Chameleon Communicators

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…. http://larryfire.wordpress.com/2008/11/11/samsung-propel-ozzy-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: http://aac.unl.edu/yaack 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? 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)

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

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 Communication Symbols (PCS) Picture Exchange Communication System (PECS)

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

26. Rank Reinforcers

27. PECS • 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 VITeaches 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 30-40 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

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 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

42. 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

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 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

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