Kommunikation och interaktion är viktigt för att utveckla både språklig och social kompetens. Barn som använder alternativ och kompletterande kommunikation (AKK) får dock inte alltid samma möjligheter som talande barn att kommunicera. Speciellt svårt kan det vara att interagera och därigenom skapa relationer med jämnåriga. Det övergripande syftet med denna studie var att studera samtal mellan jämnåriga, speciellt hur de bygger upp och upprätthåller gemensam förståelse i samtal. Studien innefattade två unga pojkar som på grund av cerebral pares (CP) saknade talförmåga och därför använde bliss som AKK. De filmades under ett samtal med varsin klasskamrat. En samtalsanalytisk metod (conversation analysis, CA) användes för att identifiera mönster i interaktionen och analysera deltagarnas strategier för att etablera gemensam förståelse. De strategier som användes visade sig vara tolkningsförslag, följdfrågor, formuleringar och reparationer. Strategierna användes främst vid responspunkter efter blissyttranden, men reparationer förekom även under konstruktionen av yttranden. Analysen visade också att förståelsestrategier ibland saknades i det ena samtalet vilket då ledde till att samtalet stannade av. De talande tog större delen av ansvaret för förståelsearbetet i båda samtalen, men även de blissande pojkarna var delaktiga. Sammantaget visade analysen att samtal med AKK kan se mycket olika ut. Vilka strategier deltagarna använde sig av för att etablera gemensam förståelse var av stor betydelse i båda samtalen. Det krävdes att alla samtalsdeltagare var engagerade i förståelsearbetet för att samtalet inte skulle avstanna. / Communication and interaction are important parts in developing both linguistic and social skills. Children who uses augmentative and alternative communication (AAC) may not always have the same opportunities as talking children to communicate. It can be especially difficult to interact and thereby create relationships with peers. The aim of this study was to explore conversations between peers, more specifically in which ways they establish and maintain common understanding in the conversation. Participants in the study were two young boys with cerebral palsy (CP) causing non-intelligible speech, and therefore using blissymbolics as their AAC. The boys were videotaped during a conversation with a classmate. A Conversation Analysis method (CA) were used to identify patterns in the interaction, and to analyze the participants' strategies to establish common understanding. Strategies used were suggestions of interpretation, following up-questions, formulations and reparations. The strategies were most used in transition-relevance places, but reparations could also be found during the creation of blissymbolic utterances. The analysis also found that understanding-oriented strategies sometimes were missing in one of the conversations, which led to breakdown in the conversation. The talking individuals were responsible for establishing common understanding in the major part of both conversations, but the boys using blissymbolics did not leave the responsibility entirely to them. In total the analysis showed that conversations with AAC can differ in many ways. Which strategies the participants used to establish common understanding were of great importance in both conversations. Every participant in the conversation were obliged to engage in creating common understanding in order to not lead the conversation to a breakdown.

La présente recherche a pour objet la pratique orthophonique en suppléance à la communication (SC) auprès de personnes qui ont une déficience intellectuelle (DI). Des recherches ont montré que les aides à la communication à sortie vocale (ACSV) pouvaient améliorer la communication des personnes ayant une DI. Cependant, la plupart de ces recherches ont été menées dans des conditions idéales qui ne reflètent pas nécessairement celles que l’on retrouve dans les milieux cliniques typiques. On connaît peu de choses sur les pratiques professionnelles en SC auprès des personnes ayant une DI. Le but de cette recherche est de décrire la pratique orthophonique, de documenter les perspectives des utilisateurs sur les résultats des interventions et de décrire l’implication des parents et leurs habiletés à soutenir leur enfant dans l’utilisation d’une ACSV afin de proposer un modèle d’intervention en SC auprès de cette clientèle qui tienne compte de ces différentes perspectives. Une méthode qualitative a été choisie pour réaliser la recherche. Des entrevues individuelles semi-structurées ont été réalisées avec onze orthophonistes francophones et avec des parents ou familles d’accueil de dix utilisateurs d’ACSV et des entrevues structurées ont été menées avec huit utilisateurs d’ACSV. Un outil d’entrevue a été conçu à l’aide de pictogrammes pour permettre aux utilisateurs d’ACSV de répondre à des questions portant sur leur appréciation et utilisation de leur ACSV, leur satisfaction et priorités de communication. Un cadre conceptuel a été conçu à partir des guides de pratique clinique et un codage semi-ouvert a été utilisé pour réaliser les analyses thématiques des données provenant des orthophonistes. Un codage ouvert a servi à analyser les données provenant des parents. Des analyses descriptives ont servi à examiner les réponses des utilisateurs. Diverses procédures ont assuré la crédibilité des analyses. Entre autres, les analyses des entrevues des orthophonistes ont été validées lors d’un groupe de discussion avec sept participantes orthophonistes. Les résultats montrent que les ACSV sont utilisées surtout dans le milieu scolaire. Elles sont parfois utilisées lors des loisirs et dans la communauté, mais ces contextes sont ceux où les utilisateurs ont exprimé le plus d’insatisfaction et où se situe la majeure partie des priorités qu’ils ont identifiées. Les analyses ont permis d’identifier les facteurs qui rendent compte de ces résultats. Les orthophonistes manquent d’outils pour réaliser des évaluations exhaustives des capacités des clients et elles manquent de procédures pour impliquer les parents et obtenir d’eux une description complète des besoins de communication de leur enfant. Conséquemment, l’ACSV attribuée et le vocabulaire programmé ne répondent pas à l’ensemble des besoins de communication. Certaines orthophonistes manquent de connaissances sur les ACSV ou n’ont pas le matériel pour faire des essais avec les clients. Il en résulte un appariement entre la personne et l’ACSV qui n’est pas toujours parfait. À cause d’un manque de ressources en orthophonie, les parents sont parfois laissés sans soutien pour apporter les changements à la programmation lors des transitions dans la vie de leur enfant et certains ne reçoivent pas d’entraînement visant à soutenir l’utilisation de l’ACSV. Un modèle d’intervention en SC est proposé afin d’améliorer la pratique orthophonique auprès de cette population. / This research targets the practices in Augmentative and Alternative Communication (AAC) of speech-language pathologists (SLPs) who work with individuals who have an intellectual disability (ID). Prior research has shown that speech generating devices (SGDs) can help individuals with ID to improve their communication. However, these studies were conducted under ideal conditions, which do not necessarily reflect those that prevail in typical clinical settings. We have little information about AAC practices with individuals with ID or about the efficacy of SGD attribution and AAC intervention under typical conditions. The goals of this research are therefore to describe AAC practices of SLPs with individuals who have an ID, to document the users’ perspectives on the outcome of AAC interventions and to describe the parents’ implication and their abilities to support their child’s use of an SGD in order to propose an intervention model that takes into account these different perspectives. Qualitative methods were chosen to address these questions. Individual semi-structured interviews were conducted with eleven French-speaking SLPs and with the parents or foster families of ten SGD users, and structured interviews with eight SGD users. These interviews were analyzed in order to gather information about research questions. An evaluation tool, made of graphic symbols, was developed to gather information from SGD users about their use of their SGD, their satisfaction, and communication priorities, and about their appreciation of their SGDs. A conceptual framework was developed based on clinical practice guidelines to analyze SLP’s interviews, and a thematic analysis was conducted with semi-open coding. Open coding was used for the data from parents’ interviews, and descriptive analysis of the SGD users’ responses was performed. Steps were taken to ensure credibility of the findings; in particular a focus group was conducted with seven of the participating SLPs to validate the interview results. The results showed that the SGDs are used most frequently in school settings. They are used only occasionally in leisure activities and in the community, but these are the contexts in which the users were most dissatisfied with their communication and in which they most frequently indicated priorities for communication. Factors that explain these results were identified through thematic analysis. SLPs lack the tools they need to perform a comprehensive evaluation of the users’ capacities. They lack procedures for involving parents in the evaluation and for obtaining a thorough description of their child’s communication needs. This might result in attribution of SGSs and identification of vocabulary that do not meet the user’s needs. Some of the SLPs lack sufficient knowledge and do not have SGDs available for trials with their clients, resulting in a less-than-perfect matches between the users and the SGDs. Lack of professional resources leaves parents without support to make changes needed in times of transition in their child’s life. Parents may be unable to support their child’s use of SGD in a variety of contexts. An attribution and AAC intervention model is proposed in order to improve AAC intervention and SLP’s practices.

When an individual’s ability to communicate with speech does not function as expected, in many cases, augmentative and alternative communication, (AAC), can serve as a support interaction with other persons. The purpose of this study is to investigate how a specific child’s communicative possibilities and abilities develop during the first months after introducing a speech generating device. The study’s main participant Alex is 6 years old and has been diagnosed with autism spectrum disorder and ADHD. Alex also has confirmed limitations regarding gross and fine motor skills and further investigation will examine the presence of childhood apraxia of speech. Two play situations were videotaped at approximately four months intervals and then analysed via conversation analysis and multimodal interaction analysis. At the study’s initial recording session Alex’ communication consisted of gestures and body language together with isolated vocalisations. There were no observed occurrences of spoken words. At the start of the study Alex had been using their speech generating device, SGD, for approximately six weeks. At the end of the study the SGD is found to have been integrated in Alex’ communication during the observed play situations. Its role as a communicative resource has developed from being primarily a device which the child presses in order to answer direct questions, into being used to organise, for example, turn taking, initiate new play rounds or asking questions, by way of other types of manipulation. In addition, Alex’ use of vocalisations has increased and become more situation specific. Baseline measurements were not conducted in this study, wherefore it is not possible to indicate the implementation of an SGD as the reason for Alex’ communicative development. Continued research is needed in order to achieve individual and optimum solutions for all who are dependent on support in their communication. / När en individs möjligheter att kommunicera med tal av någon anledning inte fungerar som förväntat kan i många fall alternativ och kompletterande kommunikation, förkortat AKK, fungera som ett stöd i interaktionen med andra människor. Syftet med denna studie är att undersöka hur ett specifikt barns kommunikativa möjligheter och förmågor utvecklas under de första månaderna efter att ett högteknologiskt AKK introducerats. Studiens huvuddeltagare Alex är 6 år och har diagnoserna autism i barndomen och ADHD. Alex har även konstaterade grov- och finmotoriska begränsningar och vidare undersökningar kommer att undersöka förekomst av verbal dyspraxi. Två leksituationer videofilmades med cirka fyra månaders mellanrum och analyserades sedan med samtalsanalys och multimodal interaktionsanalys. Vid studiens inledande inspelning utgjordes Alex kommunikation av gester och kroppsspråk samt enstaka vokaliseringar. Inga talade ord förekom. Vid studiens slut konstateras att hAKK vid den observerade leksituationen integrerats i Alex kommunikation. Dess roll som kommunikativ resurs har utvecklats från att främst vara en apparat som barnet trycker på för att svara på direkta frågor, till att genom annan typ av manipulering exempelvis organisera turtagning, initiera en ny lekomgång och ställa frågor. Även Alex användning av vokaliseringar i leksituationen har ökat och blivit mer situationsspecifika. Alex mamma och en av hens förskollärare intervjuades och besvarade skattningsfrågor. Resultaten visar att de båda noterat en generellt ökad vilja till kommunikation hos Alex samt lyfter frågan om vilka begränsningar som fortfarande finns gällande Alex kommunikativa möjligheter vid studiens slut. Baselinemätningar saknas i denna studie, varför det inte är möjligt att ange implementeringen av hAKK som orsak till Alex kommunikativa utveckling. Fortsatt forskning behövs för att kunna uppnå individuella och optimala lösningar för alla som är beroende av stöd i sin kommunikation.

THIS THESIS IS IN THE EXAMINATION PROCESS The ability to locate symbols on a visual display forms an integral part of the effective use of AAC systems. Characteristics of display design and perceptual features of symbols have been shown to influence rate and accuracy of symbol location (Thistle&Wilkinson, 2009; Wilkinson, Carlin,&Jagaroo, 2006). The current study endeavoured to compare the use of two colour-coded organisational strategies (alphabetical order and subcategorisation) for their effectiveness in symbol location and to investigate if some bottom-up features influenced the performance of the participants in these tasks. 114 learners in Grade 1 to 3 in a mainstream school were randomly divided into two groups. Both of the groups were exposed to two visual search tests in alternating order. The tests involved searching for 36 visual targets amongst 81 coloured Picture Communication Symbols on a computer screen in one of two colour-coded organizational methods, namely alphabetical order or subcategorisation. The data from the research task was collected through computer logging of all mouse selections. Findings showed that locating symbols on a computer screen with a subcategorisation strategy was significantly faster and more accurate than with an alphabetical strategy for the Grade 1 to 3 participants. The differences between the rates and accuracy of target symbol location using the two strategies decreased significantly as grade increased. It was also found that although the tests in this study placed heavy top-down processing demands on the participants, there was still evidence of bottom-up factors influencing their performance. Implications for display design in AAC clinical practice were discussed. / Thesis (PhD)--University of Pretoria, 2012. / Centre for Augmentative and Alternative Communication (CAAC) / Unrestricted

Talet är något som många människor tar för givet, men för en del barn och vuxna är detta något som inte är lika självklart. Människor med språksvårigheter kan få hjälp och denna hjälp kan börja redan i förskolan. Alternativ och kompletterande kommunikation, AKK, är ett samlingsbegrepp av olika hjälpmedel som kompletterar talet. Teckenstöd och grafisk AKK är de två vanligaste AKK. Teckenstöd tecknar man med händerna samtidigt som du säger ordet. Grafisk AKK är bilder och symboler där man till exempel gör bildscheman över dagen. Tidigare forskning har visat att personal som gått en kurs inom alternativ och kompletterande kommunikation har börjat tänka mer på hur de kommunicerar med personer med språksvårighet och har också börjat använda sig mer av olika sorters AKK. Även de barn som inte har språksvårigheter gynnas av att använda alternativ och kompletterande kommunikation då det ger extra tydlighet i kommunikationen. Om alla barnen lär sig att använda alternativ och kompletterande kommunikation så kan de även använda denna i leken tillsammans med barn med språksvårigheter. I leken härmar barnen varandra både verbalt och icke-verbalt vilket innebär framsteg i kommunikationen.   I mitt examensarbete har jag intervjuat fyra förskollärare i olika kommuner i centrala och östra Värmland. I intervjuerna så framkom att arbetet med alternativ och kompletterande kommunikation varierar mycket, beroende på vilket behov som ansågs behövas. Inställningen till alternativ och kompletterande kommunikation var positiv bland alla de intervjuade men det upplevdes svårt att mäta förbättringen då detta är en lång process. Det framkom också att utbildning i kommunerna inom alternativ och kompletterande kommunikation inte var så stor men att det fanns en önskan bland samtliga förskollärare att lära sig mer om detta. / The spoken language is something that many people take for granted, but for some children and adults this is something that is not obvious. People with language difficulties can get help and this help can start already in preschool. Augmentative and alternative communication, AAC, is a collective concept of various aids that supplement the speech. There are two different types of AAC, aided systems and unaided systems. With unaided systems you use your body and hands to sign word while saying them out loud. Aided systems are pictures and symbols, for example, you create picture schedules throughout the day. Previous research has shown that staff who have taken a course in augmentative and alternative communication have started to think more about how they communicate with people with language difficulties and have also started to use more of different kinds of AAC. Even those children who do not have language difficulties benefits from using AAC as it provides extra clarity in communication. If all children learn to use AAC, they can also use this in the play together with children with language difficulties. In the play, the children mimic each other both verbally and non-verbally, which leads to progress in communication.  I have interviewed four preschool teachers in different cities in central and eastern Värmland. In the interviews, it became apparent that the way of working with AAC varies. The variation is caused by the individual extend to which the need for AAC is seen. The attitude towards Augmentative and alternative communication was positive among all interviewees. However, the measurement of improvements caused by AAC is being seen a challenge. The interviewees stated that the long period of time which is needed when using AAC makes it difficult to measure possible results. The preschool teachers participating in the interviews were of the opinion that education in their respective cities within AAC shows room for improvement and that there was a desire among them all to learn more about the concept.

Service delivery to children with severe disabilities (CSDs) in developing countries share some common characteristics. These include inaccessible services due to the fact that the majority of services are located in a few large cities, the focus of services are usually on school-age children (with few for pre-schoolers), many services require specialised staff and high technology equipment that is not always available and professionals who tend to work in isolation with minimal integration between services. A particularly vulnerable group within the sphere of CSDs are beginning communicators because of their inability to articulate their needs, feelings and rights. Programmes to specifically address these communication needs by equipping them with the necessary skills to interact and participate in society, are very limited. Often the first contact that primary caregivers of a CSD have with professionals, is with the community health nurse. Furthermore, they often remain the only professionals who provide continuous support and assistance to these caregivers. It is therefore clear that these nurses need to be equipped with the necessary knowledge and skills in order to assist caregivers in dealing with their children with severe disabilities. This can be done by training these nurses (through multiskilling) to function as transdisciplinary professionals. Furthermore, a need for appropriate materials for service delivery to this population also exists. Consequently the BCIP (Beginning Communication Intervention Protocol) was developed. The BCIP addresses four important communication domains, namely communication means (including objects, photographs, manual signs, PCS symbols and a simplified 4-option digital speaker), functions (namely informational functions e.g. requesting more, requesting help, etc. and social functions, e.g. greeting, drawing attention to self, etc.), partners (both adults and peers) and the deliberate creation of communication opportunities (e.g. by providing small portions, placing desired items out of research) etc. Care was taken to ensure culture sensitivity and the authenticity of the BCIP. Twenty community health nurses were trained in the application of the BCIP. Training employed adult learning principles and was one week long, followed by three follow-ups that were conducted in situ (at two weeks, six weeks and five months post-training). Multiple measurements were used to evaluate the knowledge and skills acquired after training, namely questionnaires, structured interviews, skill demonstrations (which were video recorded and rated by the researcher and an independent rater) and a focus group. Results indicated that the BCIP training is relevant in bringing about a significant change in the targeted domains, namely knowledge and skills. Peripheral behaviours (namely attitudes, job satisfaction and type of service delivery provided) were all rated high at the onset of the research and thus quantitative data failed to show improvement. On the other hand, qualitative data from the focus group suggested improvement. / Dissertation (PhD (Augmentative and Alternative Communication))--University of Pretoria, 2004. / Centre for Augmentative and Alternative Communication (CAAC) / unrestricted

The structure of graphic symbol utterance constructed by children with typical development and also children with little or no functional speech often differs considerably from spoken utterances. Whether the structure of graphic symbol utterances constructed by these two groups is influenced by similar factors is as yet unknown, as a systematic comparison between the two groups of children has not been conducted. This study aimed to investigate and compare the graphic symbol utterances arranged by children with little or no functional speech with those arranged by their typically developing peers when they were matched according to receptive language age. The utterances were analysed in terms of three variables, namely content, order and intelligibility. The results indicated that children with little or no functional speech do not differ significantly to children with typical development on tasks of graphic symbol utterance construction. The results also indicated that children with higher receptive language age start to use the spoken language word order as a model when arranging graphic symbol utterances more than children with lower receptive language age. The findings suggest that receptive language age plays a role in graphic symbol utterance constructions. The use of structures that do not follow spoken language may be explained by effects of the visual modality. / Dissertation (MA)--University of Pretoria, 2014. / gm2014 / Centre for Augmentative and Alternative Communication (CAAC) / unrestricted

Nonvocal alert patients in the intensive care unit setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. A novel communication tool, the Manually-Operated Communication System (MOCS), was developed for use in intensive care settings for patients unable to speak due to mechanical ventilation. It is a speech-generating device designed for patients whose limited manual dexterity precludes legible writing. In a single-arm device feasibility trial, 14 participants (11 with tracheostomies, 2 with endotracheal tubes, and 1 recently extubated) used MOCS. Participants, family members, and observing nurses were interviewed whenever possible. Interviews included a modified version of the System Usability Scale (SUS) as well as open-ended questions; a qualitative immersion/crystallization approach was used to evaluate these responses. Participants with a tracheostomy and their family members/care providers rated MOCS on the SUS questions as consistently “excellent” (average rating across all groups was 84 +/- 17; all subgroups also rated the device highly). Through a qualitative interview process, these stakeholders expressed support for the use of MOCS in the ICU. Based on these data, MOCS has the potential to improve communication for nonvocal patients with limited manual dexterity.

Prior studies have shown that individuals with disabilities, especially those with communication disabilities, are at higher risk for being exposed to domestic violence. The Swedish National Board of Health and Welfare recommend the municipal social services to use Augmentative Alternative Communication (AAC) as a means to facilitate communication with such individuals. Further, it is recommended that the social services use a standardized instrument called FREDA-risk assessment to ask clients about domestic violence. However, little is known about the use of those instruments among LSS administrators who handle service and support for individuals with disabilities, who may also have communication disabilities. The aim of this study was to investigate the use of FREDA- risk assessment and AAC among LSS administrators, and to explore whether the use of AAC affects the use of FREDA-risk assessment. In order to do so, a digital survey was conducted, in which 366 respondents spread over 144 municipalities participated. The results show that both instruments are not use at their full potential and that the use of AAC could facilitate the use of FREDA- risk assessment. Implications for social work practice and further research are discussed.

Att kommunicera är en rättighet som alla har, oavsett funktionsförmåga. I UNICEF Sverige (2021) under artikel 12 i FN:s konvention om barnets rättigheter, Barnkonventionen, tas barns rätt att uttrycka sin mening och höras i alla frågor som rör barnet upp. Detta är tyvärr inte självklart för flerspråkiga barn i språklig sårbarhet eftersom de har svårigheter att uttrycka sig samt att göra sig förstådda.  Denna studie handlar om metoden Alternativ och Kompletterande Kommunikation, AKK, och delaktighet. Syftet med studien var att med stöd av interventionen undersöka om AKK, med särskilt fokus på bildstöd är en möjlig väg till ökad delaktighet hos flerspråkiga barn i språklig sårbarhet i förskolan. Studiens syfte var även att undersöka hur förskolepersonal som deltar i interventionen beskriver sitt arbete och hur de upplevde användningen av bildstöd som syftade till att öka barns delaktighet. Med studien önskade jag undersöka om en aktiv användning av bildstöd kunde vara ett arbetssätt för att öka tillgängligheten i förskolans vardagsrutiner och undervisning. Ökad tillgänglighet skulle vara betydelsefullt för samtliga barn, fast särskilt för flerspråkiga barn i språklig sårbarhet. Förhoppningen var att metoden skulle öka barnens möjlighet till delaktighet och lärande i sin utbildning.   Intervention genomfördes med två grupper av flerspråkiga barn i språklig sårbarhet på en förskola under fem veckor med två undervisningstillfällen per vecka som ägnades åt interventionen. De två grupperna bestod av en kontrollgrupp som deltog i ordinarie undervisning och en interventionsgrupp som deltog i stödinsatsen (bildstöd). För att besvara studiens syfte och forskningsfrågor valde jag att använda mig av strukturerad observation och kvalitativa intervjuer som metoder för datainsamling. Effekterna av interventionen mättes genom en strukturerad observation med stöd av ett delaktighetsbaserat observationsschema (se bilaga 6) innan och efter interventionsperioden. Efter observationerna användes delaktighetsmodellen av Szönyi och Söderqvist Dunkers (2018), med fokus på de tre delaktighetsaspekterna; tillgänglighet, samhandling och engagemang för analysen. Resultatet beskrivs därefter utifrån dessa aspekter. De semistrukturerade intervjuerna genomfördes med två pedagoger som deltog i intervention efter att interventionsperioden avslutats.  Studiens resultat visade, trots att den genomförda interventionen kan betraktas som kortvarig, ändå att en aktiv användning av bildstöd hade ökat barns delaktighet efter interventionsperioden. Resultatet som framkom under intervjuer visade också att pedagogerna hade en positiv inställning till användandet av bildstöd. Pedagoger upplever att bildstöd är ett verktyg som förstärkt det som sägs samt underlättar barnens kommunikation. / Communication is a fundamental human right that everyone should have access to, regardless of their functional ability. Article 12 of the Convention on the rights of the child provides that every child has the right to express freely his/her opinion on all the questions which concern his/her life. Yet, due to difficulties in communicating for multilingual children with linguistic vulnerabilities are at particular risk of not being heard. This study is about Augmentative and Alternative Communication (AAC) and participation. The purpose of this study is to examine about AAC, with specific focus on if picture cards in an intervention study are a possible way for promoting multilingual children with linguistic vulnerabilities’ participation at preschool. With my study I wished to investigate if active use of picture support can be a way to increase accessibility in preschools everyday routines and education. The purpose of the study is also to examine preschool teacher’s description of their work with active use of picture support.  This intervention study lasted for a period of five weeks (two lessons a week). To answer the research questions, I have used data sources that consist of observations and interviews. Two groups of children (the control group and the experimental group) have been observed over a period when picture cards are used to help teaching. The data were collected before and after intervention. Intervention effects were analyzed using the participation models of Szönyi and Söderqvist Dunkers (2018) with three aspects: accessibility, interaction, and involvement. Semi-structured interviews were conducted with two preschool teachers at one preschool at the end of intervention. The result of the intervention shows that active use of picture cards has increased multilingual children with linguistic vulnerabilities’ participation. The preschool teachers expressed positive feedback of using picture cards in teaching. Picture cards can support speech and expand children’s ability to communicate.