Friday, September 15, 2017

Setting Up Your Home for the Picture Exchange Communication System (PECS)

My 4-year-old son has cerebral palsy and struggles with communication. My husband and I and our son's therapy team have tried encouraging him to communicate via a variety of methodsspeaking, using American Sign Language, and selecting pictures on an iPadbut ultimately the method that we've found works best for him right now is the Picture Exchange Communication System (PECS).

The idea behind PECS is simple: When a child wants something, he gives a picture of that item to someone, who in turn gives him that item.

My son's speech therapist did some initial PECS training with him at school back in the early spring, and then in April, she visited my family's home to show my husband and me how to further train him at home. (She'd continue training him at school as well.)

At that home session, we did PECS trials during snack time. I prepared a plate with small pieces of apple on one side and small pieces of cookie on the other. 

His speech therapist held the plate within my son's sight but out of his reach, and then presented him with 2 picture cardsone of apple and one of cookie.

If he gave the speech therapist the apple card, he was presented with the side of the plate containing apple, thus encouraging him to take a piece of apple. If he gave her the cookie card, he was presented with the side of the plate containing cookie.

My husband and I continued using the communication book at snack time every day, expanding to include pictures of a wider variety of snack items (but only 2 in a given PECS trial). That went reasonably well. But I was having difficulty figuring out how to branch out to use PECS in other parts of our lives.

In more advanced stages of PECS, the child goes to the book himself, pulls off a picture card, and then goes and finds a "communication partner" to give the picture card to. My big question was: How would my son be able to independently pull the picture cards off the communication book? Doing so would require using his non-dominant, left hand to stabilize the book and his right hand to pull the card off. Using his left hand in this way is difficult because of his cerebral palsy, so I wanted to find a way to eliminate this step, i.e., this barrier to his ability to communicate. I decided we needed a communication board mounted to a wall. Then my son would need only to pull a picture card off with his right hand, without needing to use his left hand at all. 

I had remembered seeing cheap desk mats in a local store that I thought would make good communications boards:

front of desk mat
back of desk mat
Each desk mat is basically a piece of cardboard and a paper insert of an image from the movie Cars, in a sleeve made of clear plastic on one side and black vinyl on the other. 

I purchased one of these mats. It was larger than I needed it to be, so I cut one side off with scissors. I then made some measurements on the vinyl side of the mat with a ruler and a pencil and stuck down 6 strips of adhesive-backed hook-and-loop fastener (e.g., VELCRO®). I affixed the other side of the board to a wall (actually, a window) in a central location of our first floor using double-sided foam tape.

Next, I created picture cards for items that interest my son and/or would be useful for him to ask for, like his toy train, animal figurines, potty, and apple. Most of the pictures came from the Pics for PECS® Version 14 CD, but some are photographs I took. I printed out all of the images at home, laminated them, and put a small piece of adhesive-backed hook-and-loop fastener on the back of each one. Then I attached them to the board.

I soon learned that in order to effectively teach my son how to use PECS, I needed not only to introduce a communication board to him but also to reorganize his toys. Let me illustrate with an example.

Sometimes my son reaches for a container of toys that is too high for him and then looks at me. This is a good opportunity for me to teach him a better way of communicating that he wants those toys. For example, I can lead him to his communication board, show him the picture card of the toys he wants, and hold out my hand to encourage him to give me that card.

But in order to lead him to the correct picture card, I need to know exactly what he wants; i.e., any container of toys that he reaches for needs to have only one type of toy in it. That way, it's clear to me what he wants, and I can lead him to the correct picture card. After some reorganization, his toys are now organized by categorye.g., "cars and trucks," "blocks," "animals," and "balls."

My son now freely goes to his communication board and, if he wants something badly enough, will come find me in another room and hand me the picture card of interest. These are his favorite picture cards:

In fact, he was requesting to go outside and watch videos so much that I'm now limiting his access to these 2 cards. Per his speech therapist's advice, I put these cards on his communication board only at times when I'm able to take him outside or when I'm okay with him watching a short video. That way, I'm not having to say "no" in his early attempts at using PECS, which could potentially discourage him from making further attempts. Saying "no" will come in a later phase of PECS training. (By the way, if you're training your child to use PECS, I highly recommend purchasing The PECS Training Manual, which discusses in detail how to train your child in each of the 6 phases of PECS.)

After my son became more adept at using his communication board downstairs, we expanded his PECS usage to other areas of our home. For example, I created another communication board and placed it at the top of our stairs. Now, when my son wants to go downstairswhich he often does since there's more to do down therehe can hand me the "go downstairs" card.

our PECS set-up upstairs
close-up of our "go downstairs" PECS card
We were running into a recurring problem at meal time or snack time where my son, strapped into his high chair, sometimes wanted something but I couldn't figure out what, making him very upset. For times like these, I now give him his PECS communication book open to a "menu" of available food options, which has helped.

our "menu"
We've also branched out to using PECS outside of our home, which I'll write about in a separate post.

I hope this post gives you some helpful ideas for how to set up your own home for PECS. If you have any additional ideas, please leave them in the comments section below!

Disclaimer: I am not a speech therapist, and I was not paid to write this post. I just wanted to share some ideas that have been working for my family as I train my son to use PECS. 

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