Speech therapist and private paediatrician disagree, who should we listen to?

[Neighboursandnames]

Our child is completely non-verbal, rarely babbles. He's nearly 3 years old.

We saw a private paediatrician 6 months ago who said we could introduce him to PECS.

We got an appointment with a NHS speech therapist 2 months ago who told us not to use PECS. The reason is that they said this would disengage interaction.

My son has no interest in PECS but he did he seem keen on an AAC app on the iPad.

I have no idea what to do? Would you use the AAC or keep away still?

I'm not sure why PECs would make your ds disengage interaction. If it was me I think I would go for whatever ds was interested in, to help him communicate.

Their logic was that he needed to focus on our faces to try to learn speech, so he needed to be off PECS. It conflicts with what the private paed recommended though.

I would use pecs, aac (Keezy is good for recordable buttons and free, music, sign and anything else you can think of (eg here we used to say ch-ch-ch-ch for going upstairs, and a specific song for going to the loo etc). Communication is more important than words, words are easier to communicate with so will come if and when he can anyway.

Mine had a slightly different profile with words but only nouns and colours for years.

I agree with the pp communication is more important than words. It took ds a long time to look at us and be interested in what we were doing. We tried makaton twice the first time he was completely uninterested then we waited a year and tried again, he was signing himself within a few months. I think you, as a parent, work out what level of engagement your child is ready for and it's great if he's already showing interest in something.

I'm a SALT.

Is your DS bringing objects to you to make requests? Eg handing you the TV remote to ask for the channel to be changed, bringing up a packet to have it opened, handing you his drink bottle if it's empty? If so, he's showing readiness for PECS.

If he's not doing these things, then a trial of PECS is not appropriate. Paediatricians often recommend PECS with no understanding of the precursor skills that need to be present.

Having said all that, I'm confused by the reasons the SALT gave for why PECS wasn't appropriate. Not all SALTs are PECS trained and understanding of how the system works is very variable.

Pecs in themselves are not necessarily going to be his thing. My son really couldn’t “see” pictures for much longer than other children (actually as disordered as his language but nobody but me recognised that). Photos came long long before pec style drawings and letters/numbers. Colours on the other hand and notes/music were easy for him. Really any method of communication helps. I’m shocked that anyone would suggest keeping him isolated till he speaks

That's some terrible advice from nhs salt! Unfortunately it seems to be common. My son is 9 and non verbal. I was told my son was not ready to use an aac app (proloquo2go). That he would not be able to grasp it. We went ahead anyway. He can use proloquo2go to make full sentences to request and reject, use social interaction and action words. Best thing we ever did was employ a private specialist salt who specialises in aac. Worth every penny.

From our experience the nhs salt we saw pushed what they understood not what was necessarily best for my child. We where pushed to makaton constantly. My son has never signed anything, he doesn't even wave. The salt knew a lot about it, doesn't mean it was right for my ds.

Does he look at your faces? Because we were told to do signing and it was pointless as he didn’t look at us he looked through us. He didn’t seek us out and give us the remote etc either he would struggle for ages rather than approach someone for help. Even when he started using words he didn’t understand he had to say them to someone he would just say them in an empty room. Pecs (and any other method using ABA) starts from scratch teaching to use words and symbols and then crucially that you need to exchange them with a person. Also has a reward element to motivate or tempt them to communicate to get something they really want and once they have learnt that exchange between two people then you can build on that. Pecs starts with using two adults one to sit with the child and model, hand over hand if necessary how to exchange a symbol for something and the other to receive it. So all the steps needed are taught as part of the pecs programme and the child promoted through it. So I would disagree you need pre requisite skills like social interest / asking for help from others. That wasn’t our experience. I’d suggest going on an official course run by pyramid. It’s really good to learn from the trainers directly and they run them around the country. But if he’s interested in aac that’s a really good sign and I would push that too. I would look to see if any ABA workshops near you or look at ABA YouTube videos in teaching language. We found ABA staff had far more success than salt at that age as they understood he just wasn’t motivated to communicate or interested in us and we had to create that motivation. If we’d waited for him to tune into our faces or approach us spontaneously then we’d still be waiting years later.

Where PECS can be used, the evidence leans towards it supporting interaction. It also supports sentence structure, with or without the development of speech.

Agree that not all pre-verbal autistic children can engage with it, though. Ds2 was 7 or 8 before it even began to click with him and he started speaking and reading and even typing, very soon after, so it was a part of a major developmental snowball.