Communicating with Autistic Children Implementing Picture Exchange Communication System Claudina Antoine UVI nursing
Overview of Autism
What is Autism
Autism is one of the five disorders coming under the umbrella of pervasive development disorders.
Pervasive developmental disorders is a group of disorders with similar features that usually begins early in childhood.
Autism or Autism Spectrum Disorders is a group of complex neurodevelopmental disorders that is characterize by impairment in social interaction, communication difficulties and repetitive, and stereotyped patterns of behavior.
Onset is usually before 36 months but some children
may show signs and symptoms earlier
Autism is more prevalent in boys than girls
( according to research it is 4 times more common in boys than girls)
The exact cause of autism is unknown, but abnormalities in the
brain structure and function are probable causes .
Some diagnostic studies show that neurotransmitters such as dopamine,
and serotonin are abnormal in children with autism.
Other probable causes includes :
Childhood Vaccines may contribute to a late onset of
Autism (evidences is very limited and no proven facts)
Overview Autism continued
Signs and Symptoms
One of the hallmark characteristic of autistic children is unusual or delayed speech and language development
Displays little eye contact with and makes few facial expressions.
Displays limited capacity to relates to parents and peers.
They can not engage in play or make-believe with toys
They engage in stereotyped behaviors such as head bagging, hand flapping, and body twisting
Treatment and Therapies
Applied behavior analysis
Treatment and education of autistic and related communication handicapped children (TEACCH)
Social stories technique
Pictures exchange communication
Medications: SSRI’s ( for depression)
Antipsychotic: ex; Risperdal, Clozaril and seroquel
Stimulants are sometimes prescribe for hyperactive and impulsive behaviors in child with Autism
Picture exchange Communication
Picture Exchange Communication System (PECS) was developed by Andy Bondy, PhD and Lori Frost, as a form augmentative and alternative communication .( Ganz & Simpson, 2004)
Based on the principles of Applied Behavior Analysis, PECS is a method for individuals with Autism to communicate without relying on verbal communication. The PECS helps to foster language development
Children with autism is usually visual learner and learn systematically.
How it works
PECS can be used for any individual with autism. There is no age limit specified or the use of PECS, but most research focuses on children.
The six phase of PECS
Expanding the use of pictures
Choosing messages in PECS
Introducing sentences in PECS
Teaching to answer questions in PECS
(Christy, Loc lee,& Kellet, 2002 )
1. Physical exchange
The child is taught to hand a blank picture card to a communicative partner
2. Expanding the use of pictures
The child is taught to go to his PECS board, get a picture card, seek out a communicative partner, and place the card in his or her hand to receive a reinforcer.
3. Picture discrimination
The child is taught to discriminate among multiple pictures on the PECS board.
4. Sentence structure
Starts the child in the process of building sentences through "sentence strips “
5. Answering questions
Challenges the child to build questions using sentence strips, starters and pictures.
The child is taught to respond to the question; example, ‘‘What do you see?’’
Research have shown that one benefit of PECS is that some children often develop speech. Another benefit of using PECS is that many people in the child's community can use the system without special training. ( Ganz & Simpson, 2004)
Impaired verbal communication r/t speech and language delays
Impaired social interaction r/t communication barriers, inability to relate to others
Nurses and other health care provides need to be prepare and creative when working with children with Autism.
Parents are a major resource
A 15-30 minutes conversation in person or via the telephone with the parent prior to schedule clinical visits can be very helpful in developing the plan of care.
The nurse can assess the child ability to follow commands and how the child communicates. If the child is nonverbal the nurse can use PECS and other forms of augmentative communication to help the child communicate during clinical visits.
Nurses can help parents by developing pictures containing clinical procedures to help familiarize the child with the environment and the procedure before the clinical visit. Parents can bring in pictures of things the child like and other familiar items during visits..
NCLEX style Questions
1 . When teaching a group of students about autism the instructor knows that her teaching was effective, when which of the following was stated by the students?
A Pervasive developmental disorders is a group of disorders with similar features that begins early in childhood.
B One of the hallmark characteristic of autistic children is unusual or delayed speech development
C There is no cure for autism but treatment aims to reduce symptoms
D PECS can be used for any individual with autism.
E All of the above
The nurse understands that which of the following is not a phase in the picture exchange communication system
Expanding the use of pictures
Teaching to answer questions
Bondy, A. (2001). PECS: Potential benefits and risks. behavior analyst today , 2, 127-132
Charlop-Christy, M.H., Carpepenter, M., LE, L., LeBlance, LA., & Kellet, K. (2002). Using the PECS with children with Autism: asessessment of PECS Acquisition, speech, social-communicative behavior and problem behavior. Journal of applied behavior analysis, 35, 213-231
Ganz J. B., Simpson, R. L. (2004). Effects on Commnicative requesting and speechdevelopment of the Picture exchange communication System in children with characteristics of Autism. Journal of Autism and developmental disorders , 34, 395-402
Understanding the world of children with autism, Http//rn.modernmedicen.com, access 2/4/2010