/Stop” symbol

Choice making – two symbols plus the “All done/Stop” symbols are required for this i.e. book vs. teddy, walk vs. car, visit Granny vs. visit shops, jack in the box vs. popper etc, etc. Even choosing clothes, colours, toys etc.

Playing games – Simon says is a great game for group activities. Use a couple of actions such as “dance”, “blow raspberries”, “sing”, “wiggle your bum” “hop” etc. etc, so that the child  can tell others what to do.

Use teddies/dolls for pretend play. Ask the child which s/he wants to play with first (“teddy” and “doll” symbols) and then choose what to do i.e. “have a drink”, “have a bath” “go to bed” etc. etc.