Transcript Picture Exchange Communication System

Picture Exchange Communication
System
“What?”, “Why?”, “When?”, “Who?” “Where?” and
“How?”
Amanda Craig
“What is the Picture Exchange
Communication System (PECS)?”
 Is used to help individuals who have no, or limited, functional
communication skills in a systematic and evidence-based
manner.
 If taught properly, the use of PECS has been shown to lead to
rapidly acquired basic communication skills
 Helps with the development of speech
 Often precedes a reduction in behavior management issues.
Augmentative/Alternative
Communication (AAC)
 Augmentative Communication
Any device, method or system used to supplement
speech
 Alternative Communication
Any device, method or system used for communication
when speech has not developed or has been lost
 PECS can be both!
 PECS is an AAC system
Low-tech or No-tech
 communication aids are defined as those that do not need
batteries, electricity or electronics.
No power switch!
High-tech
 AAC aids permit the storage and retrieval of electronic
messages, with most allowing the user to communicate using
speech output.
 VOCA-Voice output communication aid
Digitized-
play
recorded words or
phrases generally more
intelligible
Synthesized- uses can
be harder to understand
but that permits the user
to spell words an speak
novel messages.
Common misconceptions about PECS
 If you use pictures, you’re using PECS
 If you implement PECS, the learner will never develop
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speech
If the learner begins speaking, stop using PECS
immediately
Sign language is better
Receptive always precedes expressive in language
development
There is no research to support PECS
PECS doesn’t work
PECS Research
 Increases in functional communication skills
 Increases in spoken utterances, including increases in
mean length of utterance (MLU)
 Decreases in contextually inappropriate behaviors
 Research clearly suggests that PECS is an effective
communication tool
 When difficulties arise, problems are often due to:
 Lack of powerful reinforcers
 Trainer error
How widespread is PECS?
 Over 86 published articles (including
28 2008-2010)
 63 data based or case studies
 6 literature reviews
 Used in 52 countries worldwide!
“Why should we use PECS?”
 PECS is an approach that teaches early
communication skills using pictures
 Teaches functional communication that is
immediately useful
 Can be used across ages and disabilities
 Students are taught to exchange pictures for
something they want
History of PECS
 Lori Frost, MS/CCC-SLP
 Began in 1985
 Andy Bondy, PhD
 Based on principles of
Applied Behavior Analysis
and on B.F. Skinner’s 1957
Verbal Behavior
 Protocol was developed as
a result of creative problem
solving with one learner
The Pyramid Approach to Education
Developed by Andy Bondy, Ph.D.
A systematic approach to designing effective
learning environments
Based on a broad spectrum application of Applied
Behavior analysis (ABA)
Blends motivational systems, functional activities,
and creative communication training with the
science of learning
Functional Activities
 To teach skills to
 Get a job
 Live independently
Teach versus “take care of ”
“A functional skill… is an action what will be
performed by someone else if a person with
disabilities does not perform it” Lou Brown,
1984
PECS is NOT….
The use of any picture
Visual Schedules
First /Then boards
Reinforcement Systems
Choice Boards
Following a Visual Schedule
 We use them everyday!
 Recipes
 “To do” lists
 Overhead aisle markers in
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grocery stores
Visual directions for
assembling furniture or toys
Menus
Roadside billboards
“Men” or “Women” icons on
bathroom doors
Other visual schedules
Visual Schedule Video!
 http://www.youtube.com/watch?v=P8vYXtPDnuQ&featur
e=related
4:08
 http://www.youtube.com/watch?v=oeq-
46CFB1s&feature=related
0:57
Powerful Reinforcers
Powerful motivation that drives learning
Two methods to get students to participate:
Make them versus Entice them
 Reinforcers can be social or tangible
 Which do you prefer at work?
 Are social reinforcers always effective?
Reinforcer-First Strategy
No reinforcer, no lesson!
 Consider novelty, choice, control
 ½ second rule for NEW skills
 Differential reinforcement
“Better than before? Then give ‘em
more!”
Let’s Make a Deal
 Show student potential reinforcers
 Ask student to perform short, known task
 Immediately give reinforcer
Over subsequent opportunities, slowly
“stretch” the deal by asking for more work.
Visual Reinforcement Systems
Visual Token Economy
 http://www.youtube.com/watch?v=RO6dc7QSQb4
2:59
PECS is…
 The EXCHANGE of a picture to a
communicative partner to express a persons
wants, needs, and desires.
 A functional communication system
 An AAC device
 A supplement to verbal speech
Functional Communication
 Skills that are useful now and in the future
 Not all behaviors are communicative
 Must occur between two people
 Communicator directs behavior to
communicative partner
 Communicative partner mediates access to
reinforcer
Contextually Inappropriate Behaviors
Focus on functionally equivalent alternative behaviors
“Why we behave the way we do!”
 To gain some type of R+
 Concrete, activity, social, sensory
 To escape/avoid
 Demand, activity, setting
 Elicited
 Loss/delay of reinforcement
 Rate of R+ induced
 Biomedical factors pain
The Pyramid Approach to Education
The Top Elements
 Generalization
 Skills generalized right from the start
 Effective Lessons
 Sequential, Discrete, Incidental
 Specific Teaching Strategies
 Goal is to eliminate prompts
 Minimizing and Correcting Errors
 Opportunities to teach, not just fixing mistakes
 Data Collection
Advantages of PECS
 Requires interaction with other people
 Individual initiates communication
rather than responding to a prompt
 Starts with requesting
First PECS lesson= requesting reinforcer
Teach that exchanging a picture is “easier” than current
method of getting reinforcers
When?
Picture is worth 1,000 words!
 Lack of functional communication
 Lack of spontaneity
 Lack of initiation
 Lack of intelligible utterances
 Lack of gaining attention
 Lack of sentence length
 Lack of word retrieval
Where?
 New story
In the classroom
In therapy
In the sensory/playroom
On the playground
Within the school
 At home
Kitchen
Bedroom
Living Room
 In the community
Generalize across all environments!
How?
Preparing to begin PECS
 Identify reinforcers
 Prepare Data Sheets
 Prepare a PECS book
 You can purchase planners donated at thrift shops
(Salvation Army, Goodwill, etc.)
 Make picture icons that represent the students
reinforcers
 Leave some pictures generic to plan for attributes in
the future (Boardmaker, Pics for Pecs, Google images,
Digital Pictures)
Setting the Stage
 Identify POWERFUL reinforcers
 Items student exerts effort to gain access
to
 Items students resist having taken away
 Item student spends a lot of time with
Examples of Powerful Reinforcers
 Specific food items (apple, chip, cookie, cracker,
banana
 Specific drinks (juice m lk)
 Toys (ball, car, bubbles, train, playdoush, puzzle,
drum)
 Physical actions (up, push, tickles, chase, jump)
 Individualized reinforcers (hat, book, music,
video)
Do not pre-empt communication
Do not anticipate and meet needs
Do not ‘speak’ for the student
Do not assume student cannot
communicate
Phase 1 : Physical Exchange
Goal: Initiate communicative interaction
 Teaches how to communicate
 The “rules” of communication
Approach communicative partner
Deliver message
 Picture discrimination is not a prerequisite
 Initiation means student must “go first”
(What does this look like?)
Phase 1 : Physical Exchange
Upon seeing a “highly preferred” item,
the student will pick up a picture of the
item, reach toward communicative
partner, and release the picture into the
communicative partner’s hand.
Phase 1
Once student initiates, teach the motor response:
Pick up
Reach
Release
Lesson Type: Sequential
Prompt Type: Physical
2-person prompt procedure with backward chaining
Phase 1
 http://www.youtube.com/watch?v=ZP48lxnNdHM
3:01
Phase 1
 Role of the open/empty hand
 Provides information to the student on where to put the
picture
 Is not shown until student has initiated
Must not become a PROMPT!
Communicative Partner
 Entices and holds out desired item
 Does not put out hand until reaches
 Keep hand close to object like a “trap door”
 Praise with happy voice
 Deliver item within ½ second
 State name of item
What it should look like!
 Communicative partner
 Waits for initiation
 Present Item
 Use happy voice!
Phase 1 Video!
http://www.youtube.com/watch?v=-X2llIpmvf0&NR=1
1:39
Second Person Prompter
 Makes sure picture is on the path to the
item
 Waits for student to initiate
 Physically prompts student
 Eliminates prompts using backward
chaining
 Play the role of the “silent partner”
NO SPEAKING!
Second Person Prompter Video!
 http://www.youtube.com/watch?v=wqMnwoL0Txk
1:40
Practice!!!
What if?
 Student doesn’t look at picture?
Move the picture around!
PECS Phase 2 :
Distance and Persistence
 Goal: Persist across obstacles
Continuing to teach “how” to communicate
No discrimination
The student goes to his/her communication book pulls the
picture off, goes to the trainer, gets the trainer’s attention,
and releases the picture into the communicative partner’s
hand.
Each student must have book!
Phase 2 Traveling
Teach students to travel:
To communicative partner
•With book or to get picture from book
•From room to room with book
Lesson Type:
Sequential
Teaching Strategy:
Shaping
Phase 2 Persistence
•Get rid of subtle prompts
•Request during group activities
•Request items out of sight
•Picture- on communication book-moved further from student (still
single pictures, no discrimination)
•Get Communication partner’s attention when back is turned
•Persistence taught
•Variety of People, activities, locations, reinforcers involved
Phase 2 Video
 http://www.youtube.com/watch?v=tr3lQXNEcps
3:07
Naturally come to you first
 Say, “I don’t have it!”
 No verbal prompts!
 “Go to ….”
 “Get your book!”
Backward Chaining
 Sequence back to where start (before error)
 Then to person
 With peers
 No VERBAL Prompts
 Don’t take book from student
 Don’t put it under your desk
Expectations!
Students should take book everywhere!
Generalize across people and environments
Use peers to increase social interactions!
Items should be everywhere for them to ask for! (In
sight, but out of reach!)
Have reinforcing items on you at all times!
Where an apron!
Practice
Get up and move around!
Phase 3 Discrimination
 Goal: choose from among all pictures on or in
book
Only one teacher is needed!
The student requests desired items by going to a
communication book, selecting the appropriate picture
from an array, going to a communicative partner, and
giving the picture
Phase 3A Simple Discrimination
Where should you start?
Motivation to use correct picture is getting desired item and avoiding
undesired item
Begin with highly preferred vs. non-preferred
Lesson Type:
Discrete
New Skill:
Choose the correct picture
Trainer should…
 Entice with both items
 Praise correct item and deliver correct item
 Say nothing and give distracter item
 Error Correct
Discrete Trial Instruction
4 Step Error Correction
Model
Practice
Switch
Repeat
What it should look like!
Cycle through 4- step three times
 Return to level of mastery
 4 step counts as one trial
 Keep communication book at level of mastery
when not teaching Phase 3A
What it should look like!
“Switch” ideas
Give the student a single task to complete (e.g. clap
your hands, touch your nose, stand up, turn around)
Gesture for the student to pick something up form
the floor
Turn PECS book over
Model a motor action for the student to imitate “Do
this”
What it should look like!
Phase 3A
 http://www.youtube.com/watch?v=ukcK5JWIFcs
3:04
 “Ooh” at the moment of choice and give reinforcer after
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the exchange (1/2 second)
“Ooh the new”
If give distracter picture, say nothing, and Give the nonpreferred item
If student plays with distracter find a new one!
Picture being taught varies by what is currently
reinforcing
Vary the “distracter “ picture
Switch you switches!
Move pictures around on book
Pair preferred item with picture ON BOOK!
No Verbal Prompts!
Practice
“Ooh the new”
4-step
Model
Practice
Switch
Repeat
Pair item to picture on book “NOT IN SPACE”
Say nothing when distracter is given
Move the pictures on the book
No verbal prompts!
Alternative Strategies
 Big Pictures far apart
 High Preferred vs. Blank
 Big vs. Small
 High Preferred vs. Aversive
 Try different symbol sets Boardmaker vs.
digital photo or Google images
Phase 3B Preferred vs. Preferred
Student exchanges picture
Student must demonstrate correspondence between
picture and chosen item
State “Take it,” “Get it,” “I want that”
Determine whether student’s actions match his
request
This is the “correspondence check”
What if student takes the other
item?
Block it! Don’t let them take it!
Muffin Tin
Teach to the Reach
Use 4-Step Error Correction Procedure following
mistakes
What it should look like!
 Increase amount of preferred items on
book
 Move pictures inside book, student has to
look inside book
 Student will turn pages to find picture
 Begin organizing pictures
 Reintroduce Phase 2
Practice
Entice with both items
“Take it” “I want that”
Give item if corresponds!
Block item if does not correspond
Teach to the reach
4-Step
Drop Back to level of mastery after 3 errors
Phase 4 Sentence Structure
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 form the communication book, approaching the
communicative partner, and giving them the strip.
 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
Phase 4 Sentence Structure
Lesson
Sequential
Prompt
Physical
Teaching Strategy
Backward Chaining
One Teacher!
Phase 4 Sentence Structure
 “I want”+ reinforcer picture put on sentence strip
 Exchange entire strip given to adult
 Building toward spontaneous commenting
 Sentence Starters provide information to listener on function
of communication
 Teach student to construct and exchange a sentence strip while
maintaining a requesting function
 20 or more pictures!
 Variety of Communicative partners!
Phase 4 Step 1 Add Reinforcer Picture
to Sentence Strip
 “I want” sentence starter already on strip
 Wait for initiation
 Physically prompt to add R+ picture and
exchange strip
 Eliminate prompts over trials
 Quickly read strip to student and give R+
 Reinforce target behavior within ½ second
 “Ooh the new”
What should it look like?
Step 1 Video Physical Prompt
 http://www.youtube.com/watch?v=B_a2j5krILI
0:21
Naturally give you picture, “new skill” put picture on strip!
Phase 4 Step 1 Fading Prompts
 http://www.youtube.com/watch?v=vuJdvTufgLY&NR=1
0:22
Step 2 Add both pictures to Sentence
strip
 Wait for initiation
 Prompt adding “I want” to Sentence strip-
eliminate prompts over time
 Student will independently add R+ picture and
exchange strip
 Quickly read strip to student and give +
 Reinforce target behavior within ½ seconds
 “Ooh the new”
What should it look like?
Read Back Strip!
 http://www.youtube.com/watch?v=vPRZIg9levk
0:36
Step 3 Read the Sentence Strip
 Teach student to point to pictures as you
read strip
 Use backward chaining to eliminate the
prompt
 Differentially reinforce when independent
Step 3 Pointing to icons Video
 http://www.youtube.com/watch?v=Mgx7tblcbR8&NR=1
1:25
What did she do?
What should it look like?
Phase 4 Sentence Structure
Continue to perform
correspondence checks!
Add more pictures to front of book
Move pictures inside book!
Step 4 Encourage Speech
 Add constant time delay (3 seconds) to
encourage speech
 Differently reinforce talking (have a party!)
 Do not insist on speech!
 Do not withhold reinforcer if student does
not speak!
 Honor the exchange!
 No Verbal Prompts!
Phase 4
 Begins with “I want” already on sentence strip
 Waits for initiation
 Physically guides student to put R+ picture on strip and
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exchange strip
Verbal praise, read strip
Teaches the assembly of entire strip-backward chaining
Reinforces new behavior within ½ second
Uses physical prompt to teach student to point while “reading”
strip
Use 3 second delay
Differentially reinforce when student speaks
Practice
No Verbal Prompts
What if?
 Student adds the 2nd picture to the strip first but puts it
in the correct order?
This is okay!
 The sentence strip is handed to you with the pictures in
the wrong order?
Back Step Error Correction
“I don’t understand”
 The student taps out the strip but doesn’t exchange it?
Back Step Error Correction
After Phase 4
Attributes
Responsive Requesting
Commenting
Attributes
 Use attributes to clarify requests for specific
reinforcers
 Must demonstrate a preference for a
particular attribute
 Does not have to know the attribute
receptively as a prerequisite
Attributes
 Step 1: Three-picture sentence construction
 NO attribute discrimination required
 Step 2: Discrimination between high and non-preferred
attribute icons
 4-Step Error correction
 Step 3: Discrimination between 2+ preferred attribute
icons
 Correspondence Checks
 4-Step Error correction
Examples of attributes
 Big/Little
 Colors
 Colored containers with items in
 Crayons
 Flavors
 Numbers
Why to keep some icons generic?
Have a way to increase sentence length, plan for this at the
beginning
Actual DVD’s
Artists
Type of Chip
Exact books
Phase 5: Responsive Requesting
This is begins to…
Teach a building block towards commenting
Teach responding to a question while maintaining
requesting function
Introduce new prompting strategy
Progressive time delay
Finally! We begin to use “I want”
 Phase V
 Step 1
Simultaneously ask question (natural cue) and point to Sentence
Starter
Progressive time delay
 Step 2 Gradually lengthen interval between natural cue and
prompt until student “beats the prompt”
 Step 3 Alternate between opportunities for spontaneous
requesting and answering, “What do you want?”
 Create lessons
 Maintain Spontaneous requesting
Why do we comment?
Surprises
Changes in expectations
Novelty
Unusual events
Our lessons must have these elements!
Phase 6: Commenting
 Many of our students do not respond to
social reinforcement so spontaneous
commenting may be difficult
 Our first commenting lesson involves
answering a question
 Start with questions that are likely
reinforcing from the student’s perspective
Examples
 What do you smell?
 Student really likes smells
 What do you hear?
 Student likes particular artists
 What do you see?
 Student likes to look in mirror
 People
 Objects
 What is it?
Step 1 Answer the Comment Question
 No sentence starter discrimination
 Ask, “What do you see/hear/smell/have?”
 Eliminate prompts using a progressive time
delay
 Differentially Reinforce
 http://www.youtube.com/watch?feature=player_detailpag
e&v=WvAJ3XfiWX4
Step 2 Sentence Starter Discrimination
 Alternate asking, “What do you want?”
and “What do you
see/smell/hear/have?”
 “Ooh the new” at moment of correct
choice
 Differentially reinforce
Decrease Question Prompt
Decreasing the question to elicit
spontaneously commenting
 Shorten utterance
 Fade volume
 Time Delay
Generalization
Books!
The Hungry Caterpillar
Brown Bear “What do you see?”
Thank You!