Transcript Slide 1

Nikky Steiner
Speech and Language Therapist
Orchard Hill College
20th March 2012
[email protected]
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
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 High rates of abandonment
 Transition is a particularly difficult
Why is PECS successful in schools?
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“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
Contrast to college/adult services
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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
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
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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
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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
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Effectiveness Framework for
Functional Communication
Effectiveness Framework for
Functional Communication
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
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Video at snack time
Video G.Q.
Video S.P.
Video T.A.
M.K.
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
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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?
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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?
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Discussion: PECS user
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Need to look beyond requesting/commenting
and at qualitative non-verbal communication
 consider
which modes are most effective
in different environments
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when does the PECS become a tool to use to
communicate? Why are we still in training
phases in late teenage years?
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review the design of the system to be improve
timing e.g. Consider motor skills/demands,
number of symbols
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
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Discussion
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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
Future
Evaluation
of EFFC as an outcome measure
and case studies
extending to other areas of AAC and nonverbal approaches e.g. Intensive interaction
more research into use of PECS with older
students and adults
Thanks
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Many thanks to the staff and students at
Greenvale and Tuke school.
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.
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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