ABA PECS and SALT

[mizmiz]

Just looked through this for the first time. Fascinating for me as I am an SALT for people with special needs. Feel that I am getting an insight into parents' minds , something that isn't always easy.

Do any of you use PECS at home, with/without ABA? I have been working on this for a while and consider the two to be the most exciting stuff I have come across in 12 years in this field (although as some of you note, some SALTS are suspicious of it, which drives me nuts as I don't think they understand what it is about.)

Do ypu find using these methods at home sustainable, or is it too much bother and fuss? I would love to know. I have introduced it with some dramatic results to some of the families and schools I work with, but now that I have gone abroad to live, I worry about their ability to carry on.

BTW if you have any questions about SALT, I would be glad to try and help. help. Time lies heavy on my hands in a new country.......

Mizmiz - Thanks from me too. I'm really impressed that children can be seen as early as 6mths old. It seems so logical to look at communication rather than purely language so I suppose the limited availability is probably for short-term costs reasons. Thanks again!

What a fantastic thread! And welcome, Mizmiz, have found your comments very interesting. I have a question- my dd is classically autistic and is just starting to use PECS (she is 4 and on a full-time ABA programme at home. We tried signing and she picked up biscuit beautifully and a few other with prompts but it didn't 'take off'). We are not using it in a traditional way- at the moment we have three pictures on a board with the objects behind for reference. We then ask DD what she wants (she is a way off spontaneous requesting yet, trying to get her in to it). DD enthusiastically hands over a picture (I am totally amazed she has grasped this, she is a star) but not always the one she really wants (ie: hands over a pic of bubbles whilst looking earnestly at 'crisps'). What do do? We have tried everything, but I still don't think she is always looking at the pictures properly...
Grateful for any advice...

Jakbrown, why are you doing it that way? I strongly recommend you follow the traditional PECs method, it really is tried and tested. Can you go on one of their training courses? They're based in Brighton. If you don't do it the trad way you may well find you just have to back track at some point.

Davros, it's very interesting you say that. I'm really going off what I've been advised by DD's speech therapist and Aba (VB) therapists/consultant etc who don't feel trad Pecs would suit DD. But you know, now you've raised the question, they've never really explained WHY?!!! I am going to go on the PECS course which is in Brighton (so no excuse) with DH. How does traditional PECS work? (sorry for ignorance). Know it involves some form of hand over hand for pic exchange? (which we did with DD). Does it start with one pic? We did start with one pic (or to be precise a 'scrunched' up crisp packet with DD but we are struggling to move her on with it. Mind you, she did it perfectly today!

Davros is right, jakbrown and I shalltry to explain why.
PECS is based on Behaviourism. You dont have to know a great deal about it (I dont) but a key factor is that we all are motivated by reinforcement (ie reward). Some people criticise this saying that it treats people like robots (I used to think so too!) but in fact it does no such thing. We all do continue to do things because of the end result (ie work, suffer through pregnancy, sweat in the gymn, whatever!)

Now, consider a child with s/n. By definiton they will get a lot wrong. Until fairly recently, they were rarely 'backstepped' through a process to where they went wrong. They tended to be corrected and things would just carry on as before.
So what had they learnt? Often nothing.
(An example from my work. I might have various action cards on a table and ask a child 'Show me 'swimming''. He chooses something else, so Isay, 'No,swimming'and guide his hand towards the picture.
Has he learnt from his mistake?Probably not.
Is the exercise motivating and reinforcing (ie offering some sort of reward)? No!
Is it boring and pointless? Yes!!
For some kids (partic. ones with ASD) it probably served no purpose whatsoever.

PECS has really tried to address this problem by prescribing stages that have to be followed very very closely in order for a child (or adult) to

A.)Learn from their mistakes

B.) Be motivated to keep on learning because what they are doing is reinforcing (ie has 'rewards' for them.)

With PECS a child first learns to hand over a picture in exchange for something. It is, Iagree amazing when it happens, but can quickly become a meaningless 'robot' exercise, unless the child then masters the next step, namely discrimination (posh word for looking at a picture and understanding what it means/represents) which is exactly where your child (and many many others!) have problems.
Discrimination is the key to a picture based communication system because once you know what the picture 'means' you can be on your way asking for 'swimming' 'swings' 'drink' 'slide' or whatever is your thing.

Your child is getting the 'wrongpicture and giving it to you.
I imagine you are doing one of two things:

A.)aying 'No X, you want this picture' and directing her to the right picture and helping her give it to you.

B.) Taking the 'wrong' picture and giving her what you know she wants anyway.

So, what has she learned? Not what you want her to (pic. discrimination)She has learned something along the lines of
'I just sort of reach out for a picture, there may be a bit of fumbling and swapping that Idon't really understand, but eventually Mummy will give me what Iwant.'

Not great is it?!

PECS recognizes this common problen by building in a stage where the child is presented with 2 pictures-one of something she loves (eg 'bubbles') and one of something of no interst to her (eg 'sock')
The child is encouraged to choose one and, now this is the crucial bit.....

SHE GETS WHAT SHE ASKS FOR!!!!!!!

(Whether that is the sock or the bubbles.)
There are precise steps to run through when the child makes the 'wrong' choice which will in 99% of cases, help her to understand that she has to learn how to discriminate to get what she wants.

With your system (the one that most of us,including me used until PECS came along) it is highly unlikely that she will learn to discriminate. She'ljust become bored and frustrated (as will you) because she doesn't really know what you want her to learn and is not being properly reinforced (rewarded) to learn it.

The fabulous thing about PECS is that if you folow it to the letter, you can't really go wrong, but to understand what to do and why, you must, must, must go on a 2 day training course
(costs about £160. Contact them to find out where the next one nearest to you is being held. Company is called 'Pyramid')

In my job, we fought for the NHS or Social Services to pay for parents to attend PECS courses in order for them to be able to have much more understanding of and power over their children's therapy instead of having to rely on infrequent clinic appointments and vague advice, which especially for children with ASD is, IMO just not good enough.

I suggest you ask for funding for you to attend (even if you can afford it, it is a matter of principle.)

The 2 day course is fascinating and not overwhelming. They are attended by a real mix-parents, health professionals, teaching staff,extended family and so on.

I really dont think you can use PECS properly without being on the course.

BTW Ido not work for PECS or have any financial interests in it. I simply know from my own experince that it is a superbly thought out communication system which has allowed children whom if Iam honest I had almost given up on, to become effective communicators.

I could go on and on forever about this (I am such a PECS bore!!!) but I hope that Ihave answered your question. Please, go on a PECS course. It may well be one of the best things you ever do for your child.

Best of luck!!

mizmiz, thanks SO much for this! You are right, DD has learnt to hand over a picture to request (which I think is a miracle in itself). But definitely needs help with discrimination. Will discuss all with DD's ABA therapist tomorrow. She does discriminate some of the time (today she requested crisps ten times in a row, picking from three pictures) but not consistently. Thanks so much for your advice

A pleasure jakbown!
Saw your earlier post and am so glad that you are going on a PECS course. Hope that Theresa (sorry can't remember her last name) is one of the consultants running it. She is just great!! (Mind you they all are.)

Just been on the website. There's a course in Southampton in early December so going to try and get on that one. It's hard as a parent because at first you kind of take on board what people tell you but then start to question whether it's always the right decision!! We have been giving DD what she's chosen but then she gets frustrated if she clearly wanted something else (usually food). We then prompt her to pick the food pic then try and get an independent response. It works sometimes, but not consistently enough. Thanks for your help!

As I guessed!
She is not going to learn to discriminate like this (will just rely on you to sort it out for her, and let's face it, 99% of what we do for our kids we do in order for them to eventually learn how to manage things for themselves) and it will become so demoralising for all of you.

BTW there must be a reason that your therpaists have advised against PECS (wonder what it is?)

Please don't make final decisions based solely on my advice (not that I am flattering myself!). As I mentioned to someone else I can give you a few pointers on this based on my experiences but
this can in no way be compared to a clinical assessment of a child.

PS Geat that your dh is going on the PECS course too! That is optimum setup If you do decide to use PECS you can help each other out. So much easier with two than one!

Yes, I'm bemused as to why they are against PECS. I think DD's speech therapist (who I really loved) thought DD wasn't ready for it (this was 18 months ago). She just wanted her to make the connection between pictures and objects at that point. I will ask DD's supervisor tomorrow! I know the unit I'm trying to get DD in for next Sept is really big on PECS and I feel as if it's got so much potential as DD loves it. Just need to use the right method! ps think it will really help DH feel more involved...

Do ypu know if the therapist had been on a PECS course herself (because if she hasn't, however lovely she is she is not in a position to decide on whether or not PECS is suitable for your child)?

As for making object/picture connections, well that is precisely what PECS helps a child to do!!

To you and anyone else-don't accept the advice of anyone re the suitabilty of PECS for your child unless they know about it (and by that I mean that at the very LEAST they need to have gone on a 2 day course, not just done a bit of reading about it.
Ask and make sure they answer!!

PS If she has gone on one,very sorry for the rant! But if she has just can't understand why she is talking about acquiring picture/object connections first.
Doesn't make sense.....

I feel really stupid as I have PRESUMED she has been on one! Will get to the bottom of it...

Well let me know when you find out! (And don't let her fob you off with 'I haven't actually done the 2 day course but...I read about it/already use it anyway/a colleague went on one and gave a presentation to the team etc etc.)

Won't do I'm afraid!

(And as Imentioned before, very sorry if she has and Iam being a troublemaker!)

Jak, I have to say that a lot of ABA tutors and, I'm afraid, especially VB ones are full of prejudice about PECs based on misinformation and the simple preference for signing. I'm sure that sometimes they may be right but most of them simply aren't qualified to make that judgement, I think you need to decide, maybe with an SLT, and they then have to put it into practice. DO NOT let them make your decisions for you, I've seen this far too much....... Very often when you question them they simply don't know WHY they think what they do. A consultant is probably much more aware of why they make their recommendations but still have their preferences but the general team members should be doing what YOU tell them, not you doing what THEY tell you....

mizmiz, just an update: looks like our most local ASLTIP person has agreed to take us on - spark of hope in yet another weekend where we've been forced (birthday parties ...) to see how "different" ds is from boys his age whose language - and, or maybe and consequently?, their social integratedness - somehow comes to them instinctively. Ds's problems - which in familiar situations are of the "now you see it, now you don't" kind that wrinkle an eyebrow but can sort of be borne with, the "quirky" thing again - are rather stark in a roomful of children all familiar with each other but strange to him ... But he's such a love with us, came into our room this morning specially to ask whether we'd had a nice time at the party we went to last night - if only he could translate that into the simplicity and dexterity other children have.

In your, or your colleagues', experience - but you don't have to answer this one if it's another $64K one - can language problems really sort themselves out altogether? Or ought our goal to be a strictly realistic one of getting as good as possible at coping mechanisms so as to compensate?

He sounds like a little sweetheart!
Know what you mean exactly about being with other children and having to compare and contrast. I do it a lot with my own ds (in fact have just had to put down a 'humorous' article of the 'kids say the funniest things' ilk because actually no, my own kid doesn't and isn't!)

Yes, they do often sort themselves out (lang. problems) Current thinking is that early intervention is the key to preventing things going awry. It is a double edged sword I suppose. on one hand we could feel sad that very young children are 'labelled', on the other isn't it great that early diagnosis and intervention is now available?!
(I am amazed for example how 'au fait' peole are with the notion of lang. disorder when 10 years ago hardly anyone had ever heard the term!)

We know that children's Pragmatic skills (are you familiar with that term? Can't remember if you used it? If so, sorry if I sound patronising!) are still developing around the age of 12-13.
Areas like grammar and phonology also continue to be honed for a good while.

So.... although the average 5 year old is a pretty fluent and effective communicator, even the most articulate are still developing.

I think your answer is to

A.)Ensure that you are as well informed as possible (obviously so in your case!)

B.)Press for and accept assistance and reassure yourself that be doing so you are not locking your child away in a 'special needs' compartment for ever.

C.)Remind yourself that things will change and improve. He is only very little and there is a long way to go.

PS Perhaps a little irrelevant, but always remember an old boyfriend telling me that he was a very quirky little kid, so much so that his grandmother took him to see a psychiatrist (terrible I know!) behind his parents back. He is now one of the most normal, charming, successful, laidback guys I know! (Not that I see him that often I hasten to add!)

PPS I think you're trying to ask if kids get 'better'. Not all but some definitely. Saw a kid in the supermarket the other day that I used to see regularly (very quirky, strange phonol,odd Pragmatics and so on.) Anyway, I followed him and his mother around incognito for a while just to see how his s & l were, and I was delighted-didn't do or say anything at all that would have been of note. Made my day!
Surprised I wasn't thrown out for stalking though!

Wow mizmiz, what a great thread. You will certainly be kept busy with us lot on MN!
I haven't really seen this until just now, my dd has DS and we don't used PECS/ABA, so I haven't really looked!
It's a long hard slog with her ATM, she is just 3, saying very little, but signing 150 signs. Gave up on SALT via NHS earlier in the year and are now paying privately for SALT specialising in DS! She is coming on great guns, but still, rather daunting, has a very long way to go.
Just saying hello and thanking you for all the help you have been and will be in the future.

Mizmiz, just seen your post on the other thread but didn't feel it appropriate to hijack it!
I know it's wrong to compare children and that there are all individuals,,,but...when dd was born there were other babies born witning weeks of her. It came to light the other day that some mum, have chosen not to teach their children sign as the had concerns that this would "take over" and speech would not come. As a comparison to dd now, they have even lee in the way of vocals,vocabulary and with no sign have no other form of communication. All in all they are probably very frustrated little 3 yr olds. With DS you obviously may have memory problems, hearing problem, eyesight problems,,,the list could go on. With this in mind isn't it even more vital to use whatever resources are offered?

OMG!! look at all the spelling mistakes!
Time to go to bed me thinks!

Oh God,completely!
I have mentioned on this thread my dismay at seeing children I know could have been helped so much by an additional method of communication, but the parents/family have desisted and the result is...well, you have spelt it out.
As I said, loads of research to back this up. Needs to be available in a parent friendly leaflet IMO.

I respect that it is an individual choice, but personally I hammer this message home to every family that I see, and also enlist help from parents in my quest! For example, ask mothers who sign with their children to come and talk of their experiences when I do training days and so on.

The other lovely thing about something like signing is that you are making use of a child's strength, not simply focussing on their areas of need (latter being most depressingly the norm IMO). For example, as I am sure you know, people with DS often have excellent visual skills which are far superior to their auditory processing skills so by using signing, you are tapping into that strength.

PS Am obsessed with PECS and signing1!!

Oh blimey, Davros, very stressed about this now. Am going to talk to DD's supervisor this morning about it. As wonderful as they are (and DD's 'team' are wonderful) I am now worried that we haven't taken the right approach with dd's pictures. I think they obviously get a tiny bit 'defensive' about decisions they make and it's a bit 'cliquey', if you know what I mean. Like any 'specialism'. Anyway, rambling now... Will report back...

Don't feel stressed!
They have taken a clinical decision and are doing what they think is right.
Noone is going to agree on everything all the time!
Lots of salts have different views and approaches.
You do however have a right to know why they have taken the decision they have. if you are calm and open, I'm sure that they won't be defensive.

Really intersted to know what happens/has happened.

Good luck.

mizmiz, more thanks - have a lump in throat. Yes he is a darling darling - on his own terms and when he feels secure. For instance he could not be a lovelier big brother - he trusts his little sister to understand (she does, she's the utter opposite end of the continuum from him in social/language skills - so birthday parties with the two of them are quite a strange experience - dd sparklingly gathering up the wallflowers & ds, well you know) - and "tunes into" her and other individual children very intently. And he has very very good eye contact with her, while otherwise it can be fleeting. But group dynamics are simply another planet to him - and pragmatics, yes, that's exactly the issue.

I sometimes wonder whether one of those theatre-game outfits - Perform or similar - might be good for pragmatics/group dynamics? Do you know if that sort of thing is ever recommended? He does love make-believe, and perhaps the "just pretend" nature of it would help him feel safe.

(You are doing so much for us all here - is there anything I can do for you?)

Hi MizMiz

I'm attracted to re-training as a SALT once children at school (DD only 6 months so this is a long term plan) .. do you happen to know what the training is like .. I have a good degree (but is not really relevant subjects .. economics and management science) thirteen years in marketing ... SAHM since 2002 (which I love) ..

I am currently trying to read Crystal / Varley The pathology of language but fear I have baby mush-brain so it is slow going, albeit enjoyable

Will I find it extremely tough without a linguistics / science background?

I'm hoping to do the 2 year post-grad at City Uni and know I should be asking them the questions but frightened to look like a nut-job cos its so far in the future

Next year am planning to shadow the SALT at our local clinic (have been told she's open to that) to determine if it really is for me?

also would love to know what ABA is

JakB, sorry I seem to be stalking you and alarming you! Maybe you will get an explanation that makes perfect sense and maybe you'll decide to change how its being done. Either way should be no harm done.