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Common Misconceptions About Picture Exchange Communication System

What is a Picture Exchange Communication System (PECS)? PECS is a form of Augmentative and Alternative Communication (AAC) which uses a picture/symbol system to teach initiation ofBlog-Picture Exchange Communication System-Main-Landscape
functional communication. PECS was developed by Lori Frost and Andy Bondy in 1985 to be used with preschool children on the autism spectrum who demonstrated little to no socially-related communication. Examples include: children who avoided interactions with others, did not approach others to communicate, and/or only communicated when prompted to do so.

Myth #1: The Picture Exchange Communication System is strictly used for nonverbal children or children on the autism spectrum.

A common misconception about the Picture Exchange Communication System (PECS) is that it is strictly used with nonverbal children. While PECS and other forms of AAC have proven very useful and successful with nonverbal children, the system services many other populations with the purpose of eliciting and initiating functional communication.

To fully understand the meaning of functional communication, a distinction must be made between actions directed to the environment vs. actions directed toward a person. A child may climb on a step stool to reach a toy car on a shelf. From this action, we could infer that the child wants to play with the car. However, this is not communicative. If this same child looks from the car to his mother, or leads his mother over to the car, this is considered communication. Neither interaction involved speaking, however the distinction is that communication occurs when an action is directed towards someone else to achieve a certain outcome.

Therefore, Picture Exchange Communication System is appropriate, not just with children or adults that are not verbally communicating, but with those who are verbal, yet lack person-directed communication.

Other populations where PECS might be appropriate (to name a few):

-late-talking children (research is showing benefits for the introduction of AAC as early as 12 months)

-adults with aphasia

-Childhood Apraxia of Speech (CAS)

-children with reduced speech intelligibility

-verbal children with reduced social language and initiating

Myth #2: Using PECS will deter my child from communicating verbally

For some children, verbal communication can be a challenge; speech and language are not developing as quickly as would be anticipated and, accordingly, result in accompanying frustration and associated behaviors. Introduction of an augmentative and alternative communication system like PECS can help bridge the gap for children who are not yet verbally communicating but need an accessible means of communication as speech and language develop. Without an effective means of communication, these children are at risk for social, emotional, and behavior problems, including feelings of frustration and isolation.

Often, parents are concerned that using an augmentative or alternative form of communication will replace or deter verbal communication. In fact, research has shown just the opposite:

“Research over the past 25 years has shown not only that use of augmentative communication systems (aided or unaided) does not inhibit speech development but that use of these systems enhances the likelihood of the development or improvement of speech.” (Bondy & Frost, 2004)

The PECS program mirrors the acquisition of typical language development; children are taught one-word labels for frequently requested items before transitioning to formulation of two-word utterances. Verbally requesting and labeling can be targeted in conjunction with the program. The PECS program also details modality transitioning (i.e., transitioning from PECS to verbal communication), if and when it is appropriate.

If your child is using PECS now, this does not mean that you are “giving up on speech”. It is a system that is being utilized to give your child a means of communicating and interacting with others while speech is developing.

Myth #3: PECS cannot be used with children who have visual impairments, fine motor, or gross motor difficulties.

PECS can be used with a wide range of age-groups and disabilities. Accommodations can be made for children and adults with visual impairments, fine motor, or gross motor difficulties, to name a few.

Pictures can be made in various sizes to accommodate visual impairments. Additionally, you or your child’s speech language pathologist can select and modify pictures to suit your child’s needs; photographs can be used instead of clipart or Boardmaker pictures, and images can be modified to create more contrast.

Pictures can also be put on objects (e.g., bottle tops) to make them easier to grasp and pick up from a table or book for children with fine motor difficulties.

Step 2 of PECS involves ‘distance and persistence’, meaning a child is taught to move across a room, multiple rooms, etc. to select a picture from his book and persist when giving it to his communication partner. Students that are non-ambulatory can use a voice switch or a button to request his communication partner in order to perform the exchange.

If you have questions about PECS and if it would be appropriate for your child, please consult with a licensed speech language pathologist.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

Meet-With-A-Speech-Pathologist

Potty Training a Child with Autism: The Toughest Case

Potty training can be a very challenging process, and even when you have a plan in place there will more than likely be issues that arise. Potty training children with autism can add additional challenges, but potty training is still possible. It is important to remember that potty training is a process that takes time, so be patient and eventually your child will be potty trained.

Keys for successfully potty training a child with autism:

  • Always start with urine training – It is much easier to control fluid intake, and urinationPotty Training a Child with Autism: The Toughest Case occurs more frequently. After your child is successfully urine trained, you can then work on bowel movements.
  • Create a reward system to reinforce positive toileting behaviors – Start with basic toileting skills (i.e., sitting on the toilet) then begin rewarding additional behaviors such as going in the toilet, requesting to go, etc.).
  • Do not use punishment for accidents – Always keep in mind that your child is learning and accidents are a part of that learning process. If you punish accidents your child could begin to associate normal bodily functions as something bad. The preferred method of handling accidents is to provide natural consequences such as making them assist in the clean-up, making them change their own clothes, etc.
  • Create a toileting schedule – This will keep both you and your child on track. In the beginning you can start taking your child to the bathroom every 15 minutes. After following this schedule for a week or two you can adjust the time either up or down depending on how well they are doing.

Potential challenges of potty training a child with autism and how to handle them:

  • Child will not sit on the toilet – If this happens you will need to pair the toilet as something reinforcing. The best way to do this is to withhold their favorite toy such as an iPad and only let them play with the item when they are on the toilet. You can set a timer so they know how long they need to sit. Start with a shorter time, and then slowly increase the amount of time they need to sit.
  • Child will only urinate or have a bowel movement in their diaper – The quickest solution for this is to completely eliminate diapers. If there are no diapers in your home, your child can’t rely on using them anymore.
  • Child will sit on the toilet, but will have an accident as soon as they get off the toilet – In this situation you will need to sit your child on the toilet, and continue to give plenty of fluids and have them sit there until the go. Once they eventually go, reward them.
  • Child will never ask to use the bathroom – This can be common in children with autism since often times they have communication challenges. The best way to address this is to teach them how to communicate when they need to go to the bathroom from the start. Use whichever mode of communication they are currently using (i.e., vocal, sign language, PECS). Prior to taking them to the bathroom, prompt then to request to go.


Potty Training 101: The Easy How-To Guide For Parents Download our free, 15-Page eBook

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

childhood apraxia

Childhood Apraxia: The Facts

Childhood Apraxia of Speech (CAS)

Childhood apraxia of speech (CAS) is a neurologically-based motor speech disorder. Children with CASChildhood Apraxia: The Facts have difficulty producing speech sounds in the absence of muscle weakness or paralysis. Though a child with CAS knows what he/she wants to say, impairments in planning and/or coordinating lip, tongue, and jaw movement results in speech sound errors and differences in prosody (patterns of stress and intonation).

CAS is uncommon, occurring in 1-2 children per 1,000. It affects more boys than girls and occurs more frequently in children with galactosemia, fragile X syndrome, and Down Syndrome.

Acquired Apraxia of Speech versus CAS

There are two main types of apraxia of speech: acquired and developmental. Acquired apraxia of speech (AoS) is caused by damage to the parts of the brain involved in speech production and involves loss or impairment of existing speech skills. Causes of AoS include stroke, head injury, tumor, or illnesses affecting the brain. This disorder may occur with muscle weakness affecting speech production or language difficulties caused by brain damage. In contrast, CAS is present from birth and occurs in the absence of any muscle weakness or paralysis.

Cause of CAS

The cause of CAS is yet unknown. While some researchers believe that CAS is a disorder related to overall language development, others believe it is neurologically based and that it disrupts the brain’s ability to send signals to move muscles involved in speech production. Recent research also suggests a genetic component to this disorder, as children with CAS often have family members with a history of communication disorders or learning disabilities.

Diagnosing CAS

There is no universally agreed-upon list of diagnostic features that differentiates CAS from other childhood speech sound disorders such as phonological disorders or dysarthria. However, three characteristics of CAS are generally accepted by researchers and speech-language professionals:

  1. Inconsistent speech sound errors on consonants and vowels across repeated productions of syllables or words. While a child with an phonological or articulation disorder may make the same error each time he/she says a particular word, a child with CAS will not demonstrate a consistent pattern in his/her errors, even when repeating the same word.
  1. Longer and disrupted coarticulatory transitions between sounds and syllables. Children with CAS have difficulty combining sounds to form a word and may produce long pauses between sounds.
  1. Differences in prosody. Children with CAS produce speech that sounds choppy or monotonous, with stress on the wrong syllables.

Other Possible Signs/Characteristics of CAS

Young Children:

  • No cooing or babbling as an infant
  • Late development of first words
  • Production of limited set of consonant and vowel sounds

Older Children:

  • Numerous substitutions, deletions, and distortions of sounds
  • Understands language significantly more than can speak
  • Difficulty imitating speech, but imitated speech is more clear than spontaneous speech
  • Groping behavior when attempting to produce sounds
  • Saying longer words or phrases are more difficult to produce than shorter ones
  • Difficult for listeners to understand speech
  • Speech sounds choppy or monotonous or the wrong syllables are stressed
  • Distorted or inconsistent vowels

Possible Concomitant Conditions:

  • Language delay
  • Word finding or word order difficulties
  • Fine motor coordination difficulties
  • Oral hypersensitivity
  • Difficulty learning to read, spell, and write

Treatment of CAS:

Children with CAS receive frequent and intensive one-on-one therapy, tailored to their specific speech and language needs. Treatment focuses on improving speech imitation skills, speech-based motor sequences, length and complexity of producible syllable patterns, teaching rules of speech sound patterns, and, in severe cases, using augmentative communication systems (e.g., picture exchange communication system).

If you believe that your child shows signs of CAS or another speech sound disorder, do not hesitate to consult with a speech-language pathologist.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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ABA therapy

The Importance of Parent Involvement in ABA Therapy

Applied behavior analysis therapy (ABA) is a well-known, scientifically proven intervention for increasing functional skills in children with autism or developmental delays. While children can make great gains with ABA therapy, the children who make the most gains are the ones who have parents who are actively involved in their child’s therapy. Being actively involved doesn’t mean you need to observe every session and/or attempt to run your own sessions at home. However, what you can do is to carry over the skills your child is learning in therapy and then practice them during your child’s everyday routine. For example, if the therapist tells you they are working on increasing your child’s receptive identification skills, at home you can look through picture books with your child and have them point to various pictures in the book.

The Importance of Parental Involvement in ABA Therapy:

Children are with their therapist for only a small portion of each day, so the more they can practice thethe importance of parental involvement in ABA therapy skills they are learning, the sooner you will begin to see progress.  Conversely, if you do not carry over what your child is doing in therapy, it will most likely take them longer to meet their goals. It can also be counter-productive if you are doing something completely different than what is happening in therapy. For example, if a child is working on a certain method of communication in therapy, but the parents/caregivers do not make the child communicate this way at home, the child is going to get very confused and consequently will not learn to effectively communicate in a functional manner.

For suggestions on what type of activities you can be working on at home with your child, ask the behavior analyst on your child’s team.  They can give you suggestions based on your child’s specific needs and goals.

Below is a list of some general activities that you can do with your child at home:

  • Have your child request preferred items and activities using their current mode of communication (vocal, signs, PECS, etc.). Keep their favorite items in sight but out of reach so they need to ask someone to get it for them. Or have preferred items in clear plastic bins that are not easy to open. So in addition to requesting the item, they can request “help” or “open.”
  • When your child requests something, have them make eye contact with you before you give them the item.
  • Look through picture books and ask your child to point to various pictures.
  • Ask your child to follow simple commands (e.g., clap, jump, find your nose, touch your toes).
  • Sing songs that have motions with them (i.e., Wheels on the Bus song). While singing do the different motions and prompt your child to imitate your motions.
  • Play a variety of developmentally appropriate games with your child to expand the variety of toys they find reinforcing.

Make the activities fun for your child. They are already probably receiving therapy multiple days a week, so you don’t want this to seem like work. If it seems like work, they will be more resistant to engage with you. Also follow your child’s lead and try to create “teachable moments” based off what they are currently interested in.

NSPT offers ABA Therapy services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Multimodal Communication

Multimodal Communication: Communicate Without Using Words

Does your child ever communicate without using words? Multimodal communication is simply communication through “modes”.  Multiwhata? What did you say? Some examples of modes may be verbal, pictures, gestures, sign language, etc. Multimodal communicators use more than one “mode” to communicate.

In the high technology world we live in, we use many modes of communicating daily. Next time you have a chance, ask your cell phone provider how many text messages you send per month. Sometimes, verbally communicating is not the easiest way for us to communicate. A quick, “I forgot eggs for my recipe, can you get them on the way home?” text message is much more efficient than a phone call. The same concept holds true for children who are struggling to speak verbally. Sometimes, other forms of communicating are more efficient at meeting their needs.

“Wait a minute”, you say to yourself. “I want my child to communicate verbally, I don’t want my therapist to stop working on that and I’m afraid if they use one of these ways to communicate they’ll stop wanting to talk”. That’s a common fear of parents, but let me tell you it is a myth. Study after study continues to show that utilizing varying ways to communicate does NOT (I repeat does NOT) hinder or interfere with the development of speech. So why is your therapist talking about introducing all of these non-verbal ways of communicating? Your therapist only wants to alleviate your child’s frustration. The goal of your speech therapist is giving your child a way to communicate their needs and wants in a more efficient way. By teaching your child more than one mode of communicating in a systematic way, you are giving them a greater opportunity to express themselves.

Multimodal Communication and How They Can Help:Multimodal Communication

Signs: The use of specific hand gestures representing true words can help children to communicate what they want across environments. Signs are typically introduced first to children who are struggling to produce spoken language. Spoken words are a symbolic system, and when we speak we are exchanging “symbols” or words. This can help teach children how to exchange “symbols” or words in the absence of verbal language.

Visuals: Visuals are typically used for quick and easy communication for a specific purpose. For example, your therapist might introduce a YES or NO board to your child. This way, your child can easily communicate their response by pointing to their answer. Before your flags go off, this is a great way to teach the difference between yes and no before it can be used verbally. For children with difficulty communicating verbally, they often misuse the words yes or no. Some other quick visuals can be, “bathroom” or “break”.  Another easy way to implement visuals at home is having pictures of items placed on or next to their corresponding real life representations. For example, in the kitchen have a picture of “food” posted on the refrigerator. These pictures are typically placed in an easily accessible place within a specific environment. These visuals can immediately alleviate frustration for children.

PECS: The Picture Exchange Communication System is form of communication where your child will exchange pictures for their desired items (hence the name). This is different from visuals. PECS is intended for use when communicating for a wide variety of items or actions and carried with the child across all environments. PECS is taught in many phases, by a trained PECS speech therapist, each one encouraging your child to become more and more independent with communicating. For children, this is often how they learn their communication and language is meaningful. Over time, this mode of communicating can alleviate frustration and teach children how to use communication to express themselves versus a meltdown.

Speech Generating Devices: These devices are typically in tablet form with a variety of “buttons” that have picture representations embedded within them. A child will then press their desired “button” for their desired object, and the device will produce the verbal output. There are many common misconceptions when talking about SGDs or assistive and augmentative communication devices. However, these devices that generate speech are specifically formatted for your child and can improve or increase verbal language output. Not only do these devices model language constantly, they can also continue to teach children how to use language.

I know that all of these alternative ways of communicating can seem overwhelming. Just remember, your child’s therapist is only trying to immediately alleviate the frustration your child feels in not being able to communicate needs and wants. It is okay for your child to use sign language and PECS, or visuals and an SGD, or any other combination of modes of communication. Studies show that when therapists introduce these modes of communicating early, children can increase vocalizations and improve overall speech abilities. Your child’s therapist will continue to model spoken word when using multimodal communication. Remember, spoken word will still be the target and utilized when teaching and using these alternative modes of communication.







AAC: Speech Devices for Autism

For a child with autism, communication can be a challenging and difficult hurdle to manage. For some children, verbal communication may simply be an impossible or ineffective means of communicating. For these circumstances, an augmentative/alternative communication device (AAC) may be an answer.

What is AAC?

AAC is an acronym for Augmentative Alternative Communication and describes a communication tool that is substituted for traditional expressive speech to allow a child to communicate. These tools can be low-tech like PECs or an eye gaze board or they can be high-tech speech generating devices. Many insurance companies will cover AAC devices with the proper paperwork.

Use of AAC with Autism

AAC devices can be used at any age and across many settings. Research has been shown to support growth in attention, communicative initiation, expressive and receptive language and pragmatic skill development through use of an AAC.

Many children with autism acquire language early in life and regress quite suddenly. Other children with autism simply develop very few words, if any. With proper intervention, children with autism can explore a variety of options and find better ways to gain speech and language skills. Some research suggest that, when used in intervention, speech devices have resulted in faster progress in therapy.

Use of AAC with the Verbal Child

AAC devices can be used for children with verbal skills as well. One characteristic of autism is echolalia, or the repetition of heard speech. For children who script or repeat in conversation, an AAC device can assist is helping them to formulate novel utterances and to participate in more meaningful conversational turns. More importantly, use of an AAC device will not prevent your child from using and increasing their verbal skills.

Is AAC Right for My Child?

A speech-language pathologist with a concentration in AAC devices can assist you and your child in determining the appropriate device based on individual needs and skills.

To read about common misconceptions about augmentative and alternative communications, click here.

For more information and resources of AAC devices for autism, check out The Center for AAC and Autism’s website.

What is PECS (Picture Exchange Communication System)?

PECS or Picture Exchange Communication System is an augmentative and alternative form of communication that can be used across ages and disabilities.  It teaches functional communication that is immediately useful for individuals who have either not developed speech or who have lost speech.

Common Questions about PECS:

What about speech?

Many parents are concerned that by implementing PECS, we are disregarding speech or talking. That is not the case.  While implementing PECS, we are also addressing the development of speech. For those that have the ability to speak, we are continuously modeling and encouraging speech throughout the entire process. Read more

The Use Of Visuals For Speech Development | Pediatric Therapy Tv

In today’s webisode, a Pediatric Speech and Language Pathologist gives details on how different visual aids can help children develop speech.

 In This Video You Will Learn:

  • What is a speech visual
  • What types of visuals can help with the development of speech
  • What ages and conditions the visuals work best with

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now your host, here’s Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I’m your host, Robyn
Ackerman. Today I’m standing here with Deanna Swallow, a
pediatric speech and language pathologist. Deanna, can you tell
us what visuals are and how they help children with speech?

Deanna: Sure. A lot of research has been done to find out which ways
children learn the best. It’s been well-documented that children
learn well with a multisensory approach. Because speech and
language rely so heavily on an auditory system, we try to use
the visual system to help enhance a child’s ability to process
and use spoken language.

There are a lot of different ways and reasons that visual
support can be used, depending on the child’s needs. I’ll show
you an example that I made for one of my kids who has difficulty
following directions. I made a schedule for them that had each
different step visually presented so I could speak each step to
the child and then point to it as I spoke. In this example
visuals are used to help process.

For developing toddlers, oftentimes people will use baby sign to
enhance their development of speech. For older children or
children who don’t have means to verbally communicate at all,
sometimes we will use an entirely visually-based communication
system such as PECS, the Picture Exchange Communication System.
This system was developed for preschool-aged children with
autism.

There are a lot of augmentative communication devices that rely
wholly on visual input. Here’s an example of a binder I made for
my kids that has a lot of different activity choices. I’ll use
these in a variety of ways to help children to let me know
different activities they want.

Robyn: Thank you so much, Deanna, and thank you to our viewers. And
remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of
mind to your family with the best in educational programming. To
subscribe to our broadcast, read our blogs, or learn more, visit
our website at LearnMore.me. That’s LearnMore.me.