Monthly Archives: February 2019

Picture Exchange Communication System: Is PECS appropriate for my child?

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When people think of communication, they often think of verbal communication. However, communication is not limited to one modality. In fact, communication can occur through a variety of modalities: verbal exchanges, written exchanges, facial expressions, gestures, sign language, etc. Picture exchange is another modality through which people can communicate. To capitalize upon this modality, Picture Exchange Communication System, or PECS, was created as a leading therapeutic technique for children who cannot yet verbally communicate.

As a pediatric speech-language pathologist, I often come across the question from parents, “Is PECS appropriate for my child?” Let’s dive into what PECS is, how it works, and for whom it may be appropriate.

What is PECS?

Picture Exchange Communication System (PECS) is a form of augmentative and alternative communication (AAC) that allows people to communicate using pictures. Although PECS contains a formal protocol that systematically moves through six phases of communicative exchanges, the method of picture exchange can be modified to meet the needs and skill level of the child.

How does PECS work?

  • Children using PECS are first taught a cause-effect relationship between pictures and communication. In other words, they learn that when you give a picture, you receive something in exchange.
  • Children are then taught to use pictures to communicate with different people across a variety of environments.
  • After the basic communicative exchange is established, the child learns to discriminate between multiple pictures in order to request specific objects or activities.
  • Pictures can then be combined to communicate phrases and sentences of increasing complexity, such as “I want ___.”

Who benefits from PECS?

PECS is often recommended for children who do not yet have a means of verbal communication. For PECS to be effective, however, the child must be motivated to communicate, as PECS relies upon the child initiating communication exchanges by giving pictures to another person. PECS also requires that child must have the cognitive skills to understand the cause-effect relationship between giving a picture and getting something in return. Therefore, a child who does not yet understand the cause-effect nature of a basic communicative exchange would be an inappropriate candidate for PECS until this skill emerges.

Myths Debunked

  • PECS is only for people who won’t learn to talk: The use of PECS does not imply that the child will never learn to use verbal language. In fact, the use of PECS can facilitate verbal communication by providing children with an outlet to reduce frustration and establish early communication skills.
  • PECS is only for people with Autism: PECS is frequently recommended for children with Autism Spectrum Disorder due to deficits in expressive language and social communication. However, recommendations of PECS should be child-specific and may or may not be appropriate for any child who does not have a means of verbal communication.
  • PECS only targets requesting: As a child moves through the PECS hierarchy, they can learn to use pictures for different functions, including requesting, answering questions, and ultimately, commenting independently. PECS involves high priority vocabulary to teach children that they can expand their expressive vocabulary to meet their wants and needs.

Questions or concerns?

If you have questions or concerns about whether PECS is appropriate for your child, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

References:

Bondy, A. (2001). PECS: Potential benefits and risks. The Behavior Analyst Today, 2(2), 127.

Vicker, B. (2002). What is the Picture Exchange communication System or PECS?.

Photo Credit: sitemaker.umich.edu

Teaching Play Skills to Children with ASD

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Pretend play can often be very difficult for children with autism spectrum disorder (ASD) because it directly impacts their ability to develop and understand social skills along with communication skills. Play skills are necessary for children to establish and create meaningful relationships with peers and understand the world around them. This blog will help provide some information to help engage your child with ASD while learning new foundational and essential play skills.

Where do I start?

Just like every child is different, every child with autism is different. It is important to understand your child’s strengths and weaknesses. Before introducing new unfamiliar activities with your child, make sure your child is at a ready-to-learn and regulated state. This means your child is demonstrating a calm body and is ready to play. It is important to reinforce eye contact and joint attention while playing with your child to help increase their engagement skills. Your child’s skill level, attention span, and interests will determine and help guide you in the right direction to begin introducing new unfamiliar play. Begin where your child is at and remember to slowly build on their current level of understanding and skill. If your child resists the new play, begin new play schemes with some of your child’s favorite games or toys. Remember, all children learn by repetition and benefit from having a model or demonstration with how to the use objects appropriately.

Sensory Play

Sensory activities include activities that stimulate our senses, whether in a positive way or a negative way using all our senses: taste, sound, visual, tactile, and smell. These different textures, colors, smells, taste, and experiences impact the way you experience the world around you. Sensory-based activities help children become engaged and focus on the activity presented. These activities can improve attention span, increase flexibility and exposure to new items, and help self-regulation. Please use caution when implementing new sensory items with your child and notice for any aversive or negative reactions.

  • Music is a great way to engage any child! Fingerplays (e.g. “Wheels on the bus”) and dancing improve your child’s attention span, imitation skills, and gross-motor coordination.
  • Water, whether it’s outside when weather appropriate or in the bathtub all year round.
  • Play-Doh (roll, squish, animal shapes)
  • Waterbeads (fill and dump, have animals swim)
  • Sand

Functional Play

Functional play is the child’s ability to use objects as they are intended and expected (e.g. block to build). Use cups to fill up and dump the water/waterbeads in the bathtub or a car to drive across the sand. Use the blocks to build a tower and crash them. Provide hands-on assistance and a demonstration if your child does not use the object functionally.

Pretend Play

Pretend play or symbolic play is when a child uses a realistic item or non-realistic item as something else (i.e. using play food or a spoon as a toothbrush). Use animals in the bathtub to walk across the tub and use the sounds associated with each animal. Once your child has mastered the play imitation skills, expand upon this play and encourage your child to have the animals go down the slide in the bathtub. Use their favorite stuffed animal during meal times and encourage your child to “feed” their animal. Continue the child’s bedtime routine with their favorite animal, while you demonstrate and explain what you are doing with your child and their animal.

Questions or concerns?

If you have questions or concerns about your child’s play skills, please contact us at info@playworkschicago.com or 773-332-9439.

Kelly Scafidi, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

Reference: The Australian Parenting Website (2017). Play and children with autism spectrum disorder.

Retrieved from: raisingchildren.net.au/autism/school-play-work/play-learning/play-asd.

Photo Credit: rawpixel via Unsplash.com

Gender Differences in Autism Spectrum Disorder (ASD)

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Are girls with autism being missed?

A growing body of evidence supports the hypotheses that autism spectrum disorder (ASD) is being underdiagnosed or misdiagnosed in girls. Why might that be? And how could that affect your child? We will delve into a few of these issues in this blog post.

First, an overview of autism spectrum disorder.

What is ASD?

ASD is a biologically based, neurodevelopmental disorder. Meaning, autism is a disorder present at birth that affects how the brain develops. Individuals with ASD often display behaviors that are repetitive in nature and have difficulties participating in social situations. Autism is characterized as a “spectrum disorder” because it presents differently in each individual, causing the symptoms to vary in type and intensity. The current prevalence of autism is 1 in 68 children. Autism is more prevalent in boys, presenting with a ratio of four boys to every one girl with autism spectrum disorder.

Red Flags:

Potential signs of ASD that you might notice in your child are outlined below.

  • Your child does not use gestures to communicate, such as pointing, clapping, or nodding their head
  • Your child does not use a combination of eye contact, gestures, sounds, and words to communicate
  • Your child has a delay in speech and language skills
  • Your child does not imitate actions, sounds, or words that they overhear
  • Your child does not respond when you say their name
  • Your child has sensory differences, including over- or under-sensitivity to certain sounds, textures, smells, etc.
  • Your child has unusual ways of moving their hands or bodies
  • Your child has significant difficulty with transitions
  • Your child does not play with, or similarly to, other children their own age

The red flags outlined above may indicate a difference in your child’s development. If your child exhibits one or more of the red flags mentioned above, it does not necessarily mean that they have autism spectrum disorder. For example, not responding to their name could be due to a potential hearing loss. It is recommended that you discuss any concerns regarding red flags with your child’s medical team, including their pediatrician and therapists.

So, Girls:

Why are they being missed?

As mentioned above, professionals in the field have begun to discuss this issue of underdiagnosis or misdiagnosis of ASD in girls. One potential area of difficulty is that assessments commonly used to diagnose ASD are based on data collected from the general population of children with autism, which consists of more boys than girls. That means the tests are less sensitive to detecting girls with ASD. Girls with well-known or easily understood symptoms will likely not be missed, but those that present with less obvious red flags may be. As ASD is less common in girls it might not be the first diagnosis that comes to mind, especially if symptoms are less severe. Although girls may and do exhibit some of the red flags outlined above, it can present differently or less obviously in girls. It is also common that girls are intrinsically more socially motivated, so symptoms of social communication difficulties may be less obvious.

What does it look like?

A few more specific signs of ASD that you might notice in girls are outlined below.

  • Your child has interests that are age-appropriate but very intense
  • Your child plays with toys in a “pretend” but repetitive manner
  • Your child displays sensory differences, but might begin to hide these as they get older
  • Your child has extreme reactions to change or transitions
  • Your child is exhausted after social interactions
  • Your child has difficulty making or keeping friends
  • Your child has difficulty with conversational skills, such as topic maintenance and turn taking
  • Your child may internalize their emotions, resulting in anxiety

How does this affect your child?

The slight variation in type or intensity of red flags in girls may cause them to be diagnosed with something other than autism spectrum disorder, such as an anxiety disorder or a language disorder. The misdiagnosis results in recommendations that may be less appropriate or encompassing of symptoms and may result in your child missing out on early intervention strategies to support their development.

What can I do? 

If your child is demonstrating the behaviors above, or any general red flags for autism spectrum disorder, consider following up with your child’s therapist or pediatrician. Although individual speech-language therapists cannot provide a diagnosis of autism spectrum disorder, they can make appropriate referrals for testing and possible diagnosis.

Questions or concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

Ana Thrall Burgoon, M.S., CCC – SLP 
Speech-Language Pathologist

References:

Bartley, Janine. “Autism Spectrum Disorder.” Grand Valley State University, 4 Dec. 2018, Grand Rapids. Lecture.

Rudy, L. (2018, December 4). Symptoms of Autism in Girls . In VeryWell Health .

Volkers, N. (2018, April). Invisible Girls. The ASHA Leader, 23(4), 48-55.

Photo Credit: Photo by Jens Johnsson on Unsplash