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A guide for patients about the
Picture Exchange Communication System (PECS) Phase three – picture discrimination
We can help develop the child’s communication so the child learns to choose between two or more pictures to ask for their favourite things from their communication book. What we want to see In phase three we can help a child learn to:
• go to their communication book
• to choose a picture or symbol of something they want
• they will then take the picture or symbol and go to their partner
• get their partner’s attention and put the picture in the partner’s hand.
Why do this activity? We are teaching the child a new skill, to learn how to make choices. What do we do? • To start with the child works with just one person (partner).
• The child and the partner can sit at a table, facing each other.
• Have some objects or activities the child likes and some that the child does not like, with pictures of the objects or activities there.
• Create lots of chances to exchange pictures during the day.
• Use speech only to name the object or activity.
• Move the pictures around in the communication book, so the child has to really look at them.
How do we do it? We begin showing the child two items and their matching pictures e.g. chocolate buttons with a picture and raisins with a picture. Put the two pictures on the communication book. One will be one the child likes and the other one something the child does not like. We can help the child learn that the picture they choose matches what they want or don’t want. The new skill is choosing the correct picture, rather than putting the picture into the partner’s hand. The instant the child touches the correct picture we say yes or that’s right. If the child selects the wrong picture (the one they don’t want) we give them that object and watch the child’s reaction. If they look cross or disappointed that is good. Now we can teach the child they must use the right picture to get what they want. Show or tap the picture of what they do want and hold your open hand near that picture and wait until the child gives you the picture or is physically prompted to do so. When the child gives the picture praise them but do not give them the item, pause, put the two pictures back on the communication board and try again with the two choices.
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When the child has chosen between the item they like and an item they don’t like, the next step is to learn to choose between two items they like. Set the communication book up in the same way with two pictures, both things they like on the front of the book. We now need to check that the child is using the right picture to get the item they want. • Show the child a try with two items they like on it. Put the communication book beside the tray with the two
matching pictures on the front.
• When the child gives a picture hold the tray out and say good, take it. If the child reaches for the correct item say well done and let them take it. If the child reaches for the wrong item, block his hand and point or tap the correct picture. Hold open your hand near the picture and help them physically.
• When the child gives the picture, praise them, but do not give them the item, but replace both pictures and try again.
• If the child does not seem to make progress here, leave this for a while – perhaps it is too early.
• When the child is able to choose between two items with their matching pictures then gradually add another item and picture up to five items.
At five pictures this stage is nearly complete. The final step at this stage is to teach the child to look inside their book for a picture. To do this:
• clear all pictures from the front cover of the communication book
• open the book and put one or two pictures the child really likes inside the book
• show the child the items and when they reach for the picture, gently close the book
• encourage the child to open the book to take the correct picture. You can help them to begin with, then fade this help
• then add a second page and take the pictures off the front page and put them on the second page and encourage the child to turn the page over to look at all the pictures.
Begin to organise the communication book using different pages for different groups, e.g. food, toys, activities. As the child learns new words, add these to their book. When the child is able to choose between activities in their book, add phrases too so the child learns to move to their book and to their partner. Sometimes, the child will need to ask for items that are out of sight. Begin to create chances for the child to do this in a different place. Do this by putting something away straight after the child has asked for/had it, and then see if they will ask for it again, e.g. put a toy in the toy box or put the lid on the bubbles. Monitoring progress A record sheet is to be kept (copy attached) to record progress and show the number of attempts at each session, the items child likes or does not like. It notes when the child shows a negative reaction. How far the child travels to the partner and to the book and if they are able to request items out of sight.
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When to move on We are ready to move on when the child can:
• travel at least two feet to their communication book to ask for an item, which could be out of sight
• choose between up to five items they like
move at least two feet to the trainer to make the exchange. Contact the Children’s Therapies Service Please contact your Integrated Therapy Team if you have any queries or concerns regarding the information in this leaflet.
Dartford, Gravesham and Swanley Phone 01322 428242
Tonbridge, Tunbridge Wells and Sevenoaks Phone 01892 501860
Maidstone and Malling Phone 01622 742333
Canterbury Phone 01227 783042
Thanet Phone 0300 042 0871
If you need communication support, an interpreter or this information in another language, audio, Braille, Easy Read or large print, please ask a member of staff.
You will be asked for your agreement to treatment and, if necessary, your permission to share your personal information.
Leaflet code: 00963a Published: July 2016 Expires: July 2019 Page 2 of 2
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Customer Care Team If you have a query about our health services, or would like to comment, compliment or complain about Kent Community Health NHS Foundation Trust, you can contact the Customer Care Team.
Phone: 0300 123 1807, 8am to 5pm, Monday to Friday Please say if you would like the team to call you back Text: 07899 903499 Email: [email protected]
Address: Customer Care Team, Kent Community Health NHS Foundation Trust, Unit J, Concept Court, Shearway Business Park, Folkestone, Kent CT19 4RJ Web: www.kentcht.nhs.uk
