Enhancing Photographic AAC Displays for Children with Cortical Visual Impairment: Foundations for Accessible Design and Implementation
Authors: Kevin Pitt, Jamie B. Boster, Keaton Underwood, and Amber Thiessen
Published: 2026, Disability and Rehabilitation: Assistive Technology. https://doi.org/10.1080/17483107.2026.2662436 (not open access)
Introduction
For children who have difficulty communicating through speech, augmentative and alternative communication (AAC) can provide another way to express and share needs, ideas, feelings, and interests. One promising AAC approach uses photographs of real-life and real life setting or situations, referred to as visual scene displays (VSDs).
Photographs can be especially meaningful because they are concrete and familiar, things children recognize from their own lives. A real picture of a child’s favorite toy, teacher, sibling, or classroom activity may be easier to understand than an abstract symbol. This can be particularly helpful for children with cortical visual impairment (CVI), who may benefit from concrete and familiar representations while developing early communication and language skills.
A VSD might show a child playing with a parent, eating lunch, riding a bike, or doing an art project. Important people, objects, or activities within the photograph can then be programmed as communication “hotspots” in place of presenting communication choices as isolated symbols in a grid as is typical of traditional AAC.
There is, however, an important challenge: a photograph can be familiar without being visually easy to process. Real photographs often contain many details: people, objects, colors, shadows, and background details. For a child with CVI, all of that information can compete for their visual attention making it difficult to visually access, or overwhelm them entirely. For instance, imagine trying to find your child’s red backpack in a classroom where every surface is covered with brightly colored objects. The backpack is there, but finding it takes extra effort. The authors suggest that photographic AAC displays may need similar “decluttering” so that the most important information is easier to find.
Main Research Question
The article asks how photographs used in AAC might be changed to make them easier for children with CVI to see, understand, and use.
The authors are particularly interested in ways to reduce unnecessary visual complexity while keeping the meaningful context of the photograph. They also consider how these changes might eventually be incorporated into just-in-time (JIT) programming, which allows caregivers and professionals to create or modify an AAC display quickly for a particular activity or situation.
Methodology
This article is a perspectives paper, rather than a study in which a group of children with CVI was tested. The authors reviewed existing research and used that information to propose practical ways of modifying photographs.
They explored several readily available editing approaches, including professional photo-editing software, smartphone tools, and AAC applications. The examples include tools such as Photoshop, Photoroom, Clean Up, Magic Eraser, Snapseed, GoVisual, and Snap Scene.
The authors organized their discussion around four main areas:
1 Remove unnecessary visual elements and increase spacing
2 Improve contrast, brightness, and color.
3 Use outlines or borders to emphasize important objects.
4 Consider familiarity, object size, and the child’s visual perspective and preferred visual field.
These ideas are presented as starting points rather than a fixed set of rules. The authors repeatedly emphasize that children with CVI have different visual strengths and challenges, so photographs should be adapted to the individual child.
Image Description: A young woman at a patio table with several plants looks at two devices: one with plant vocabulary outlined in red and one with realistic images of plants.
Key Findings
Simplifying the photograph can make important information easier to find
One of the clearest ideas in the article is that less can sometimes be more. Removing objects that are unrelated to the main activity may reduce visual clutter and make the important parts of a photograph easier to notice.
For example, if a photograph is meant to communicate about a child painting a pumpkin, a collection of unrelated objects in the background may not add anything useful. Removing some of those objects could make the child, paintbrush, and pumpkin easier to see.
But simplification has to be balanced with context. A completely empty background may make a photograph visually simpler while also taking away information, or context, that helps the child understand what is happening.
In other words, the goal is not to remove everything. It is to remove what gets in the way while keeping what gives the picture meaning.
Contrast can help important objects stand out
The authors also discuss changing brightness and color saturation so that important parts of an image are easier to distinguish from the background. A key person or object might be made brighter, while distracting parts of the background are made less visually prominent. Color saturation can also be adjusted to potentially increase visual attention to the relevant subject matter.
A useful way to think about contrast is as a visual highlighter. If you highlight the one sentence you need, it becomes easier to find. But if you highlight the entire page, the highlighting no longer helps. The same principle applies to photographs: too much visual emphasis can become distracting rather than helpful.
Outlines may help direct attention
Another possible strategy is placing an outline around an important person, object, or activity. The authors connect this idea with “Roman word bubbling,” a technique used with some children with CVI to make words and letters easier to perceive as distinct shapes.
For a photographic AAC display, an outline could help a child notice the part of the image that has an important communication function. The color of the outline may also matter for children who have particular color preferences.
Familiarity and size matter
Children with CVI may benefit from photographs containing people, places, and objects they already know. Familiarity can give the child an important starting point for understanding what they are seeing. The authors also suggest enlarging important objects or activities so they take up more of the available visual space.
The child’s preferred visual field is another consideration. Some children consistently look more successfully toward one area of their visual field. If that is known, important information might be positioned in that area.
For parents and teachers, this means that observing where and how a child looks can be just as important as choosing the photograph itself.
Significance for CVI
The most important message for CVI practice is that AAC photographs should be individualized.
CVI is related to how the brain processes visual information, not simply to how clearly the eyes see. The visual characteristics of CVI impact children differently. Some may be attracted to particular colors or light. Some may need more time to process what they see. Others may struggle when several objects appear together or may have difficulty recognizing faces. Visual performance can also change with fatigue and environmental conditions.
This makes individualized design especially important. A display that works beautifully for one child may be confusing or tiring for another.
For educators and families, the practical message is to think about the child first and the photograph second. What does this child recognize easily? Which colors attract or distract them? Where do they look most successfully? How much visual information can they comfortably process? Which parts of the scene actually matter for communication?
The article identifies JIT programming as a promising direction because photographs could potentially be adjusted quickly for a child’s current activity. However, the authors point out that this will require efficient editing methods and a strong understanding of each child’s visual needs.
Conclusions
The authors conclude that photographs have considerable potential as AAC tools for children with CVI, particularly because photographs can represent familiar people, objects, and activities in meaningful contexts.
At the same time, realistic does not automatically mean accessible. A photograph may accurately capture an activity but still contain too much visual information for a particular child. The authors therefore propose several promising strategies: simplifying backgrounds, increasing useful contrast, adding outlines, enlarging important objects, using familiar content, and considering visual-field preferences.
However, these strategies should not yet be treated as proven prescriptions. The article’s purpose is to establish a foundation for future research. Researchers still need to test these modifications directly with children and determine which approaches improve visual attention, AAC selection, communication, and literacy.
The authors also see potential in emerging technologies, including AI-assisted photo editing. Faster editing could eventually make it easier for a teacher, therapist, or caregiver to adapt an image while an activity is happening. However, current technology has limitations, and AI will need to account for the highly individual nature of CVI.
Key Takeaways
- Start with the child, not the picture. Consider the child’s individual visual preferences and abilities.
- Keep the important information and reduce the distractions. A simpler photograph may be easier to process.
- Do not remove meaningful context automatically. The background can sometimes help a child understand the activity.
- Make important objects easier to see. Size, brightness, color, spacing, and outlines may all help.
- Use familiar people, places, and objects whenever appropriate.
- Pay attention to where the child looks best. Positioning important information within a preferred visual field may improve access.
- Remember that CVI can vary from child to child and from situation to situation. Fatigue and the environment can affect visual performance.
- Treat these strategies as possibilities, not guarantees. More research is needed to determine which modifications work best and for whom.
- Collaboration matters. Families, educators, speech-language pathologists, occupational therapists, vision professionals, researchers, and technology developers can each contribute valuable information.
- Above all, the goal is not simply to create a “prettier” or simpler photograph. The goal is to create a communication tool that the individual child can actually see, understand, and use.
Pitt, K., Boster, J. B., Underwood, K., & Thiessen, A. (2026). Enhancing photographic AAC displays for children with cortical visual impairment: foundations for accessible design and implementation. Disability and Rehabilitation: Assistive Technology, 1–18. https://doi.org/10.1080/17483107.2026.2662436