Research Based Communication Strategies

1. Research Based Communication Strategies

2. Picture Exchange System • A functional Communication System • A way for students without verbal or limited verbal skills to communicate • Developed to help people with Autism and other developmental disabilities • Can be used in conjunction with a voice output system

3. What is PECS • PECS was developed by Lori Frost, a certified Speech-Language Pathologist, and Andrew Bondy, PhD., at the Delaware Autistic Program.  • Using the PECS, the student learns to spontaneously initiate communicative exchanges. People using PECS are taught to approach and give a picture of a desired item to a communicative partner in exchange for that item. Using PECS, students learn to gain the attention of the communication partner in order to make a request.

4. Pyramid approach • Start with basic communication and work your way up! Words first, and then sentences. • Strongly correlated to Skinner’s behavioral theory (operant conditioning) involving an object and reinforcement • Population served: PECS can be used with children or adults who are not yet initiating requests, comments, etc.

5. Benefits • It’s Visual!!! • Pictures are universally understood • May assist a verbal child in organization of language • Follows a systematic approach • Progresses through several “phases” • Can be transferred into a variety of settings

6. Picture Symbols • Three main “types” of pictures are used to exchange depending on the level the student is at • Actual Pictures (digital camera of specific items/objects) • TOBI’s (True Object Based Icons) • May be a picture of a sucker, but is cut in the same shape of the actual object • Boardmaker, or other line drawings • Can be done with objects

7. Words • It is beneficial to have words underneath pictures • Transition to words for students needing assistance with organization or structure (and are “readers”)

8. Preparing for PECS • Participants • Student • Communication Partner • Physical Prompter • Reinforcers • How to determine items of interest • Variability • Supplies (http://www.pyramidproducts.com/) • Reinforcers • Book with velcro • Pictures with velcro (Boardmaker)

9. Phases of PECS • Follows the pyramid format on one stage building upon another. • Stages 1-6 • Each stage has objectives and specific procedural guidelines

10. Phase 1 “How” to Communicate • Terminal Objective: Upon seeing a highly preferred Item, the student will pick up the picture of the item, reach toward the communication partner, and release the picture into the partner’s hand

11. Phase 1 • No verbal prompting • One picture at a time • Two trainers required to teach initiation • Allow for 30-40 request opportunities per day • Pictures can be any size as long as they match student motor skills

12. Phase 1 • Procedure: • Communicative partner sits facing student • Picture is placed between student and trainer • “First one is free!” • Student is enticed by desired item • Student reaches for desired item • Hand-over-hand to assist student in giving the picture to the trainer’s open hand • Trainer says “I want….” • Trainer gives desired object within ½ second • Trainer puts the picture back in place • If objects is a toy, trainer takes back the object to initiate another cycle of requesting • Pointing to pictures is discouraged as pointing does not require interaction with a person.

13. Phase 1 • Fading • Fade physical assistance • Fade open-hand cue • Move to phase 2 if goal is met

14. Communicative Partner’s Responsibilities Entice the student Reinforce the student’s Exchange (with the item) Time the open hand appropriately Physical Prompter’s Responsibilities Wait for the student’s initiation Physically prompt the student to exchange the picture Systematically fade prompts Phase 1: Practical Application

15. Phase 1 of 6 • Spontaneously Requesting Items or Activities

16. Phase 2 Distance and Persistence • Terminal Objective: The student goes to his/her communication board/book, pulls the picture off, go to the communication partner, and release the picture into the partner’s hand.

17. If object exchange is to be used, collect the items the child will use as the representative sample. The following suggestions may assist in gathering these items: • 1. A plastic cup to request a drink. • 2. A few pieces of the child's favorite snack taped to a piece of cardboard. • 3. A few pieces of the favorite food inside a clear cassette case taped shut. • 4. A sample of the favorite item inside a clear video case box.

18. Listener factors Distance to communicative partner Variety of communicative partners Expectant look Enticement style Eye contact Body orientation Taking picture from room to room to find communication partner Environmental Factors Distance to book Variety of rooms Variety of reinforcers Variety of activities (lessons) Sitting vs. standing vs. “on the move” Furniture Phase 2: Introducing Variables

19. Phase 2 • This stage may last a long time. • No verbal prompting • Use a variety of communication partners • Get the student to travel. • Allow for spontaneous requesting throughout the day • Use a communication book to attach the picture to.

20. Communicative Partner’s Responsibilities Plans for student to have a communication book Arranges and positions trainers and environment Entices appropriately Gradually increases distance between student and communication book Teaches student to cross room to reach communication book Reinforces appropriately Turns away from student without body cues Teaches student to travel room to room Does not insist on speech Physical Prompter’s Responsibilities Waits for initiation Prompts removal of picture from book if necessary Physically guides student to trainer if necessary Physically guides student to communication book if necessary Does not interact socially with the student Uses backstepping if necessary Phase 2: Practical Application

21. Phase 2 of 6 • Child has mastered independently making a request with one item, now child is required to move a greater distance to get to the first teacher. • After this is accomplished begin using system in different settings and with different people • Can use other reinforcing items as well

22. Phase 3: Picture Discrimination • Terminal Objective: The student requests desired items by going to a communication book, selecting the appropriate picture from an array, going to a communication partner, and giving the picture.

23. Phase 3 • If trouble discriminating: • Vary sizes of different pictures to contrast each other • Place pictures further apart • Make both pictures larger • Make a blank picture card to compare with one with a picture • Arrange pictures to correspond with actual objects • Place pictures onto actual items • By the end of stage 3, student should have a book of items that they can discriminate

24. Communicative Partner’s Responsibilities Kim Arranges effective training environment Entices with both items Socially reinforces as soon as student touches correct picture Appropriate reinforcement with requested item Uses a variety of distracter items anda variety of target pictures Conducts error correction Moves pictures around on book No insistence on speech Physical Prompter’s Responsibilities Kim Blocks student from taking items May assist in some hand-over-hand if student becomes frustrated Phase 3: Practical ApplicationHigh vs. Distracter discrimination

25. Phase 3 of 6 • Teacher asks child to choose between several items on a board and request item

26. Communicative Partner’s Responsibilities Arranges effective training environment Entices with both items Conducts error correction Moves pictures around on book (diagonal, vertical, horizontal) Teaches 3, 4, 5-way discrimination Uses a variety of target pictures in the 2-, 3-, 4-, or 5-way mix Teaches looking inside book No insistence on speech Physical Prompter’s Responsibilities Blocks student from taking items May assist in some hand-over-hand if student becomes frustrated Phase 3: Practical ApplicationMultiple Preferred discrimination

27. Phase 4: Sentence Structure • Terminal Objective: The student requests present and non-present items using a multi-word phrase by going to the book, picking up a picture/symbol of “I want,” putting it on a sentence strip, picking out the picture of what is wanted, putting it on the sentence strip, removing the strip from the communication board, approaching the communicative partner, and giving the sentence strip to him. By the end of this phase the student typically has twenty or more pictures on the communication board and is communicating with a variety of partners.

28. Phase 4 • The student must be able to request AND comment The sequence to teach: • Get book • Remove “I Want” icon from book • Put “I want” icon on sentence strip • Remove reinforcer picture from book • Put reinforcer picture on sentence strip • Remove sentence strip • Give sentence strip to communicative partner (Use time-delay strategy while reading sentence strip to encourage student’s speech. 3-5 seconds) (Student can eventually request multiple items)

29. Communicative Partner’s Responsibilities Waits for initiation Physically guides student to put picture on strip and exchange Fades physical guidance to put picture on strip and exchange Verbal praise and turns strip around and reads sentence Use backward chaining to teach the sentence strip (work through the seven steps backwards) Reinforces new behavior within ½ second Reinforces with tangible item Phase 4: Practical Application

30. Communicative Partner’s Responsibilities Uses physical assistance to teach student to point while strip is being read Uses delay (3-5 seconds) in reading strip Reinforces if student speaks Avoids verbal prompting Conducts error correction for incorrect picture sequence Organizes communication book appropriately Does not insist on speech imitation/drill during PECS Create opportunities throughout the day for spontaneous requesting Simplify some aspects of the lesson while teaching new behaviors, then reincorporate Phase 4: Practical Application

31. After Phase 4 • At the same time, add more vocabulary and progress to Phase 5. • Attributes are excellent to incorporate into a student’s vocabulary. They can be included in the sentence strip.

32. Phase 4 of 6 • After student can quickly and easily choose between pictures and make spontaneous requests with different people can focus on Sentence Strips. • Start with “I want” • Attach pictures to sentence strip and exchange entire strip

33. Phase 3 • By stage 3, student should be socially using pictures to harness the power of communication • No verbal prompts • Use a variety of trainers • Create opportunities for functional communication throughout the day • Vary positions of 2 pictures on the board/book until discrimination is mastered • Highly preferred vs. non-preferred • Highly preferred vs. highly preferred

34. Phase 5 and 6 • Occur simultaneously • Focus on different extensions of words being added • Add more pictures to book • Use more items, “I see,” “I hear,” “I feel,” “I smell,” etc.

35. Phase 5 Responding to, “What do you want?” • Terminal Objective: The student spontaneously requests a variety of items and answers the question, “What do you want?”

36. Phase 5 • Continue to verbally and tangibly reinforce each correct response • Use “delayed prompting” during this phase • Create opportunities to answer “What do you want” and to spontaneously request • Continue creating multiple communicative opportunities throughout the day.

37. Communicative Partner’s Responsibilities Uses delayed prompting to teach “What do you want?” Uses differential reinforcement if student “beats” the second prompt Reinforces new behavior within ½ second Creates multiple opportunities for spontaneously requesting AND answering, “What do you want?” within the same lesson. Phase 5: Practical Application

38. Phase 6 Commenting • Terminal 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 requests and comments.

39. Phase 6 • Reinforce each communicative act appropriately • Use delayed prompting to train responses to each new question during this phase • Use discrimination training to teach discrimination between sentence-starter icons • Create at least 30 opportunities per day for the student to request or comment during functional activities

40. Communicative Partner’s Responsibilities Facilitate communication Think of some activities that can involve special sets of PECS pictures Make use of PECS as natural as possible Phase 6 Practical Application