Aaaarghh PECS - falling at first hurdle. Anyone with lots of PECS experience about?

[r3dh3d]

Hey all.

We're starting PECS with DD1 (SLD, developmental age of about 8 months. ASD-like behaviour/social processing)

We're struggling with Phase 1. We can't backwards chain. Enticing the initial reach is easy. We then hand-over hand the rest of the exchange. But. The moment she feels your hand over hers, she looks away. So she doesn't see or pay attention to the part where she puts the card in your hand.

She now believes the way PECS works is:

• she reaches for the card (she's got that bit)
• she hands over responsibility for the rest of the transaction to you
• popcorn (our reinforcer) happens

If you try to backward chain, ie stop physical prompting just before she puts the card in your hand, she just drops it the moment you let go of her. Still not looking at the CP so from her pov it doesn't make any difference where the card goes. Repeating the sequence correctly doesn't help because she's not interested in the sequence. As far as she's concerned, what just happened is that you failed the bit of the exchange that you are responsible for, and fortunately she is very patient and happy for you to have a few goes before you get it right again. After all, free popcorn, mustn't grumble, eh?

Any suggestions? We are trying to fade the prompt further down the arm, but as she drops the card the minute you touch her that isn't working either.

Hi
Are you using a second person as a physical prompter???
PM me- I would be happy to help!

Yes, we are using a second person.

Which is particularly frustrating: opportunities where there are 2 of us available to work on this are few and far between. So we're in a catch-22 where we can't do enough training to get the hang of it, because she hasn't got the hang of it well enough to practice with one person!

Are you using photo's or pictures?

How long have you been trying? it can take a while for them to catch on, dd2 picked it up after a few days but some take weeks. Also if you can get another child (sibbling or friend) to do it too she may copy. I think one of the reasons dd picked up on it quick was because all the other children were using it at nursery (sn nursery) at snack time.

What happens if you don't put your hand over hers?

Can you do the whole transaction super-quick so she doesn't have time to look away?

Marne, we're using pictures, the Widgit Visual Impairment set, printed extra large and covered in matt stickyback plastic (after huge debate with school and VI advisory). But for phase 1 it can be anything, can't it? Blank card, ace of spades, whatever. We've only just started really. School have been at it a while but in a very small/partial way so I wasn't surprised they'd not got anywhere; she doesn't "copy" at all so she won't have picked it up in class that way. I'm trying to orchestrate a blitzkrieg approach! The thing is, if she's going to get something she usually picks it up surprisingly quickly.

SA, if we don't hand-over hand, she picks up the card and then drops it straight away while pushing it aside (which is her way of showing she doesn't want the card, she wants the other thing, ie the popcorn). If popcorn is not forthcoming at this point, she screeches angrily, picks the card up again and attempts to destroy it.

I don't know if we can speed the exchange up enough to pre-empt her. It's not a deliberate look away as such, it's more a reflexive withdrawal. So the instant you touch her, she's away with the fairies.

The reason i asked about the pictures was because we started with photo's, it makes it easier to make a conection between the card and the item (popcorn). Is she visualy impared? maybe the size of the cards are making them difficult to pick up/hold?, would she point to a card (rather than picking it up), i know the point of PEC'S is to hand over the card in exchange for the item but if she pointed to the card it would still be communiction (telling you what she wanted). Would she take the card off you if you put it in her hand (without touching her).

Stick with it, i can remember sitting down with dd2 tring to get her to hand me the card (it gets frustrating) but once she had done it a few times something clicked.

I think the idea is that your DD should only get the popcorn if she hands the card over - not easy to enforce I know. Sorry no help whatsoever.
Are there any SLT's at your local child development centre who could help. When we did PECS with DD we had a few 1:1 sessions at the CDC.

It shouldn't takel ong to get.The longer it takes the more the child gets stuck at a stage and therefore more resistant to change that comes with the later phases.
Hence lots of supposed 'PECS users' who are little more than performing monkeys working at single picture level for years. It saddens and infuriates me.

From what you say, you need to be firmer physically with grasping her hand and faster. Get it to the other person's hand super quick and they need to say 'Popcorn!' and get it to her in literally a second.

Keep a tally of how many times you do it. I'd be recommending 30-40 exchanges a day (I'm a SALT and know PECS inside out). Also you need to change the reinforcer frequently. However much she loves popcorn, I doubt she wants it all the time.

You should have pictures for between 10 and 15 of her favourite reinforcers and be using these throughout the day.

OK. Part of the problem may be that I was CP today: will swap round tomorrow and see if I can vary the timing a bit and what her response to that is. My suspicion is the faster we go the worse it will get because she will get progressively more bothered by the hand-over-hand element. But we won't know till we try it!

Marne - we did discuss photos. But VI said Do Not Use.

Moondog - why only 30-40 exchanges per day?

'only' No, not at all!
Do as many as you can!
I am thinking along lines of shifting unmotivated peopel. If you can do more then fab!
I have worked with tonnes of people who are often been hugely resistant to initial physical prompts. But if you get it done quick they realise the consequence of doing this is getting something good so the challenging behaviour stops.

I've yet to see anyone fail at this phase.

Don't vary the time in any way other than to go really fast.

Oh, OK - more it is, then! We do find it difficult to make opportunities for exchange because she has so few motivators which is why it's taken so long to be able to start PECS at all. But I think we have a critical mass of them now.

The story with hand-over-hand resistance is that she has spent a lot of time from babyhood in hospitals either having blood removed or meds pumped in, and though generally she's a trooper we have had one or two completely incompetent people cause her a lot of pain so increasingly it involves holding her hand/arm while she screams in terror. Plus she only has one hand that works, so you have to hold that one but when you do she is completely helpless; you've effectively tied her up iyswim. So the moment you touch her, you get withdrawal. It's made it v diff for school to do anything with her (not just PECS; messy play, all sorts) as you can imagine. She can't copy, but you can't "show" her either.

But ITA to keep at it; there really isn't another way, is there? The breakthrough I think will be when she realises she needs to keep hold of the card till it gets to the waiting hand. Then I can fade the prompt down the arm, the whole thing will be less stressful and we'll start to make progress.

Yes, you have a challenge there with past history. Poor little thing-she knows that someone taking her arm generally means sometihng scary is going to happen.

Super super quick.
Chnage reinforcers often.
Be imaginative.They don't all need to be food. Tickles, bursts of music, rocking, whatever. All can work if reinforcing enough.

lol, if only she was interested in anything that functional, moondog! Our non-food reinforcers are things like Being Permitted To Chew The Stairs.

There are a lot of things going on here, aren't there?

The tactile defensiveness/bad association of touch with her arm seems to be the key thing there. It sounds like a respondent behaviour (e.g. like weeing or sleeping) so not easy to control. It is also making possible solutions problematic e.g. you can't be firm with her, or speed it up as much as you might like.

This is interesting:
"SA, if we don't hand-over hand, she picks up the card and then drops it straight away while pushing it aside (which is her way of showing she doesn't want the card, she wants the other thing, ie the popcorn). If popcorn is not forthcoming at this point, she screeches angrily, picks the card up again and attempts to destroy it."

What is the distance between her and the CP at this time? I am wondering if there's some way of playing around with it so that when she picks up the card you could do a quick partial prompt (away from the sensitive area of the hand) to the CP and a fast reinforcer (before she has a chance to drop it).

You need to build up some sort of behavioural momentum that connects the exchange of the card to the delivery of the reinforcer. At the moment it sounds like she is frustrated with the card as she sees or slowing down access to the popcorn.

Not an expert though! I used to do a lot of PECS but not so much so these days!

I'd be thinking about holding her sort of between the elbow and the wrist, on the underside of the arm.
Get that CP really near too.