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 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 Andy Bondy, PhD Began in 1985 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 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

Make them versus Entice them 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 Effective Lessons 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? Lack of functional communication Lack of spontaneity 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

Generalize across all environments! 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?) Demonstrate what initiation looks like, they need to reach for item first!!!

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 Must not become a PROMPT! 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!!!

Student doesn’t look at picture? What if? Move the picture around! Student doesn’t look at picture?

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

Where an apron! 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!

Only one teacher is needed! 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!

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 the exchange (1/2 second) “Ooh the new” If give distracter picture, say nothing, and Give the non- preferred 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 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?

Responsive Requesting 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

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

Our lessons must have these elements! 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!