1. Chameleon Communicators
When a Child Needs More –
Augmentative/Alternative Communication
Teri Pinto, Consultant/PECS Trainer
Dawn & Marty McRae, Parents
Cheryl Horn, M.S., CCC-SLP

2. 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….

3. Objectives 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 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

4. 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?’

5. When 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

6. Will 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)

7. When something else is needed..
Mybabycantalk.com

8. 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

9. When something else is needed..
Pointing to Pictures
Point to communicate choice

10. When something else is needed..Expressive
Picture Communication Symbols (PCS)

11. Picture Pointing Pre-requisites Identification of pictures
Matching to sample
Joint attention
Pointing
Difficulties:
Child obtaining adult attention
Prompt dependent- question / response
Point while looking away

12. Open and Dedicated AAC

13. When something else is needed.. Visual Strategies
Visual Supports
Picture Schedule
Get your shoes

14. 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

15. 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).

16. When something else is needed..Expressive
Vs.
Picture Exchange Communication System (PECS)
Picture Communication Symbols (PCS)

17. 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.

18. 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.

19. 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

20. 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

21. 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

22. 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

23. Possible Reinforcers Ask family and care givers
Don’t limit selection to conventional items
Include items the child may use inappropriately

24. 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

25. Edibles 1 2 3 4 5 6 7 8 9 10
juice x
yogurt
grapes
cheese
gummy bears

26. Rank Reinforcers Highly Preferred Preferred Non-preferred Ball chips
juice
Watchband
Soda straw
yogurt
popcorn
cheese
Gummy bears
belt
grapes
koosh
drum

27. PECS
Phase 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.

28. 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

29. Phase I: Picture Exchange

30. 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

31. 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 requesting opportunities throughout the day

32. 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!

33. 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

34. 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

35. 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

36. 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)

37. 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

38. Your Turn! raisins cheezits chips gummies cheezits chips gummies

39. 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

40. Phase II: Travel

41. Phase II Eye 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

42. Phase II Teach 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

43. 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

44. Phase II Quick 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

45. 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

46. Phase IIIb: Take It / Tray

47. 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.

48. 4 Step Error Correction Entice with both items
Child requests wrong item
Give wrong item to child, pause
Child reacts negatively

49. 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

50. 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

51. 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!

52. 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

53. 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

54. Phase IV: Sentence Strip

55. 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

56. 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

57. 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.

58. 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.

59. 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!!!

60. 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

61. Phase IV Splits Begin teaching Phase V & IV Continue with Phase IV
Teach attributes, descriptive vocabulary
Other vocabulary other than highly preferred items

62. 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.

63. 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.

64. 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

65. 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

66. Teaching PECS at Mom’s Day Out

67. What’s in the Works? Voice Output for PECS