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on line observ at io ns

ISwant to

improve functionalcommunicationstaff identify andmaximise all

communicationopportu n tiesclarify your role

The Picture ExchangeCommunication System(PECSTM) aims to teach

individual users to initiatecommunication.Sarah Heneker andLisa MacLaren Pageinvestigate the

effectiveness of introducingthe approach to wholeclasses within a school.

Sarah writes, "Sadly, sincethis article was written, Lisa

died as a result of a roadtraffic accident. Lisa was atalented and dedicated

speech and languagetherapist and friend to thewhole team. She will begreatly missed. This al'ticle

is in her memory. /I

unctiona communication:

PECSTM is a system that aims to teach spontaneouscommunication (Frost & Bondy, 1994). The abilityto initiate communicative exchanges is paramountfrom the outset and this is achieved by the studentexchanging a symbol of a desired item in order toobtain it. This system has been rapidly introducedinto a number of locations in which we work .

A local school for children on the autistic spectrum undertook an extensive programme of stafftraining in PECSTM and set out to integrate the sys-tem into their school day. They decided that, inaddition to individual PECSTM programmes, theywould offer two groups of children an entirePECSTM environment.

'Group l ' began in September 2000 andinvolved all the children in a specified class. Theentire environment was set up to facilitate theideas of PECSTM . Parents received support andadvice from class staff around the use of the sys-tem at home. 'Group 2' began in January 2001and involved a smaller group within another class.Just prior to this, class staff and parents of thechildren within the group attended a formalPECSTM training course.

We wanted to evaluate the impact that intro-ducing PECSTM had on:1. the amount that the children were

communicating,2. the functions of the communication,3. the methods of communication,4. the level of adult support needed to achieve this.Figure 1 Commun ica tive parameters obse rved

We wanted to be as non-intrusive as possiblewhilst encompassing the whole communicativeenvironment in our evaluation . We thereforechose on line observations, watching the childrenin their everyday environments. The data was co llected through interval recording which involvedthe use of a dictaphone to prompt the therapistwhen to begin and cease observation periods .The four different contexts in which the children

were observed - 'free play', 'snack', 'swimming'and 'structured teaching' - were adapted fromWood et ai 's study (1998) . 'Freeplay' and 'swi mming' were defined as 'unstructured', where theadult's attention on the children was variable,thus providing opportunities for attention gaining. 'Snack' and 'structured teaching weredefined as 'structured'. Within 'snack' the communication opportunitie s were highly predictable(for example, choice making), whilst within 'structured teaching' communication opportunitieswere less predictable as the nature of the sessionsmake them more variable.We designed an observation schedule and all

observing therapists were trained to ensure consistency. There were two observation phases: baseline follow-up.Each child was observed fo r a total of one

hour and four minutes over all contexts. Thecommunicative parameters we observed are infigure 1.

Level of cueing t Function ofcommunication Method ofcommunication Manner inwhich adult'sattentionwas gained

Adult'sresponse Level ofpromptingneeded toexchangesymbol

Physical Prompt Requesting Physical Not None None Model Question Presence ofObject I Event Presence ofListener Contextual andInteroceptive

Greeting Rejecting Commenting Labelling Responding Anticipating

Object Gestural Symbol Vocal Gesture andVocal Symbol andVocal Symbol andSigning

PhysicalPrompt Environmental Spontaneous AlreadyGained

Explained'NotPossible' Actioned

PhysicalPrompt GesturalPromptSpontaneous

tThe continuum used to observe the 'level of cueing' was based on that devised by Halle (1987) in hisresearch on spontaneous language.

12 SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2003

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e imgact of PECSTM 1in years 1 to 3 (age range 6;08 to

out in2000 when PECSTM had been recentlyAt baseline the group's communica

skills varied - few used any clear words andmain method of communication was physical

as leading the adult to the item or trying toto a required item),

out 10 months later, Wefor each part of

evaluation:Amount of Communication (Total Number Communicative Acts)

changed by the following amounts: BASELINE FOLLOW-UP

-

12 21- - - , - - - - ~ - - - -9 20

26 22 - - - - ~ - --- ;--15 29the Total Number of Communicative

during swimming decreased at follow-up,children were using more sophisticated forms

communication and needed less prompting toso,Function of Communication

was the main function at both

line, 'commenting', 'greeting '

At follow-up, the use of these functions haduse of them across situations

to have generalised,

Method, of Communicationbaseline this was generally symbols, At

of communication'symbols' ('snack' and 'structured teaching')

felt the high occurrence of the use of symbolsof no symbols

e duri ng swimming) was due to theof the use of PECSTM,

In all but one context ('freeplay'), symbol useincreased, Children's spontaneous use of symbolsvaried at follow-up - some would seek out theirPECSTM folder spontaneously, whereas otherstended to need prompting, The children wereoften using their most effective form of communication within the given situation (for example,if they were playing a joint attention game withstaff, then using physical, gestural or vocal meansappeared to be most appropriate), and this issomething that we strongly advocate,4. Level of support needed

The 'Presence of an Object or Event' remainedthe main level of stimulus to which the childrenwere responding for al l activities,

The children did not show an increase in spontaneously gaining the adult's attention, and thisremains a key area to focus on, However, they didappear to have learnt the importance of needingsomebody's attention before communicating withthem, The children showed a striking increase inthe number of attempts they made to communicate following the adult giving the child theirattention (from 48 per cent to 88 per cent),

The children learnt the process of exchangingsymbols over the period of observation, At baseline, the children generally either did no texchange the symbol, or required a physicalprompt to do so, At follow-up, the children werespontaneously attempting to exchange the sym-bols in 95 per cent of cases, This, however, did notalways result in a successful communicativeexchange, as the adult's attention had not alwaysbeen gained first.

Group 2Group 2 consisted of children in years 4 and 5 (agerange 9;04 to 10;10 at follow-up), Baseline wascarried out in January 2001, Prior to this, PECSTMhad been used solely within snack with no generalisation observed, Children were receiving structured PECSTM teaching sessions at phases 1 to 3(see figure 2) during the baseline observationweek, At baseline the group had a stock of spoken words or phrases, but their functional use waslimited,

Follow-up was carried out six months later, Aswith group 1, we have highlighted the key findings fo r each part of our evaluation:1. Amount of Communication (Total Numberof Communicative Acts)

This changed by the following amounts:

- BASELINE FOLLOW-UPFreeplay 1 - - - ~ - -5SnackSwimming

8I

163 11 --,Structured teaching 16 I 10

Although the Total Number of CommunicativeActs was observed to decrease in 'structured teaching' at follow-up, the students were being taughtthe more independent skills of commenting forthe first time, and this may have had an impact onthe amount of communication observed,2. Function of Communication'Requesting' was the main function at bothbaseline and follow-up,

(In addition, at follow-up, 'commenting' was evident in 'structured teaching' as it was being taught.)3. Method of CommunicationOver the period of observation, the children wereobserved to move towards using more formalmethods of communication across all contexts,

The children were also increasingly using a combination of methods at follow-up (such as 'physicaland vocal' or 'physical and gestural') even if theywere not always using symbols, Symbols were notalways readily accessible during all activities forthis group,

Symbol use increased in 'snack' and in 'structured teaching', During 'swimming' no symbolswere available during either baseline or followup, In 'freeplay' use of symbols remained thesame, The children's spontaneous use of symbolsvaried at follow-up - some would seek out theirPECSTM folder spontaneously, whereas otherstended to need prompting,

Figure 2 Phases of PECSTMPhase 1 Identifying a reinforcer and

teaching picture exchangePhase 2 Increasing spontaneity and rangePhase 3 Introducing th e concept of choicePhase 4 Introducing sentencesPhase 5 Responding to the question,

'What do you want?'Phase 6 Commenting in response to a

question

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o n l ine observations

Level of support needed'Presence of an Object / Event' remained

to during 'snack' and 'swimming .for 'freeplay', responses became

'Presence of a Listener' as the level ofto initiate communication.

'structured teaching', responses became less'Presence of an

t' to a 'Question'. This appears to bethe children were being taught the com-

ime.data showed an increase in spontaneously

ring 'snack' andNo major

was observed'teaching', but the chl'ldren

appeared to show less frustrati on and were ableto accept that they could not always have whatthey had asked for. When us ing symbols, we oftensaw them waiting patiently if the adu lt was notable to give them their attention immediately.

Group 1 communicated more at baseline thangroup 2 and made more progress in relat ion toNumber of Communicative Acts, but we mustacknowledge that the time between baseline andfollow-up wa s longer. We also need to be sensi-tive to the fact that group 1 were younger children who had had less experience of communication breakdowns than group 2. This supports theneed for early intervention.

This study gave us the opportunity to observePECSTM being used with a whole class group andin all situations versus a sub group. For us, this has

clarified the importance of thewhole environment be ing con -

Sarah Heneker and Lisa Ma cLaren Page arespeech and language therapists working forNorth Surrey Primary Care Trust.For further information, please contact Sarah at:Speech and Language Therapy Department,Bournewood Resource Centre, North SurreyPrimary Care Trust, North West Surrey TherapyServices, Guildford Road, Chertsey, Surrey, KT1 6OQA. Tel: 01932 722866 E-ma il:sarah .heneker@nsurreypct.nhs.uk .AcknowledgementsWe would like to express our thanks o staff and stu dents and Freemantles School in Chertsey, Surrey.

ReferencesHalle, J. (1987) TeachingLanguage in the NaturalEnv ironment

already gained not, the use of such an approachwere uSing more in the studythe entirety of the facilitates staff to identify and Handicaps 12.ducive to PECS TM Irrespective of An Analysis ofwhether children use PECSTM or children involved Sponta neity. The Association

for Persons with Severe

- soph isticatedp.'free play' forms ofbe a less communication

consequently, thext in which the and needed

less liketo be communica less prompti ng

for Group 1, the to do soin this group

learnt the processexchanging symbols. At ba seline, there was-up, spontaneous exchange occurred on aver-96 per cent of the time fo r all interact ion s

in communicationwas an

increase in the number of communicatives made and that Group 1 (who had been

PECSTM for four months longer than Groupshowed an increase in the range and quality of

of Communication. Symbol usemore formalised methods of communication

and children showed a greater awareof the importance of having somebody's

,efore communicating with them . Theobserved to use PECSTM with

and not with their peers .fact that The Presence of Object / Event

level of stimulus in order tois an interesting observation. A fur

identify whether this iscase 18 months on , and for which

tive functions.we noted that,

ma ximise all communicative Frost, L.A. & Bondy, A.S.appeared topportunities. (1994) PECSTM The PictureExchange CommunicationChallenges for the show less System Training Manual .future Wood, P., Clarke, M. &

We have many challenges for the frustration and McConachie, H.R. (1998) Thefuture . Communication is a CASTLE Projectprocess that is dynamic in nature. were able to Communication Aids andIt is therefore important that Speech and Languageopportunities continue to be Therapy in the Learn ingccept that theyidentified and set up to provide Environment. Schoolcould not alwaysommunicative environments in Observation Procedure.which the children are able to Copyright PWood, Instituteconsolidate, general ise and of Child Health.ave what they

expand the skills that they havelearnt. To achieve this, staff need to had asked for Resourcescontinue to constantly think aheadand plan for future communicativeopportunities and ensure that sufficient symbolsare always readily available.

Speech and language therapists have an ongoingrole wit h the introduction and implementation ofPECSTM. Thi s should include:1. Advising on the communicative env ironment

and monitoring vocabulary and languagelevels .

2. Stressing the importance of the developmentalsymbolic hierarchy to ensure that children areworking at a level where they are successful,moving towards a higher symbolic level asappropriate. This may mean working at anobject level before moving onto the higherlevel of symbolism.

3. Ensuring that communication is multi-moda .PECSTM should be considered alongside, andnot to the detriment of, other communicationsystems .

4. Ensuring that care is taken to movemethodically through the PECSTM phases, at anappropriate pace for the child, general singskills at each level before mov ing onto the next.

Further information aboutPECSTM (including courses)

from Pyramid Educational Consultants UK Ltd,Pavilion Hou se, 6 Old Steine, Brighton BN11EJ, tel.01273609555, www.pecs .org.uk.

Re ections Do I have an organisedapproach to observing clients? Do I evaluate therapy in termsof the amount, functions andmethods of communication and

the level of support needed toachieve this? Do I give clients the

opportunity to practise using the most effective form of communication fo r a given situation?

SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2003

mailto:heneker@nsurreypct.nhs.ukmailto:heneker@nsurreypct.nhs.ukmailto:heneker@nsurreypct.nhs.ukmailto:heneker@nsurreypct.nhs.ukmailto:heneker@nsurreypct.nhs.ukmailto:heneker@nsurreypct.nhs.ukmailto:heneker@nsurreypct.nhs.ukmailto:heneker@nsurreypct.nhs.ukhttp://www.pecs.org.uk/http://www.pecs.org.uk/http://www.pecs.org.uk/http://www.pecs.org.uk/http://www.pecs.org.uk/mailto:heneker@nsurreypct.nhs.ukhttp://www.pecs.org.uk/