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CONFERENCE CALLS

SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 200816

Lori Frost, co-devel-oper o the PictureExchange Communi-cation System, says she

likes not being able to identiy the proession opeople in the classroom. Tis ethos o shared re-sponsibility and commitment was evident in themix o people attending the 10th birthday celebra-tions o PECS in the UK. Te Edinburgh eventhad parents, teachers, nursery nurses, a oster carerand speech and language therapists participating.

PECS is a low-tech AAC tool designed to en-courage initiation o communication (see gure1). It was developed by Lori Frost and AndrewBondy in the United States while Lori was

working with children aged rom 2-6 years withautism, many o them not talking. She refectsthat when she graduated she knew a lot aboutwhatto teach but was woeully unprepared howto teach. As is oten the case, a particular clientinspired the thinking that led to the develop-ment o PECS. Tis boy was 4 years old, non-speaking, hadnt learnt sign language or speechimitation, didnt want to be touched, couldntisolate his pointer nger and - not surprisingly

- was very rustrated and aggressive. Althoughhe would tap a communication board, he wasntdoing this communicatively. Lori describes be-ing kept awake thinking, I dont know what todo with this boy because nothingis working.

Re-examining the denition o communica-tion was key to nding a solution. Loris deni-tion is that:

Not all behaviours are communicativeCommunication must occur between twopeopleTe speaker directs behaviour to the listenerTe listener mediates access to the reinorcer(what the speaker wants).Rather than encouraging her client to indicate

a picture on a communication board, Lori recog-nised that as the speaker he actually needed to takethe picture to someone. Tis orced social interac-tion and brought a ocus on the person (listener)rather than the board. Lori says there are no pre-requisites or PECS other than that the client needsto want something and the picture that is used inphase I is merely their ticket or getting it.

Spontaneous requestingTe dening eature o PECS is that it teachesspontaneous requesting as the rst skill. I a child

who uses PECS is prompt dependent or is not act-ing spontaneously, Lori argues this is because they

have never been taught or taught properly torequest spontaneously. Julie McGhee, the mother

o an 8 year old boy called Conall, describes her-sel as very stubborn in ensuring PECS is doneproperly. In talking about how Pictures meanthe world to her son, Julies own role in ensur-ing the success o PECS through encouraging thisspontaneity is clear. When Conall used his PECSolder in a ca, or example, Julie explained hehad to show the lady rather than her.

Parents stories are vital in raising awarenessamong proessionals about the real, day in day outexperience o living with autism and other devel-

opmental disorders. Teir stories also demonstratehow essential it is to acknowledge, appreciate andsupport parents coping strategies and expertise.Conall was successully introduced to PECS at hisspecial school when he was 7 by a teacher trainedin the approach. His mother was unded and en-couraged by the school to attend a 2 day course sothat Conall could bring his orm o communica-tion home. It was ascinating to hear how this hasled to him being a happier child who improvises alot with his symbols (eg. used chips as didnt havecarrot sticks), becomes excited over his achieve-ments and instigates taking his PECS older withhim wherever he goes even when thats stomping

o to his room in the hu. He maintains his ownPECS older, expresses emotions and tastes andmakes inormed choices (out o two) independent-ly. Although lie or the amily remains challenginggiven Conalls dietary preerences, sensory intoler-ances and erratic sleep pattern, Julie describes thereduction in stress and increase in amily cohesionas being like ripples in a pond. She adds thatPECS is about helping a child develop into theadult they should be.

PECS is administered in the UK by PyramidEducational Consultants (www.pecs.org.uk).Discussion with Lori, Julia Biere (Pyramid Con-sultant) and delegates conrmed that one o themajor challenges with PECS, as with many oth-er approaches, is ensuring it is oered in a waythat is true to its philosophy and thereore ina way that will work. Its airly normal practiceor one person rom a team to attend trainingand then to cascade what they have learnt to col-leagues, which can lead to a Chinese Whisperseect and a ocus on the symbols rather than thespontaneous communication. For this reason,both Lori and Julia are very positive about therole o Pyramid Consultants in supporting UKtrainees with PECS implementation.

Pyramid is an approach to education whichruns rom wake up to bedtime. It recognises thatdevelopmental disorders impact on the whole

day, not just communication, and is heavily in-fuenced by Applied Behaviour Analysis (ABA)

learning theory. Lori describes hersel as on amission to teach Speech-Language Pathologistsabout ABA, which is somewhat controversialin the speech and language therapy world. Shecautions people not to be put o by the mostcommonly held belies about ABA / the LovaasMethod as being in your ace and requiring lotso repetition, as this is such a small part.

Loris early experience involved collaborationwith occupational therapists and teachers, andincluded tying shoelaces and changing diapers.Language and communication was integrated inthe whole day. She has asked hersel what makescertain classrooms, homes and people take o

with such an approach, and believes a fat hierarchy

can help as well as each individual being smart,enthusiastic, motivated and willing to share. Herspecial contribution to the team as a speech-lan-guage pathologist has included knowledge o thedevelopmental sequence and o pragmatics.

Name the eelingsLoris husband and PECS co-developer is behav-iour analyst Andrew Bondy. He presented hismost recent thinking on how we help children

with autism develop the language o emotions.When typically developing children all, we mightsee the bleeding, but they also cry. When they eatice cream, we notice they eat quickly, but they

also smile. Tey show pain and pleasure, so wecomment on this and name the eelings. ypically

Ripples in a pondEditorAvril Nicollreports rom a daycelebrating 10 years o the Picture Exchange

Communication System (PECS) in the UK.

Figure 1 PECS at a glance

Reproduced rom http://www.pecs.org.uk/general/

what.htm (Accessed 5 November 2008)

Phase ITeaches students to initiate communicationright rom the start by exchanging a singlepicture or a highly desired item.

Phase IITeaches students to be persistentcommunicators- to actively seek out theirpictures and to travel to someone to make arequest.

Phase IIITeaches students to discriminate pictures andto select the picture that represents the itemthey want.

Phase IV

Teaches students to use sentence structure tomake a request in the orm o I want _____.

Phase VTeaches students to respond to the questionWhat do you want?

Phase VITeaches students to comment about things intheir environment both spontaneously and inresponse to a question.

Expanding VocabularyTeaches students to use attributes such ascolours, shapes and sizes within their requests.

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