C. Lynn Chambers, M.S. CCC/SLP Eden Associates 11 Eden Road, Rockport MA 01966

Transcription

1 C. Lynn Chambers, M.S. CCC/SLP Eden Associates 11 Eden Road, Rockport MA What is PECS? 1 PECS falls into the category of augmentative and alternative communication (AAC) systems and is considered an aided technique (Mirenda, 2003). AAC systems are included in a larger grouping of systems and methods that are used to help individuals who do not have typical verbal skills to communicate with others. Examples of commonly used AAC systems include sign language and picture boards. PECS is another type of AAC system that was designed to teach children with limited functional communication skills to initiate communicative exchanges and interactions within a social context. According to the developers of PECS, it is a behaviorally-based intervention that teaches the learner to use visual-graphic symbols to communicate with others (Bondy & Frost, 1994; Frost & Bondy, 2002). With PECS, learners are taught to give a picture or graphic symbol of a desired item to a communicative partner in exchange for the actual item. PECS is the system of communication, not to be confused with how PECS is taught and used (e.g., behavioral principles). 2 Communication Characteristics of children with ASD 3 Less responsive to social reinforcement, therefore, not strongly motivated to communicate for social outcomes. Request more often than typically developing peers. Communicate primarily for tangible outcomes. Comment less often, and less likely to point, show or use eye gaze More likely to manipulate an adult s hand 1 Portions of this handout were drawn from the PECS Training Manual, Second Edition and the PECS handout referenced below 2 Picture Exchange Communication System handout, Implementing the PECS Protocol to Teach Functional SGD Use, McGowan, ASHA, 11/17/11 page 1

2 There are six phases of PECS instruction, each building on the last. The phases include the following: teaching the physically assisted exchange expanding spontaneity simultaneous discrimination of pictures building sentence structure responding to "What do you want?" commenting (initially in response to a question and later spontaneously) Steps prior to introducing PECS Complete Critical Communication Skills Checklist Complete Reinforcer Worksheet Items can be identified by asking caregivers and observing the individual. Present the learner with pairs of choices, being sure to match each item at least once with the other items being sampled (this is to determine relative preference). Also, vary left and right presentation throughout to minimize the effects of a side preference on the part of the learner. Document the items chosen most often, least often, or that produce a notable response (e.g., learner tastes something and spits it out, learner throws item after choosing it). Establish a reinforcer hierarchy, i.e. Which items are most preferred by the student Create the communication book Start with 2 x 2 inch pictures Attach the hook side of Velcro on the book (easier to clean than the loop side) Use a sturdy sentence strip that is a different color from the book PECS Phases Phase I - The Communication Exchange Objective: When student sees a highly preferred item, she/he will pick up a picture of the item, reach toward the communication partner, and release the picture into the partner s hand. Place highly preferred item on table, out of reach of the student Interrupt the student s reach for the object and redirect toward the symbol/ picture PECS Overview page 2

3 Once the student grasps the picture, help him/her place it in the open hand of the communication partner If the student doesn t independently grasp the picture, provide hand-overhand assistance Once the symbol is in your hand, respond by naming the item/activity and giving it to the child. Systematically fade physical assistance. Systematically fate the open hand prompt Phase I Tips: Only ONE symbol/picture is used at a time Verbal prompts (e.g., "What do you want?") should not be used. The goal is for the desired item to serve as a visual cue by being placed slightly out of reach.. Each successful exchange is reinforced by using items known to be highly motivating to the student. Many opportunities are provided for practice and exchanges should be fun for the student. The communication partner and helper include a variety of individuals to prevent the learner from becoming "stimulus dependent" on any one person. Phase II - Distance and Persistence Objective: Student goes to communication book, pulls off picture, goes to communication partner, gets partner s attention, and release picture into the partner s hand. Increase the number and variety of reinforcer items, maintaining a balance between food, activities and tangible items. Increase the number of communication partners and environments The partner gradually increases distance and positioning from the learner so that the student learns to access the picture/symbol, move within proximity of the desired communication partner, and gain the partner's attention before making the request. Phase II Tips: Gradually increase the distance between the student and the communication book. Gradually increase the distance between the communication partner and student. As the communication partner moves further from the student, turn your back to the student. A second person physically prompts the student to gently tap PECS Overview page 3

4 the communication partner. Turn dramatically to the student and give eye contact. Phase III - Picture Discrimination Objective: Student requests desired items by going to the communication book, selecting the picture from an array, going to the partner and giving the picture. Place two pictures/symbols on the book - one highly preferred and one nonpreferred or unrelated. Reinforce the student as soon as he/she touches the symbol, (no need for the student to hand it) by saying yes, that s right or good choice. Rearrange the pictures on the front of the book before each trial. Phase III Tips: Make the picture of the relevant object larger than the picture of the non-preferred object Use color pictures of relevant/desired objects to contrast with black-and-white pictures of non-preferred/irrelevant objects Highlight the desired picture by outlining it with a magic marker Use a blank card as the other picture in the display Make the desired picture 3-dimensional by attaching it to a poker chip or block Place the desired picture closer to where you are holding the desired object Phase IIIB - Discriminating between pictures of two reinforcing items Objective: Student requests desired items by going to the communication book, selecting between two reinforcing pictures, going to the partner and giving the picture. This is done with correspondence checks to ensure that the learner is requesting and taking the item for which he or she is asking. Present two preferred items and have pictures of both available on the communication book. When the learner presents the communication partner with one picture, do not give the item and do not name the item. Offer both items and say, "Go ahead," "Show me," "Here," or something similar. If the learner takes the item that corresponds with the picture presented, allow access, provide praise, and name the item. PECS Overview page 4

5 If the learner reaches for the other item, block access and begin an errorcorrection sequence for the picture that corresponds to the item reached for by the learner. Phase IV - Building Sentence Structure Objective: Student spontaneously requests present and non-present items using a multi-word phrase by placing I want and desired picture on sentence strip. Place I want symbol on the left side of the sentence strip. Reduce the number of pictures on the front of the book. When the student removes the noun picture from the book, physically guide him/her to place it on the I want sentence strip. Say yes when the student independently places the picture on the strip.and immediately give the requested object/activity. If student reaches for the object picture block him/her from doing so and physically prompt the student to remove the I want picture and put it on the strip. Phase V- Responding to What do you want? (Responsive Requesting) Objective: The student spontaneously requests a variety of items and answers the question What do you want? Continue to verbally and tangibly reinforce each correct response. Use delayed prompting to train during this phase. Create opportunities to answer, What do you want? Continue creating multiple communication opportunities across the day. Phase VI- Commenting Objective: The student answers What do you want?, What do you see?, What do you have?, What do you hear? and What is it?, and spontaneously request and comments. Begin this Phase by moving from asking the student what do you want? to what do you see/ Gather a number of highly desired items the student already can request Place a new symbol I see on the cover of the communication book The adult places a symbol/photo of a desired item beside the I see symbol The adult holds up the symbol of the desired item and asks What do you see? and points to the I see symbol on the book PECS Overview page 5

6 If the student doesn t pick up the I see symbol, physically guide her/him to pick it up and place in on the sentence strip. Wait 5 seconds for the student to pick up the symbol and place it on the sentence strip. If he/she doesn t, physically guide the student. When the student assembles the sentence strip and hands it to the adult, say Yes, you see a Next Steps Once learners have progressed through all six phases of PECS training, they are fairly proficient in seeking their communication book, discriminating among pictures, constructing sentence strips, finding a communication partner, and completing the exchange. Logical next steps for post-pecs instruction include: Continue to add new pictures to the learner's communication book. Develop multiple copies of the book to use across settings Continue to provide multiple opportunities to communicate across settings, times and people Provide opportunities without questions to promote spontaneous commenting Introduce attributes and modifiers, e.g. Color, size Behavioral Terms Used in PECS Training - i.e. Teaching Principles Four-Step Error Correction Procedure 1. Model/Show 2. Prompt 3. Switch 4. Repeat Backward Chaining 1. Reinforce mastery of the last step first 2. Once mastered, reinforce the next to the last step 3. Continue this chain of reinforcing from last to first Shaping 1. Reinforce behavior that is closer to the target behavior Delayed Prompting - Progressive Time Delay (used in Phase V) 1. If the student doesn t respond immediately, immediately point to the I want card and ask What do you want?. 2. If the child does not pick up the I want symbol, physically guide her/ him to the I want symbol 3. Gradually increase the time delay between the prompt and the physical guide. PECS Overview page 6