Presentation on theme: "Chameleon Communicators"— Presentation transcript:
1Chameleon Communicators When a Child Needs More –Augmentative/Alternative CommunicationTeri Pinto, Consultant/PECS TrainerDawn & Marty McRae, ParentsCheryl Horn, M.S., CCC-SLP
2Why ‘chameleon communicators?’ AAC systems should be adaptable to a variety of changing communication situations. This concept is depicted very well in a recent commercial….
3Objectives Participants 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 developedConducting a Reinforcement AssessmentSpecific teaching strategies used in PECSThe importance of information based decision makingThe importance of a Transdisciplinary team approachThe importance of training parents and care givers
4When 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?’
5When Does A Child Need AAC? Ruth Ballinger’s web site:Van 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
6Will AAC prevent speech? 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)
7When something else is needed.. Mybabycantalk.com
8Sign Language Recommended ( E.G. Carr, 1982) Requires pre-requisite of visual orientationMotor imitationFew people to talk toCost of translatorExtensive trainingCompeting hand movementsNot static
9When something else is needed.. Pointing to PicturesPoint to communicate choice
10When something else is needed..Expressive Picture Communication Symbols (PCS)
11Picture Pointing Pre-requisites Identification of pictures Matching to sampleJoint attentionPointingDifficulties:Child obtaining adult attentionPrompt dependent- question / responsePoint while looking away
13When something else is needed.. Visual Strategies Visual SupportsPicture ScheduleGet your shoes
14What do they all have in common? AttendImitationJoint attentionLearned in part because of associated social consequences (Bijou & Baer, 1965)Does not teach child to initiate social contactsFocuses on how child should respond to social approaches from teacher or other adults
15Houston 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).
16When something else is needed..Expressive Vs.Picture Exchange Communication System (PECS)Picture Communication Symbols (PCS)
17What 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.
18What 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.
19Who are candidates for PECS? Children who have no speechChildren that have speech but don’t use it functionallyChildren who have echolalic speechChildren who do not routinely approach others to make requests and comment spontaneouslyChildren who actively avoid interaction with othersChildren who only communicate in response to a direct cue to do so
20Who 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
21Advantages of PECS Does not involve expensive equipment or comprehensive testing or costly staff and parent trainingDoesn’t require complex fine motor movementsLow Tech = Low CostCan facilitate verbal communicationCan ease the transition to an augmentative deviceCan be taught in a short length of timeExtensive vocabularyCan be used in situations where problem behaviors have occurredEasily understood by untrained people
22Getting Ready for PECS Conduct Reinforcer Assessment Gather possible reinforcersNon-see through box with lidClear disposable plastic cupsTwo pieces of cardboard 1’x2’Data sheet
23Possible Reinforcers Ask family and care givers Don’t limit selection to conventional itemsInclude items the child may use inappropriately
24Assessment Protocol Gather possible reinforcers Present 5-8 edible items at a timeRemove most preferred item ( selected 3 times) and conduct assessment with remaining itemsContinue until you have pool of 3-5 “most preferred” items
27PECSPhase I Teaches 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.
28Phase I Training Environment Child and two trainers:one in front (communicative partner); one in back ( physical prompter) of childAt a table or floor, seated or standingChoose one highly desired item and present it slightly out of reachPicture of item is on table/floor
30Phase I: Mastering the Exchange Upon seeing the preferred item the child will :Pick up pictureReach toward the communicative partnerPlace the picture in the partners handRelease the picture in to the partners handReceive desired item
31Phase I Protocol No verbal prompts used Use more than one preferred item…presented one at a timeGive item with in 1/2 secondDo not conduct in massed trial formatArrange for at least requesting opportunities throughout the day
32Error CorrectionThe 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 occurHowever…accidents do happen!
33Error Correction: Backstep Procedure He drops the pictureDo not make him pick it up!!!Physical Prompter takes child back in the exchange sequence to the last step completed correctlyPhysical Prompter picks up picture and replaces it on the tableCommunicative Partner entices again and Physical Prompter gives additional aid to insure successful exchangeHe gets the requested item
34Stop, Drop and TalkDo anywhere the child is likely to find something he wants!Phase I should not be conducted only during structured trainingUse a variety of trainers in variety of environmentsRefer to Voluntary Family Assessment for daily routines, imbed Phase IWhenever communicative opportunity arises, grab Physical Prompter, get on child’s eye level and conduct one exchange on the spot
35Be Prepared for Stop, Drop and Talk Always carry some simple reinforcers with you and corresponding picturesTeach everyone who is important to the child to use PECSUse waist pack or carpenters apron for small items and pictures
36Quick Review Phase I Communicative Partner Arranges training environment effectively- pictures available one at a time, trainers positioned appropriately, control of reinforcersNo verbal promptingEntices appropriatelyUses open hand prompt effectively- appropriate timingReinforces within ½ second and provides social reinforcementNo insistence on speechReturns picture( while child consumes/plays with +R)
37Quick Review Phase I Physical Prompter Waits for child to initiate ( reach for +R)Physically guides child to pick up, reach, releaseFades prompts effectivelyInterrupts/ prevents student’s interfering behaviorsNo social interaction with child- no touching or talking
41Phase II Eye ContactNot pre-requisite for PECSDifficult for child with Autism due to lack of responsiveness to social reinforcementChild is taught face to face communicationRespond to some ones eye contactElicit eye contact from others
42Phase II Teach with Peers & Siblings Child is persistent with adultsPeers systematically taught PECSPeers control child’s access to favorite item at snack time or play timePeers understand the importance of the pictures and are rewarded for sharing
43Phase II Quick Review Physical Prompter Waits for initiationPrompts removal of picture from book as neededPhysically guides child to Communicative Partner as neededPhysically guides child to communication book as neededDoes interact socially with the childUses Backstepping correction
44Phase II Quick Review Communicative Partner Plans for child to have communication bookArranges training environment appropriately- pictures available one at a time, trainers positioned appropriately, items available but inaccessibleEntices appropriatelyGradually increases distance between child and Communicative PartnerGradually increases distance between child and communication bookTeaches child to cross room to reach Communicative PartnerReinforces appropriately- new behavior with in ½ secondTurns away from child-eliminates subtle body language cuesTeaches child to travel from room to roomDoes not insist on speech
45Phase III: Discrimination of Pictures From the beginning picture learning occurs with in communicative contextNot necessary for child to learn picture matching to sample
47Phase 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.
484 Step Error Correction Entice with both items Child requests wrong itemGive wrong item to child, pauseChild reacts negatively
494 Step Error CorrectionStep 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 promptChild gives target pictureYou praise but do not give item
504 Step Error Correction Step 3. Switch- “ Do this,” pause Child performs the switchVerbally praise childStep 4.Entice with both itemsChild gives correct pictureChild gets item
514 Step Error Correction About Switching… Purpose is to change the subject, visually distract from picturesVery important to switch to a well known task! Or, use a Delay.Switch your switches!
524 Step Error Correction Within one trial repeat the 4-Step Error Correction Procedure2 or 3 times at most!!!Return to “level of mastery” and end session with success
53Phase IV- Sentence Structure Child will request present and non-present items using a multi- word phraseChild gets bookRemoves “I want” icon from bookPuts I ’want” icon on sentence stripRemoves reinforcer picture from bookPuts reinforcer picture on sentence stripRemoves sentence stripGives sentence strip to communicative partner
55Phase IV SettingA Velcro sentence strip is constructed to be velcroed to communication boardStationary “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
56Phase IVBy the end of Phase IV the child should be communicating with a variety of people and be using 20 or more pictures
57Phase IV Protocol No verbal prompts used Use “Backward Chaining” to teach sentence strip constructionUse structured training trials and opportunities for spontaneous requesting during functional activitiesConduct “correspondence” checks while adding vocabularySimplify some aspects of the lesson while teaching the new behavior, then re-incorporate.
58Phase 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.
59Phase IV Not right now using universal “no” symbol over picture Schedule access to reinforcer- put picture on scheduleJust say “no”Show empty containers (keep on hand)DO NOT TAKE PICTURES AWAY!!!DO NOT HIDE BOOK!!!
60Phase 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” stripDifferentially reinforces if child speaksAvoids verbal promptingConducts error correction for incorrect picture sequenceOrganizes communication book appropriatelyDoes not insist on or drill speech imitation/production during PECS
61Phase IV Splits Begin teaching Phase V & IV Continue with Phase IV Teach attributes, descriptive vocabularyOther vocabulary other than highly preferred items
62Phase 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.
63Phase 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.
64Communication 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
65What 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