School Has Begun!

Can you believe that we have been in school for one week now!! Dalton has started in his new program the Transtition Autism Program in Clover School District and is doing wonderfully. His teacher emailed me the other day and said that he is imitating sounds at school constantly and is generalizing a lot of his handwriting skills from this summer to school. Before long, Dalton will be passing out his signature! :-) Private speech therapy has provided us with symbols they want us to use to help visualize the sounds that we are requesting from Dalton. We are continuing to work on blending 2 to 3 sounds together at a time. We have been playing it by ear to help determine how much is too much for Dalton. With him going to school all day and then getting therapy in the evenings, we are trying to see how much this little boy can withstand with therapy hours. We don't want to overload him too much- afterall he is a kid! :-) We lost another therapist this week. Girls move on to bigger and better things in life, but it is always hard to lose a good one! If you know of anyone that is interested in being trained to learn how to do ABA please let us know!! SCEAP has provided us with a new service coordinator that we are all excited about. We will meet this Saturday to talk about Dalton's new goals. He is mastering skills pretty quickly. He still struggles with receptive and expressive langauge skills. He is doing 15 piece puzzles, block designs off the card, sorting nonidentical pictures into categories, simple games, and ANYTHING IMITATION!! We just hope to have a break through in his language. He is looking at you so much better and making sounds just trying to tell you something, but he just can't quite form the sounds and do it spontaneously. However, he is spontaneous with using his pictures. He knows what he wants and will move heaven and earth to get the particular item he is demanding! If for some reason, we don't have the picture available he will take your hand and put you on it and let you know which one he is demanding. Mom and Dad are doing a much better job of limiting his video intake! Sydney, Dalton's older sister, has learned some simple things to do with Dalton at the table and in play. We are trying to encourage Sydney to get more involved with his play and help him at home. She seems to love it- you don't want to force the issue with sibilings, especially when they are 11! :-) I think she will make a wonderful little therapist one day, but again never force it with siblings! I found it is best to let them come to it on their own and embrace it in their own way.

I thought I would give you all an idea of how we began PECS. Dalton is obviously much farther along now, but just thought I'd paint a picture of how to begin a PECS program if you are trying to do this on your own!

Dalton

Goal: Utilizing PECS, Dalton will spontaneously initiate communication.

Overall: PECS is an approach that teaches the child to give a picture for a desired item to a communicative partner in exchange for that item. Pointing is discouraged, because pointing does not require an interaction with a person. We want the child to gain attention with someone by making a request! We want them to initiate that social interaction, so we create an environment that teaches them how to do that. PECS has many steps, so I broke it down into the different phases.


PHASE 1

Goal: Upon seeing a highly preferred item, Dalton will pick up the picture of that item and reach toward the communication partner and release the picture into the partner’s hand. At this phase, it is not important for Dalton to look at or identify the picture the yet! We just want him to get the jist of take picture, give picture, receive item.

No verbal prompts are used during this phase. We DON”T want Dalton to pair “ Do you want”, “What do you want” or “Give me the Picture” with the giving of a picture. We want him to learn that he can initiate it without that verbal prompt! THIS IS SO IMPORTANT!! This is where PECS can fail quickly! Don’t pair your words with his actions. You want him to be spontaneous and not discourage his language initiation. We want to teach him to ask for it.

BEFORE BEGINNING PECS:
Identify all the objects, foods , activities, places, books, movies, games, people that the student is interested in. Avoid picking only one activity because it is important that the child learn to communicate in all activities.
Develop some sort of representation of this item: photograph, PECS (computer made) , cartoon drawing, etc.
Identify the activities that you want to begin training in.
Reminders:
Two trainers are required to teach initiation.
Present one picture at a time.
Don’t conduct training with in the same setting – vary locations.
Allow for 30 – 40 opportunities throughout the day for Dalton to request.

Use different types of reinforcers – toys, food, activities, etc.
Use PECS naturally throughout the day- not necessarily during “therapy”!

That said, there are two ways to make PECS work. I have listed them both below with the breakdown and you do what you think will work with Dalton and what help you have. Two therapist will be done in the first phases of PECS, and there after you will be doing it alone.
TWO THERAPIST : How It Works
Dalton and two trainers are in a common area, often seated, though not necessarily so. One trainer (the communicative partner) is in front of Dalton. The other trainer (the physical prompter) is in back of the student. A “highly preferred” item is held by the communicative partner out of reach of the student. The picture of the item is on the book (which is on the table or floor, etc.) between Dalton and the communicative partner.

Communicative Partner’s Responsibilities:
Entice Dalton
Reinforce Dalton’s exchange – Give her the wanted item with in ½ second
Pair social praise with the tangible reinforcement
Time the open hand appropriately (don’t accidentally prompt by having open hand out before she hands picture to you)

Physical Prompter’s Responsibilities:
o Wait for Dalton’s initiation
o Physically prompt Dalton to exchange the picture
o Systematically fade prompts (steadily fade all prompts via backward chaining so that Dalton performs the desired behavior independently)
o No social interaction with Dalton such as providing reinforcement


Target sequence: pick upà reach à release

This is not teacher-led training – Dalton goes first!
Dalton reaching or trying to get the item is “going first” behavior.

“First One’s Free” strategy:
Use to quickly assess the current value of the item
Offer a bit or let her play with the item a few seconds – if she does, assume the item is still reinforcing.


The communicative partner “entices” the student by showing her the powerful reinforcer. Both trainers must wait for Dalton to reach for the item—this is Dalton’s initiation!! AS Dalton reaches for the item, the physical prompter immediately physically assists Dalton to pick up the picture, reach to the communicative partner’s open hand. The communicative partner opens her hand to receive the picture ONLY AFTER Dalton has reached. The moment Dalton releases the picture into the communicative partner’s open hand, she immediately gives the student the reinforcer and praises (“Goldfish!!!”)

If the student is requesting a toy, allow him to play with it for 15 – 20 seconds before calmly taking it back and beginning the next trial.
ONE THERAPIST : How It Works
1. When you see Dalton reaching for the desired item, take that time to work on the exchange. I know its hard sometimes to get Dalton interested, but there are ways to tempt him.
Create many opportunities for communication.
Identify what Dalton is likely to want given the current activity
Arrange for that item to “disappear” long enough to begin to need or want that item.
Communicative temptations:
Eat a desired food in front of Dalton without offering any.
Activate a wind-up toy, let it deactivate, and hand it to Dalton.
Open a container of bubbles, blow some, close the container and give the container to Dalton. Blow up a balloon and slowly deflate it; then hand it to Dalton or hold it up to your mouth and wait.
Make sure these opportunities occur within all activities.
2. Allow the child to engage in the activity for a few seconds then stop the activity
3. Sit directly in front of the student and have the picture placed right in front of him.
4. Hold the desired item with one hand enticing the child with the item.
5. , When Dalton reaches for the item ***DALTON REACHES, it is student intiatied!!! **** immediately and without saying anything or offering any reinforcement hand over hand prompt him to grab the picture and place it in your hand.
6. AS SOON AS Dalton releases the picture into your hand, you label his action like “ Goldfish or you want to bounce”
7. As you are labeling the item give him the item he has requested. There should be no more than ½ second in between him giving you the picture and receiving the item! Continue labeling it as he is playing with the item!
8. After a few seconds take away the item and the practice the exchange a few more times. NEVER do this more than 10 times. You want the child to still prefer the item and not discourage their interest in that item.
EXPECT Communication.



This is Dalton’s communication device. Leave the pictures in their locations. All therapist, as well as Brigitte and Strait are using these with Dalton so we have to stay organized!!

NEVER make Dalton place his picture back after he gives it to you. We can’t take back our words, so don’t make Dalton replace his words right now. This is his language, treat it as such. This program will evolve over time. Phase 1 will last as long as we need it too, but no longer!! You HAVE to move on quickly and accordingly. Again, this will take shape over time. This is just how to jumpstart it for him.


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Hope this gives you some ideas. Feel free to comment or email us with questions.

More to come,
Lesslie