Dec 15, 2015
Nikky SteinerSpeech and Language TherapistOrchard Hill College20th March [email protected]
Background
PECS successfully implemented in school environments for many years
NICE guidelines Many studies related to use with children very
few adults BUT Anecdotally we know that PECS is used
much less in adult servicesHigh rates of abandonmentTransition is a particularly difficult
Why is PECS successful in schools? “School rules” having to ask/request Emphasis on teaching/learning Easy to link with IEP, clear objectives, useful for
concrete concepts e.g. Numbers/colours “I want 3 red sweets”
Communication partners trained in PECS, often a whole school approach/system
Focus on number of exchange and sentence length, vocabulary, not quality of the interaction
Contrast to college/adult services
Emphasis on independence, getting things for yourself (less requesting) more participation/ choice making
Communicative partners typically not trained in PECS, emphasis on Total Communication
Equality of control as an adult Poor transition described as “PECS user” but
strategic competence not established
Functional Communication PECS outcomes and research focuses primarily on initiation, needs and wants Light’s definition of functional communication (1988):Functional communication involves needs and wants, information transfer, social closeness and social etiquette Particularly interested in the elements of social closeness
Aim
To develop a coding framework to evaluate the qualitative use of PECS as a functional communication system
To use the coding system with older students/adults and their communicative partners
Coding Framework
Adapted version of Effectiveness Framework Of Functional Communication (Murphy, 2010 and Cameron, 2010)
Extended the framework to include qualitative indicators e.g. naturalness
Participants in study
7 Students across 2 Special schools 17-19 years 6 had diagnosis of Autism 1 had diagnosis of Cornelia de Lange PECS for 5+ years PECS Stages between 2 and 6
Video at snack time
Evaluation
6 SLT’s were involved informally in discussing/evaluating the rating scale
Modifications to EFFC made Needed a criteria/prompts to help inform
rating Feedback and recommendations for
individual participants was given to schools
Prompt questions Engagement: How were the PECS user
and Communicative Partner positioned e.g. side by side, standing, sitting? Was there shared eye contact, smiling? Was there shared enjoyment?
Balance: was the interaction balanced? Was there equality in the initiation/ending of the interaction? Was there balance between conversational turns?
Prompt questions
Pacing: was the pacing of the interaction appropriate? Were there long pauses/delays? Did these disrupt the “flow”?
Naturalness: Were any features of PECS a barrier to the interaction, were any strategies used by the communicative partner a barrier to the naturalness of the interaction?
Discussion: PECS user Need to look beyond requesting/commenting
and at qualitative non-verbal communication
consider which modes are most effective in different environments
when does the PECS become a tool to use to communicate? Why are we still in training phases in late teenage years?
review the design of the system to be improve timing e.g. Consider motor skills/demands, number of symbols
Communicative partners Training issues for communicative partner need to attend to spontaneous naturalistic
non-verbal communication formal system being given greater value
than informal or idiosyncratic behaviours some training strategies do not encourage
engagement and social closeness e.g. removal of eye contact, physical proximity, walking away, “blank” facial expression
Discussion Suggest EFFC can provide a structure and
consistency to rating qualitative aspects of communication
encourages reflection and a solution focussed approach “how could this be improved?”
could be used as an outcome measure pre and post intervention
collaborative approach identifying which modes are most effective
person centred approach rather than prescriptive
Future
Evaluation of EFFC as an outcome measure and case studies
extending to other areas of AAC and non-verbal approaches e.g. Intensive interaction
more research into use of PECS with older students and adults
References
Cameron L, (2010) The Validation and reliability if the Effectiveness Framework of Functional Communication (EFFC) for Speech and Language Therapists ISSAC presentation Barcelona 2010
Murphy J (2010) Can AAC ever be effective? Plenary Talk Communication Matters Symposium Leicester 2010.
ReferencesBondy A, and Frost L, (1994) The Picture Exchange Communication system training
manual. Cherry Hill, NJ: Pyramid Education
Chambers M, Rehfeldt RA, (2003). Assessing the acquisition and generalisation of two mand forms with adults with severe developmental disabilities. Research in Developmental Disabilities , 24 pp. 265-280
Ho KM, Weiss SJ, Garrett KL,Lloyd LL,(2005). The effect of Remnant and Pictographic Books on the Communicative Interaction of Individuals with Global Aphasia. Augmentative and Alternative Communication, Vol. 21 (3), pp.218-232
Stoner JB, Beck AR, Jones Bock S. Hickey K. Kosuwan K, Thompson JR, (2006). The effectiveness of the Picture Exchange Communication System with Nonspeaking adults. Remedial and Special Education, May/June 2006; 27,3:ProQuest Psychology Journals pp. 154-165
Sulzer-Azaroff B, Hoffman A.O, Horton CB, Bondy A, Frost L, (2009) The picture Exchange
Communication System (PECS): What do the data say? Focus Autism Other Developmental Disabilities 24 89 originally published online 23 March 2009