Chameleon Communicators

When a Child Needs More –Augmentative/Alternative

CommunicationTeri Pinto, Consultant/PECS Trainer

Dawn & Marty McRae, ParentsCheryl Horn, M.S., CCC-SLP

Why ‘chameleon communicators?’

AAC systems should be adaptable to a variety of changing communication situations. This concept is depicted very well in a recent commercial….

http://larryfire.wordpress.com/2008/11/11/samsung-propel-ozzy-commercial/

ObjectivesParticipants will become aware of:• When to introduce AAC• Difference between Picture Communication

Symbols (PCS), Visual Strategies, and Picture Exchange Communication System (PECS)?

• Why PECS was developed• Conducting a Reinforcement Assessment• Specific teaching strategies used in PECS • The importance of information based decision

making• The importance of a Transdisciplinary team

approach • The importance of training parents and care givers

When Does A Child Need AAC?• When traditional speech and language

therapy takes a long time to accomplish. During this teaching time the child generally continues to have no useful (or calm) way to communicate to others about important fundamental needs.

• When the family asks ‘Is there something else we can do?’

Ruth Ballinger’s web site: http://aac.unl.edu/yaackVan Tatenhove (1987) states the following:• Prior to age one: "...feeding difficulties, irregular

breathing...lack of oral play...overall abnormal gross motor development...“

• Twelve to twenty-four months: "...abnormal oral movements, vocal blocking, poor

coordination of respiration with feeding or vocalizations”

• Twenty-four to thirty-six months: emerging speech unintelligible...continued reliance

on non-language systems to communicate

When Does A Child Need AAC?

http://aac.unl.edu/yaack

Numerous studies have found that the introduction of AAC frequently has a positive affect on speech; children who are given AAC often develop speech faster than they would have otherwise (Bodine & Beukelman, 1991; Van Tatenhove, 1987)

Will AAC prevent speech?

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When something else is needed..

Mybabycantalk.com

Sign Language

• Recommended ( E.G. Carr, 1982)• Requires pre-requisite of visual orientation• Motor imitation• Few people to talk to• Cost of translator• Extensive training• Competing hand movements• Not static

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When something else is needed..

Pointing to Pictures Point to communicate choice

When something else is needed..Expressive

Picture Communication Symbols (PCS)

Picture Pointing

Pre-requisites• Identification of pictures• Matching to sample• Joint attention• PointingDifficulties:• Child obtaining adult attention• Prompt dependent- question / response• Point while looking away

Open and Dedicated AAC

http://www.aactechconnect.com/index.cfm

Visual Supports

When something else is needed..Visual Strategies

Get your shoes

Picture Schedule

What do they all have in common?• Attend• Imitation• Joint attention• Learned in part because of associated social

consequences (Bijou & Baer, 1965) • Does not teach child to initiate social contacts• Focuses on how child should respond to social

approaches from teacher or other adults

Houston we have a problem…

• Use of non-social rewards to teach social skills teaches the form of social skills, but the form does not serve the same function. (e.g. Teach eye contact to get M&M, teaches the form of normal eye contact but it does not have the same consequences).

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When something else is needed..Expressive

Picture Exchange Communication System (PECS)

Picture Communication Symbols (PCS) Vs.

What is PECS?

• The Picture Exchange Communication System (PECS) was developed in 1985 by Andrew S. Bondy, Ph.D. and Lori A. Frost, CCC/SLP as a unique augmentative/ alternative program that teaches children and adults with autism and other communication deficits to initiate communication.

• PECS is recommended for use with very young children.

What is PECS?

• P.E.C.S. is a communication system which enables a child to express his wants and needs by exchanging a picture symbol card for the requested need.

• The training protocol consists of taking a Pre-training Reinforcer Inventory and 6 phases.

Who are candidates for PECS?

•Children who have no speech•Children that have speech but don’t use it functionally •Children who have echolalic speech•Children who do not routinely approach others to make requests and comment spontaneously•Children who actively avoid interaction with others•Children who only communicate in response to a direct cue to do so

Who can use PECS?

• PECS was developed for use by teachers, families, early intervention personnel and direct care staff.

• It is now widely used with all ages and with individuals having a variety of social communication problems, memory and attention deficits.

• PECS communication training is a transdisciplinary team endeavor

Advantages of PECS

• Does not involve expensive equipment or comprehensive testing or costly staff and parent training • Doesn’t require complex fine motor movements• Low Tech = Low Cost• Can facilitate verbal communication• Can ease the transition to an augmentative device• Can be taught in a short length of time• Extensive vocabulary• Can be used in situations where problem behaviors have

occurred• Easily understood by untrained people

Getting Ready for PECS

Conduct Reinforcer Assessment• Gather possible reinforcers• Non-see through box with lid• Clear disposable plastic cups• Two pieces of cardboard 1’x2’• Data sheet

Possible Reinforcers

• Ask family and care givers• Don’t limit selection to conventional items• Include items the child may use

inappropriately

Assessment Protocol

• Gather possible reinforcers• Present 5-8 edible items at a time• Remove most preferred item ( selected 3

times) and conduct assessment with remaining items

• Continue until you have pool of 3-5 “most preferred” items

Edibles

1 2 3 4 5 6 7 8 9 10

juice xyogurtgrapes x xcheese x x xgummy bears

Rank Reinforcers

Highly Preferred

Preferred Non-preferred

Ball chips juice

Watchband Soda straw yogurt

popcorn cheese Gummy bears

belt grapes

koosh

drum

• Phase ITeaches students to initiate communication right from the start by exchanging a single picture for a highly desired item.

• Phase II Teaches students to be persistent communicators- to actively seek out their pictures and to travel to someone to make a request.

• Phase III Teaches students to discriminate pictures and to select the picture that represents the item they want.

• Phase IV Teaches students to use sentence structure to make a request in the form of “I want _____.”

• Phase V Teaches students to respond to the question “What do you want?”

• Phase VI Teaches students to comment about things in their environment both spontaneously and in response to a question.

PECS

Phase I Training Environment

• Child and two trainers:one in front (communicative partner); one in back ( physical prompter) of child

• At a table or floor, seated or standing• Choose one highly desired item and present it

slightly out of reach• Picture of item is on table/floor

Phase I: Picture Exchange

Phase I: Mastering the Exchange

• Upon seeing the preferred item the child will :–Pick up picture –Reach toward the communicative partner–Place the picture in the partners hand–Release the picture in to the partners hand–Receive desired item

Phase I Protocol

• No verbal prompts used • Use more than one preferred item…presented

one at a time• Give item with in 1/2 second• Do not conduct in massed trial format• Arrange for at least 30-40 requesting

opportunities throughout the day

Error Correction

The two person prompting strategy is an errorless learning strategy. If the Physical Prompter systematically fades prompts and the Communicative Partner entices with reinforcing items errors should not occur

However…accidents do happen!

Error Correction: Backstep Procedure

• He drops the picture – Do not make him pick it up!!!

• Physical Prompter takes child back in the exchange sequence to the last step completed correctly

– Physical Prompter picks up picture and replaces it on the table

– Communicative Partner entices again and Physical Prompter gives additional aid to insure successful exchange

– He gets the requested item

Stop, Drop and Talk• Do anywhere the child is likely to find something he

wants!• Phase I should not be conducted only during

structured training• Use a variety of trainers in variety of environments• Refer to Voluntary Family Assessment for daily

routines, imbed Phase I• Whenever communicative opportunity arises, grab

Physical Prompter, get on child’s eye level and conduct one exchange on the spot

Be Prepared for Stop, Drop and Talk

• Always carry some simple reinforcers with you and corresponding pictures

• Teach everyone who is important to the child to use PECS

• Use waist pack or carpenters apron for small items and pictures

Quick Review

Phase I Communicative Partner– Arranges training environment effectively- pictures

available one at a time, trainers positioned appropriately, control of reinforcers

– No verbal prompting– Entices appropriately– Uses open hand prompt effectively- appropriate

timing– Reinforces within ½ second and provides social

reinforcement– No insistence on speech– Returns picture( while child consumes/plays with

+R)

Quick Review

• Phase I Physical Prompter– Waits for child to initiate ( reach for +R)– Physically guides child to pick up, reach, release– Fades prompts effectively– Interrupts/ prevents student’s interfering

behaviors– No social interaction with child- no touching or

talking

Your Turn!

cheezits chips gummies raisins

cheezits chips gummies raisins

Phase II Traveling and Persistence

• Child will:– Travel to his communication book– Remove picture from communication book– Travel to a ”Listener”– Make face to face request

Phase II: Travel

Phase IIEye Contact

• Not pre-requisite for PECS• Difficult for child with Autism due to lack

of responsiveness to social reinforcement• Child is taught face to face

communication–Respond to some ones eye contact–Elicit eye contact from others

Phase IITeach with Peers & Siblings

• Child is persistent with adults• Peers systematically taught PECS• Peers control child’s access to favorite item at

snack time or play time• Peers understand the importance of the

pictures and are rewarded for sharing

Phase II Quick Review Physical Prompter

• Waits for initiation• Prompts removal of picture from book as needed• Physically guides child to Communicative Partner as

needed• Physically guides child to communication book as

needed• Does interact socially with the child• Uses Backstepping correction

Phase IIQuick Review Communicative Partner

• Plans for child to have communication book• Arranges training environment appropriately- pictures

available one at a time, trainers positioned appropriately, items available but inaccessible

• Entices appropriately• Gradually increases distance between child and

Communicative Partner• Gradually increases distance between child and

communication book• Teaches child to cross room to reach Communicative Partner

• Reinforces appropriately- new behavior with in ½ second• Turns away from child-eliminates subtle body language cues• Teaches child to travel from room to room• Does not insist on speech

Phase III: Discrimination of Pictures

– From the beginning picture learning occurs with in communicative context

–Not necessary for child to learn picture matching to sample

Phase IIIb: Take It / Tray

Phase III: Discrimination of Pictures (cont.)

• Add pictures as mastery occurs.• Present a similar array of items the child

can choose from.• Reduce the picture size.

4 Step Error Correction

• Entice with both items• Child requests wrong item• Give wrong item to child, pause• Child reacts negatively

4 Step Error Correction

• Step 1 Show or tap target picture( get child to look at target picture)

• Step 2. Prompt with open hand near target picture, physically or gesturally prompt–Child gives target picture– You praise but do not give item

4 Step Error Correction

• Step 3. Switch- “ Do this,” pause–Child performs the switch–Verbally praise child

• Step 4.Entice with both items–Child gives correct picture–Child gets item

4 Step Error Correction

About Switching…– Purpose is to change the subject, visually

distract from pictures– Very important to switch to a well known task!

Or, use a Delay.– Switch your switches!

4 Step Error Correction

–Within one trial repeat the 4-Step Error Correction Procedure 2 or 3 times at most!!!

–Return to “level of mastery” and end session with success

Phase IV- Sentence Structure

• Child will request present and non-present items using a multi- word phrase– Child gets book– Removes “I want” icon from book– Puts I ’want” icon on sentence strip– Removes reinforcer picture from book– Puts reinforcer picture on sentence strip– Removes sentence strip– Gives sentence strip to communicative partner

Phase IV: Sentence Strip

Phase IV Setting

• A Velcro sentence strip is constructed to be velcroed to communication board

• Stationary “I want” picture is attach to the left side of the sentence strip.

• Pictures may be categorized in side book to make finding them easier

Phase IV

• By the end of Phase IV the child should be communicating with a variety of people and be using 20 or more pictures

Phase IV Protocol• No verbal prompts used • Use “Backward Chaining” to teach sentence strip

construction• Use structured training trials and opportunities for

spontaneous requesting during functional activities• Conduct “correspondence” checks while adding

vocabulary• Simplify some aspects of the lesson while teaching

the new behavior, then re-incorporate.

Phase IV: Backward Chaining

• Provide needed assistance from the first step through the end, and fade the assistance from the end of the chain.

• The student is physically guided to put the picture of the preferred item onto the sentence strip next to the “I want” picture and then handing that to the trainer.

Phase IV

– Not right now using universal “no” symbol over picture

– Schedule access to reinforcer- put picture on schedule

– Just say “no”– Show empty containers (keep on hand)– DO NOT TAKE PICTURES AWAY!!!– DO NOT HIDE BOOK!!!

Phase IV Quick Review • Trainer should:– Uses physical assistance to teach child to point

while strip is being “read”– Uses delay(3-5 sec>) in “reading” strip– Differentially reinforces if child speaks– Avoids verbal prompting– Conducts error correction for incorrect picture

sequence– Organizes communication book appropriately– Does not insist on or drill speech

imitation/production during PECS

Phase IV Splits

• Begin teaching Phase V & IV • Continue with Phase IV – Teach attributes, descriptive vocabulary– Other vocabulary other than highly preferred

items

Phase IV

• Commenting in response to a question• This phase targets responses that include “I

want,” “I see,” “I have”• More complex sentence construction is

emphasized.

Phase V : Brief• Responding to “What do you want?”• With a desired object present and the “I want”

picture, the sentence strips, and picture of item, the teacher simultaneously points to the “ I want” card and ask, “What do you want?”

• The student should pick up the “I want” card and complete the exchange.

• Increase the time delay between asking, “what do you want?” and pointing to the “I want” card. Time is increased by 1 second per success level of 800% of opportunities successful.

Communication Bill of Rights

• We must believe:• Every person has the right to be heard.• Every person has the right to be understood.• Every person deserves the right to

communicate his or her needs, thoughts questions, emotions, and choices.

• Every person can communicate in his or her own way.

---Tanni Anthony, Project Director, Colorado Services to Children

What a Daycare Director said….

“…. I wanted to let you know that he's doing great with the PECS- we only have time to do it briefly throughout the day (snack, lunch, and center time), but he's totally independent with the pictures now……”

Michelle McDaniel

Teaching PECS at Mom’s Day Out

http://www.proxtalker.com/publication.pdf

What’s in the Works? Voice Output for PECS