Transcript AAC

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
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/sam
sung-propel-ozzy-commercial/
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
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?’
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
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)
When something else is
needed..
Mybabycantalk.com
7
Sign Language
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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
When something else is needed..
Pointing to Pictures
Point to communicate choice
9
When something else is needed..Expressive
Picture Communication
Symbols (PCS)
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
Open and Dedicated AAC
http://www.aactechconn
ect.com/index.cfm
When something else is needed..
Visual Strategies
Visual Supports
Get your shoes
Picture Schedule
What do they all have in common?
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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
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).
When something else is needed..Expressive
Picture Communication
Symbols (PCS)
Vs.
Picture Exchange
Communication System
(PECS)
16
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.
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 Pretraining Reinforcer Inventory and 6 phases.
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
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
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
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
Possible Reinforcers
• Ask family and care givers
• Don’t limit selection to conventional items
• Include items the child may use
inappropriately
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
Edibles
1
juice
yogurt
grapes
cheese
gummy bears
2
3
4
5
6
x
x
x
x x
x
7
8
9
10
Rank Reinforcers
Highly
Preferred
Preferred
Non-preferred
Ball
chips
juice
Watchband
Soda straw
yogurt
popcorn
cheese
Gummy bears
belt
grapes
koosh
drum
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.
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
Phase I: Picture Exchange
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
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
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!
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
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
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
Quick Review
Phase I Communicative Partner
– Arranges training environment effectivelypictures 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)
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
Your Turn!
cheezits
chips
gummies
raisins
cheezits
chips
gummies
raisins
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
Phase II: Travel
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
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
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
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
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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
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
Phase IIIb: Take It / Tray
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.
4 Step Error Correction
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Entice with both items
Child requests wrong item
Give wrong item to child, pause
Child reacts negatively
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
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
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!
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
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
Phase IV: Sentence Strip
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
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
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.
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.
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!!!
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
Phase IV Splits
• Begin teaching Phase V & IV
• Continue with Phase IV
– Teach attributes, descriptive vocabulary
– Other vocabulary other than highly preferred
items
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.
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.
Communication Bill of Rights
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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
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
Teaching PECS at Mom’s Day Out
What’s in the Works? Voice Output for
PECS
http://www.proxtalker.com/publication.pdf