Picture Exchange Communication System Methodology In High Tech AAC Devices

The following information was presented at the 25 th annual CSUN Technology & Persons with Disabilities Conference in Los Angeles in March, 2009. It does not provide training in Picture Exchange Communication System (PECS) methodology, but instead is a case study. For PECS information and training, please contact Pyramid Educational Consultants, Inc. at pecs.com or 1-888-732-7462.

Because Slideshare processing makes this presentation non-ADA compliant please note the following: All of the videos are at: http://www.youtube.com/josephkoconnor They are not captioned. Sorry. If you want a copy of the PowerPoint file, please email us or DM at: http://twitter.com/blacktelephone Or use contact form at: http://www.blacktelephone.com/contact/

Session ID: AAC-1014 Title: Picture Exchange Communication System Methodology in AAC Devices Speakers: Donna Banzhof, Joseph Karr O'Connor Date: Thursday, March 19, 2009 Start Time: 10:40 AM End Time: 11:40 AM Location: Renaissance - International A

Donna Banzhof, M.Ed. Pyramid Consultant Senior PECS Supervisor & Trainer 1-888-732-7462 (toll free) [email_address] http://www.pecs.com Joseph Karr O'Connor (Siobhan's Dad) Manager, University Web Communications California State University, Northridge 1-818-677-7971 [email_address] http://www.youtube.com/josephkoconnor

We will discuss… Review of today’s purpose Brief history of Siobhan Brief history of PECS Objective 1: Why start with PECS before transitioning? Objective 2: Demonstrate how to apply PECS methodology to high tech AAC. Objective 3: Supporting Siobhan as she grows and learns.

Review of today’s purpose

Brief history of Siobhan

Brief history of PECS

Objective 1: Why start with PECS before transitioning?

Objective 2: Demonstrate how to apply PECS methodology to high tech AAC.

Objective 3: Supporting Siobhan as she grows and learns.

Purpose of Presentation When a recommended AAC device arrives, where do you begin? How do you introduce the client to a new way of communicating when there is no foundation on which to build? Why is Siobhan laughing so hard? Video: “Since You Were A Fish” http://tinyurl.com/dmro8k

When a recommended AAC device arrives, where do you begin?

How do you introduce the client to a new way of communicating when there is no foundation on which to build?

Why is Siobhan laughing so hard?

Video: “Since You Were A Fish” http://tinyurl.com/dmro8k

Brief history of Siobhan Age: 16 years old Diagnosis: Cri du Chat Syndrome (or 5P-) www.fivepminus.org Non-verbal, poor balance (ataxic), loose and floppy (hypotonic), with developmental delays in all areas.

Age: 16 years old

Diagnosis: Cri du Chat Syndrome (or 5P-) www.fivepminus.org

Non-verbal, poor balance (ataxic), loose and floppy (hypotonic), with developmental delays in all areas.

Brief history of Siobhan Started PECS when 4 years old. Video http://tinyurl.com/b9sp27 Communication consisted primarily of all-purpose sounds and/or taking an adult’s hand to desired object/activity. Spontaneous communication extremely limited, occurring exclusively with familiar adults.

Started PECS when 4 years old.

Video http://tinyurl.com/b9sp27

Communication consisted primarily of all-purpose sounds and/or taking an adult’s hand to desired object/activity.

Spontaneous communication extremely limited, occurring exclusively with familiar adults.

Brief history of Siobhan Why transition to High Tech AAC (HTAAC)?

Brief history of Siobhan Siobhan resists all direct efforts to make her communicate, but responds well to Picture Exchange Communication System (PECS) reinforcer-based routines. Putting Siobhan's interests first results in communication, using PECS methodology ensures her success.

Siobhan resists all direct efforts to make her communicate, but responds well to Picture Exchange Communication System (PECS) reinforcer-based routines.

Putting Siobhan's interests first results in communication, using PECS methodology ensures her success.

Pyramid Educational Consultants Founded in 1992 by Lori Frost and Andy Bondy To provide training to professionals and families of individuals with disabilities To ensure high-fidelity implementation of PECS Exclusive home of PECS (Picture Exchange Communication System) and the Pyramid Approach to Education

Founded in 1992 by Lori Frost and Andy Bondy

To provide training to professionals and families of individuals with disabilities

To ensure high-fidelity implementation of PECS

Exclusive home of PECS (Picture Exchange Communication System) and the Pyramid Approach to Education

What is PECS? Development began in 1985 Training protocol based on B.F. Skinner’s Verbal Behavior (1957) Taught within a broad-spectrum applied behavior analysis protocol Originally developed for children on the Autism Spectrum, but now used across ages and diagnostic categories

Development began in 1985

Training protocol based on B.F. Skinner’s Verbal Behavior (1957)

Taught within a broad-spectrum applied behavior analysis protocol

Originally developed for children on the Autism Spectrum, but now used across ages and diagnostic categories

PECS is Evidence Based Practice Over 40 published articles 31 data-based or case studies 12 articles - descriptive Articles generated in USA, UK, Wales, New Zealand, Greece, Japan, Australia, France, Peru

Over 40 published articles

31 data-based or case studies

12 articles - descriptive

Articles generated in USA, UK, Wales, New Zealand, Greece, Japan, Australia, France, Peru

How widespread is PECS? "The most widely used intervention was PECS, with almost all of the participants mentioning it, even those who did not use any other intervention in their program." Stahmer, A., Collings, N. & Palinkas, L. (2005). Early Intervention Practices for Children With Autism: Descriptions From Community Providers. Focus on Autism and Other Developmental Studies , 20, 66-79.

What is 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!

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!

The Pyramid Approach to Education The “how” of teaching Data © Pyramid Educational The “why” of behavior The science of learning Teaching Strategies Error Correction Generalization Effective Lessons Powerful Reinforcers Functional Activities Contextually Inappropriate Behaviors Functional Communication

The Pyramid and PECS © Pyramid Educational Functional Activities Students engaged in functional activities have something to communicate! Reinforcement The first lesson in PECS is requesting a reinforcer, so we must identify a powerful reinforcer before beginning Functional Communication PECS begins by teaching requesting- the communication skill associated with access to a powerful reinforcer Contextually Inappropriate Behaviors Communication skills could be potential Functionally Equivalent Alternative Behaviors (FEABs)

Functional Communication “ Functional communication is behavior (defined in form by the community) directed to another person who in turn provides related direct or social rewards” (Bondy & Frost, 2001). © Pyramid Educational

“ Functional communication is behavior (defined in form by the community) directed to another person who in turn provides related direct or social rewards” (Bondy & Frost, 2001).

Functional Communication Two broad functions of communication Requests - direct reinforcement Comments - social reinforcement Two ways to begin teaching communication Spontaneous vs. Responsive

Two broad functions of communication

Requests - direct reinforcement

Comments - social reinforcement

Two ways to begin teaching communication

Spontaneous vs.

Responsive

Pyramid Principles for Teaching Functional Communication Decisions PECS Modality Pictures Communicative function to teach first Requesting Approach to spontaneity From beginning

Objective 1 Why it is so much easier to start clients off with a paper based PECS system and then transition them to high tech AAC devices? PECS, a low tech AAC, relatively low training and device costs High tech AAC relatively high training and device costs

Why it is so much easier to start clients off with a paper based PECS system and then transition them to high tech AAC devices?

PECS, a low tech AAC, relatively low training and device costs

High tech AAC relatively high training and device costs

PECS: low tech AAC Paperbased system Student learns how to communicate first PECS requires use in social context, must exchange a symbol with someone No device distractions or buttons to push High tech AAC Requires power Student must learn how to navigate device first Device can be used without interacting with someone Excessive button push can lead to miscommunication Objective 1 Why it is so much easier to start clients off with a paper based PECS system and then transition them to high tech AAC devices?

PECS: low tech AAC

Paperbased system

Student learns how to communicate first

PECS requires use in social context, must exchange a symbol with someone

No device distractions or buttons to push

High tech AAC

Requires power

Student must learn how to navigate device first

Device can be used without interacting with someone

Excessive button push can lead to miscommunication

Objective 1 Why it is so much easier to start clients off with a paper based PECS system and then transition them to high tech AAC devices? PECS: Only need “powerful R+” to start Teaches HOW to communicate First skill = spontaneous requesting

Why it is so much easier to start clients off with a paper based PECS system and then transition them to high tech AAC devices?

PECS:

Only need “powerful R+” to start

Teaches HOW to communicate

First skill = spontaneous requesting

Objective 1 Why it is so much easier to start clients off with a paper based PECS system and then transition them to high tech AAC devices? PECS: Systematically teaches: Discrimination training, Sentence structure, Expanding sentences by using attributes, Question answering, Commenting Incorporates systematic error correction procedures

Why it is so much easier to start clients off with a paper based PECS system and then transition them to high tech AAC devices?

PECS:

Systematically teaches:

Discrimination training,

Sentence structure,

Expanding sentences by using attributes,

Question answering,

Commenting

Incorporates systematic error correction procedures

Objective 2 We will demonstrate that Picture Exchange Communication System methodology, when properly applied to high tech AAC devices, and following the principles of evidence-based practice (EBP), is the perfect basis from which to proceed. Problem: evidence showed error with “I like” vs “I want.” Error correction video: http://tinyurl.com/brp6kp

We will demonstrate that Picture Exchange Communication System methodology, when properly applied to high tech AAC devices, and following the principles of evidence-based practice (EBP), is the perfect basis from which to proceed.

Problem: evidence showed error with “I like” vs “I want.”

Error correction video: http://tinyurl.com/brp6kp

Objective 2 We will demonstrate that Picture Exchange Communication System methodology, when properly applied to high tech AAC devices, and following the principles of evidence-based practice (EBP), is the perfect basis from which to proceed. Problem: Siobhan making placement errors returning icons to communication book. Solution: Simplify mainpage (works for the Web too!)

We will demonstrate that Picture Exchange Communication System methodology, when properly applied to high tech AAC devices, and following the principles of evidence-based practice (EBP), is the perfect basis from which to proceed.

Problem: Siobhan making placement errors returning icons to communication book.

Solution: Simplify mainpage (works for the Web too!)

Objective 2 FAIL! Communication book with complicated mainpage

FAIL! Communication book with complicated mainpage

Objective 2 WIN! Communication book with simple mainpage

WIN! Communication book with simple mainpage

Objective 2 Dynavox MT4 with simple mainpage

Dynavox MT4 with simple mainpage

Objective 2 Dynavox DynaMyte with simple mainpage

Dynavox DynaMyte with simple mainpage

Objective 2 Elements to consider Maintain skills Spontaneity Persistence and travel Sentence structure Continue to expand vocabulary and communication skills

Elements to consider

Maintain skills

Spontaneity

Persistence and travel

Sentence structure

Continue to expand vocabulary and communication skills

Why use both? Pros of PECS Easier for Siobhan to carry Good in noisy environments http://tinyurl.com/ao7llv Does not need repair http://tinyurl.com/c5lhpq Can be used at the pool http://tinyurl.com/cpnh3q Pros of HTAAC Voice is appealing to people unfamiliar with AAC Incorporate “stories” about her weekend or day http://tinyurl.com/d66v2g Can be responded to when someone is driving http://tinyurl.com/cpwunx

Pros of PECS

Easier for Siobhan to carry

Good in noisy environments http://tinyurl.com/ao7llv

Does not need repair http://tinyurl.com/c5lhpq

Can be used at the pool http://tinyurl.com/cpnh3q

Pros of HTAAC

Voice is appealing to people unfamiliar with AAC

Incorporate “stories” about her weekend or day http://tinyurl.com/d66v2g

Can be responded to when someone is driving http://tinyurl.com/cpwunx

Objective 3 What it takes to support Siobhan as she continues to grow and learn and what it took to get her and keep her communicating. Dedicated effort by Siobhan, parents, friends, teachers, aides, SLPs, consultants, and others… regardless of media (PECS, HTAAC).

What it takes to support Siobhan as she continues to grow and learn and what it took to get her and keep her communicating.

Dedicated effort by Siobhan, parents, friends, teachers, aides, SLPs, consultants, and others… regardless of media (PECS, HTAAC).

Objective 3 What it takes to support Siobhan as she continues to grow and learn and what it took to get her and keep her communicating. Communication planning across the day Assessing Siobhan’s routines Sabotaging known routines Teaching new skills and related items needed in the routines

What it takes to support Siobhan as she continues to grow and learn and what it took to get her and keep her communicating.

Communication planning across the day

Assessing Siobhan’s routines

Sabotaging known routines

Teaching new skills and related items needed in the routines

Communication Across the Day Activity Expressive Communication Receptive Communication Feeding Gaynor “ I want help” Follow schedule Meal time Request desired food item Request help WAIT Retrieve requested item After school Request activity Request snack Respond to “what did you do today” Follow schedule WAIT Understanding “no” Follow directions

Siobhan with PECS PECS strategies increased frequency and quality of spontaneous communication. “ Living Room Derby” video: recorded over continuous 31 minute period on September 10 th , 2008 ending at 8:32 p.m. Siobhan initiated 35 communicative exchanges, all for the pleasure of interaction. Siobhan is doing this for fun! (She’s also doing this because Dad was sitting down:-) 4 minute edited piece contains 22 interactions. http://tinyurl.com/bsjsn5

PECS strategies increased frequency and quality of spontaneous communication.

“ Living Room Derby” video: recorded over continuous 31 minute period on September 10 th , 2008 ending at 8:32 p.m.

Siobhan initiated 35 communicative exchanges, all for the pleasure of interaction. Siobhan is doing this for fun! (She’s also doing this because Dad was sitting down:-)

4 minute edited piece contains 22 interactions.

http://tinyurl.com/bsjsn5

Siobhan with PECS Communicates in various settings and with various communicative partners “ Orders Taco” video http://tinyurl.com/ao7llv Communicates in the classroom “ Siobhan PECS 2004” video http://tinyurl.com/cjtwb3

Communicates in various settings and with various communicative partners

“ Orders Taco” video http://tinyurl.com/ao7llv

Communicates in the classroom

“ Siobhan PECS 2004” video http://tinyurl.com/cjtwb3

Siobhan with MT4 or Dynamite Able to invent clever substitutes “ Today” video http://tinyurl.com/dfjw7c She makes jokes “ Hamburger” http://tinyurl.com/bthjou She has conversations “ I Like Circus” http://tinyurl.com/bhnvfy

Able to invent clever substitutes

“ Today” video http://tinyurl.com/dfjw7c

She makes jokes

“ Hamburger” http://tinyurl.com/bthjou

She has conversations

“ I Like Circus” http://tinyurl.com/bhnvfy

Siobhan Using Picture Schedule Schedule shows what she’s doing in order – no surprises means peaceful transitions “ Morning Schedule” http://tinyurl.com/bwky8q

Schedule shows what she’s doing in order – no surprises means peaceful transitions

“ Morning Schedule” http://tinyurl.com/bwky8q

Conclusion Having a functional communication system allows someone to express herself Communication training should be begin requesting items that are interesting to that person Using a low tech AAC system, such as PECS, to begin provides a foundation to teaching a person “HOW” to communicate When transitioning from a low tech to a high tech system make sure the system is taught, previous skills are maintained and communication continues to be expanded

Having a functional communication system allows someone to express herself

Communication training should be begin requesting items that are interesting to that person

Using a low tech AAC system, such as PECS, to begin provides a foundation to teaching a person “HOW” to communicate

When transitioning from a low tech to a high tech system make sure the system is taught, previous skills are maintained and communication continues to be expanded