The document provides an overview of autism and the Picture Exchange Communication System (PECS) as a form of augmentative and alternative communication for autistic children. Autism is characterized by impaired social interaction and communication difficulties. PECS uses pictures to teach communication in 6 phases, from exchanging pictures to develop speech to answering questions. Research has shown PECS can help some children develop speech and allows many untrained people to communicate with a child using PECS. Nurses should prepare for visits and use strategies like PECS and pictures of familiar items to help autistic children communicate.

1. Communicating with Autistic Children Implementing Picture Exchange Communication System Claudina Antoine UVI nursing

2. 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.

3. Etiology 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 : Genetic link Environmental factors Certain infections Childhood Vaccines may contribute to a late onset of Autism (evidences is very limited and no proven facts)

4. Overview Autism continued Signs and Symptoms One of the hallmark characteristic of autistic children is unusual or delayed speech and language development OTHER CHARACTERISTICS 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 ECT 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 (Videbeck, 2008)

5. Picture exchange Communication History 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.

6. 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 Initiating communication Expanding the use of pictures Choosing messages in PECS Introducing sentences in PECS Teaching to answer questions in PECS Teaching Commenting (Christy, Loc lee,& Kellet, 2002 )

7. Description 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. 6. Commenting 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)

8. NURSING MANAGEMENT Nursing Diagnosis: 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..

9. Summary 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 Initiating communication Expanding the use of pictures Scripted stories Teaching to answer questions

10. References: 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