Nikky SteinerSpeech and Language TherapistOrchard Hill College20th March 2012nsteiner@orchardhill.ac.uk

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

Effectiveness Framework for Functional Communication

Effectiveness Framework for Functional Communication

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

Video G.Q.

Video S.P.

Video T.A.

M.K.

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

Thanks

Many thanks to the staff and students at Greenvale and Tuke school.

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