Monday, September 13, 2010

Augmentative and Alternative Communication

If you are a parent of a non-verbal child on the spectrum, you will have agonized over this topic.  These children need a way to communicate and in particular to communicate their needs.  Without a functional communication system, the child will use other means of communication, like leading an adult to what they want, or crying, screaming, and self-abuse.

The most common system introduced to children is the Picture Exchange Communication System (PECS).  The goal of this system is to make a child an initiator (not just a responder) of communication and to understand its usefulness through exchange of pictures for desired items.  Later, children can make comments and have simple communication exchanges with PECS.  This is the system Alanna uses.  There are six phases of PECS; Alanna has remained in phase three for months.  Currently she is able to go to her communication book, choose what she wants (or choose something representing a label if we ask her what something is) and bring it to us.  If it is a request she does it spontaneously without help and she brings it because she is internally motivated to get something.  We have not gone to phase IV because that phase introduces sentence structure, and we had, to this point, been making good progress on speech.  The concern from our psychologist was that Alanna could just start saying "I want" instead of the actual items, which she was at that point.  However, her vocals have really decreased.  Hours of mand training for good clear approximations are now met with silence or throaty "guh guh" sounds.  So now the question... continue with mand training with this much intensity or dial it back and introduce more complex PECS to allow Alanna to speak in sentences and comment?

Verbal behaviourists like Dr. Mark Sundburg, Dr. James Partington, or Dr. Vince Carbone are fairly persistent in their view that non-verbal children should be taught sign language.  Don't get me wrong; we use a verbal behaviour type therapy approach.  However, sign language is not always suitable... Alanna, for example, has a lot of trouble with imitation in general.  She is improving, but her language acquisition is much faster with PECS.  There is also the problem of usability - most people are not going to understand sign, especially if they are approximations.  However, a sentence of pictures is clear to almost anyone.

There are problems with PECS, though.  Eventually she will have too many and we will have to switch to a voice system if she is not vocalizing or picking up some sign.  To me, PECS seems more functional for long term use, but sign language seems better for learning how to talk.  Obviously, we want her to talk!

Here's hoping for some clear direction...


  1. you are right, sign language is not always suitable. I know lots of kids in a "VB" program but because they have smar therapists, they also have a really funtional visual schedule /PECS -like agenda to their day, that sort of helps them communicate.

    Did you know the new ipad has a PECS app?? Its supposedly the bomb. There is a pecs for everything and so portable! No more pecs books hanging around kids necks (yes I have seen that in a center here in the GTA - talk about impractical and stupid).

    IPad also have really neat visual games where the thing will verbally ask you "Find an animal" and then you touch the right picture! Who needs a therapist? hahaha...

    guess what we are getting KHaled for his 5th birthday next year? :D

  2. Interesting, I do have an iPad Touch. I should check out that app!

  3. Just a word of caution about an "I want".

    My twin daughters started out with PECS, got to about the same place, and transitioned to verbally asking for things with an "I want" to start out. We have ditched the PECS and they have gone on to develop some functional speech (mostly one or two word phrases) but the "I want" seems to be permanently stuck at the front of everything they say.

    Even though the twins have some speech we are tossing around the idea of going back to teaching then sign language or using other alternative communication devices because talking requires so much effort for them. We have found that they can vocalize better if they have some physical sign, picture, or whatnot to associate with what they are saying.

    When they don't have some other action to associate with what they are saying they tend to scroll through a few words until they get to the one that they want. But when they have a sign to do at the same time (even if the sign is fuzzy or just an approximation) the scrolling disappears and the words are clearer.

  4. I never liked "I want" -

    We started with the mand - which is a single word for the thing you want. You wanna cookie? You just have to say cookie and things have sort of progressed from there.

    Its best to stay away from vague phrases, like my turn, again, i want etc.

    Khaled will however append his own version of words that he has sort of picked up or "developed" as he has increased langauge.

    So on his own (without being taught) he woudld often start the request with "wawa" - i.e wawa sing, wawa frenchfries etc.

    Then he made it in to "want going".

    We did not do error correction for this stuff (but we do for other things) We do very little error correction right now because these static things like language and its acquisition are not what is fragile in him - it is the motivation and dynamic aspects of communication itself that is fragile.

    So his language is developing differently to the typical ABA child, but his cognitive abilities are on another plane altogether after a year of whatever it is that we have been doing. I really prefer that.

    Although sometimes I do wish I could hear him say more :) HE is so cute when he talks.