Children with more severe speech and/or language problems often require assistive means to communicate. The use of sign language to supplement speech and enhance communication is considered a method of "augmenting" communication. When speech and gestures/signs are not enough to get a child's message accross, picture supports and voice output are considered as an augmentative and alternative means to communicate. Low technology includes the use picture card supports, such as Mayer Johnson symbols or real photos (laminated), to assist the child in conveying his/her message. Chidren with with sufficient cognitive and language skills can learn to use high tech programs and devices, such as "Proloquo 2 Go" on the iPad. Professional consultations are often sought, particularly when technological expertise is required.