PECS with older students and adults?

1. Nikky Steiner Speech and Language Therapist Orchard Hill College 20th March 2012 nsteiner@orchardhill.ac.uk PECS with older students and adults?

2. Background • PECS successfully implemented in school environments for many years • NICE guidelines • Many studies related to use with children very few adults • BUT Anecdotally we know that PECS is used much less in adult services • High rates of abandonment • Transition is a particularly difficult

3. Why is PECS successful in schools? • “School rules” having to ask/request • Emphasis on teaching/learning • Easy to link with IEP, clear objectives, useful for concrete concepts e.g. Numbers/colours “I want 3 red sweets” • Communication partners trained in PECS, often a whole school approach/system • Focus on number of exchange and sentence length, vocabulary, not quality of the interaction

4. Contrast to college/adult services • Emphasis on independence, getting things for yourself (less requesting) more participation/ choice making • Communicative partners typically not trained in PECS, emphasis on Total Communication • Equality of control as an adult • Poor transition described as “PECS user” but strategic competence not established

5. Functional Communication • PECS outcomes and research focuses primarily on initiation, needs and wants • Light’s definition of functional communication (1988): Functional communication involves needs and wants, information transfer, social closeness and social etiquette • Particularly interested in the elements of social closeness

6. Aim • To develop a coding framework to evaluate the qualitative use of PECS as a functional communication system • To use the coding system with older students/adults and their communicative partners

7. Coding Framework • Adapted version of Effectiveness Framework Of Functional Communication (Murphy, 2010 and Cameron, 2010) • Extended the framework to include qualitative indicators e.g. naturalness

8. Effectiveness Framework for Functional Communication

9. Effectiveness Framework for Functional Communication

10. Participants in study • 7 Students across 2 Special schools • 17-19 years • 6 had diagnosis of Autism • 1 had diagnosis of Cornelia de Lange • PECS for 5+ years • PECS Stages between 2 and 6 • Video at snack time

11. Video G.Q.

12. Video S.P.

13. Video T.A.

14. M.K.

15. Evaluation • 6 SLT’s were involved informally in discussing/evaluating the rating scale • Modifications to EFFC made • Needed a criteria/prompts to help inform rating • Feedback and recommendations for individual participants was given to schools

16. Prompt questions • Engagement: How were the PECS user and Communicative Partner positioned e.g. side by side, standing, sitting? Was there shared eye contact, smiling? Was there shared enjoyment? • Balance: was the interaction balanced? Was there equality in the initiation/ending of the interaction? Was there balance between conversational turns?

17. Prompt questions • Pacing: was the pacing of the interaction appropriate? Were there long pauses/delays? Did these disrupt the “flow”? • Naturalness: Were any features of PECS a barrier to the interaction, were any strategies used by the communicative partner a barrier to the naturalness of the interaction?

18. Discussion: PECS user • Need to look beyond requesting/commenting and at qualitative non-verbal communication • consider which modes are most effective in different environments • when does the PECS become a tool to use to communicate? Why are we still in training phases in late teenage years? • review the design of the system to be improve timing e.g. Consider motor skills/demands, number of symbols

19. Communicative partners • Training issues for communicative partner • need to attend to spontaneous naturalistic non-verbal communication • formal system being given greater value than informal or idiosyncratic behaviours • some training strategies do not encourage engagement and social closeness e.g. removal of eye contact, physical proximity, walking away, “blank” facial expression

20. Discussion • Suggest EFFC can provide a structure and consistency to rating qualitative aspects of communication • encourages reflection and a solution focussed approach “how could this be improved?” • could be used as an outcome measure pre and post intervention • collaborative approach identifying which modes are most effective • person centred approach rather than prescriptive

21. Future • Evaluation of EFFC as an outcome measure and case studies • extending to other areas of AAC and non-verbal approaches e.g. Intensive interaction • more research into use of PECS with older students and adults

22. Thanks • Many thanks to the staff and students at Greenvale and Tuke school.

23. References • Cameron L, (2010) The Validation and reliability if the Effectiveness Framework of Functional Communication (EFFC) for Speech and Language Therapists ISSAC presentation Barcelona 2010 • Murphy J (2010) Can AAC ever be effective? Plenary Talk Communication Matters Symposium Leicester 2010.

24. References Bondy A, and Frost L, (1994) The Picture Exchange Communication system training manual. Cherry Hill, NJ: Pyramid Education Chambers M, Rehfeldt RA, (2003). Assessing the acquisition and generalisation of two mand forms with adults with severe developmental disabilities. Research in Developmental Disabilities , 24 pp. 265-280 Ho KM, Weiss SJ, Garrett KL,Lloyd LL,(2005). The effect of Remnant and Pictographic Books on the Communicative Interaction of Individuals with Global Aphasia. Augmentative and Alternative Communication, Vol. 21 (3), pp.218-232 Stoner JB, Beck AR, Jones Bock S. Hickey K. Kosuwan K, Thompson JR, (2006). The effectiveness of the Picture Exchange Communication System with Nonspeaking adults. Remedial and Special Education, May/June 2006; 27,3:ProQuest Psychology Journals pp. 154-165 Sulzer-Azaroff B, Hoffman A.O, Horton CB, Bondy A, Frost L, (2009) The picture Exchange Communication System (PECS): What do the data say? Focus Autism Other Developmental Disabilities 24 89 originally published online 23 March 2009