Tuesday, September 13, 2011

Using Pictures To Help With Beginning Language: Part Two

In part one of this three-part series, I discussed how to help your child learn to give you a picture as a way of requesting something that she wants.  I talked about the first three steps I take to teach a child this skill: 

1. Find a motivating object,
2. Take and print a picture of the object that represents that activity, and 
3. Teach your child to use that picture to request the object.  

So, what next? 

This is where I often deviate from the PECS protocol set out by Frost and Bondy.  At this point, they would recommend teaching a child to cross a distance to exchange a picture with you. They would also recommend teaching persistence; that is, teaching your child to continue attempting to give you the picture, even if you don’t acknowledge him the first time.  I do understand why they include these steps, especially for children with autism, but I will admit that I often skip them and move on to picture discrimination instead. If I find that a child needs it, I will go back and teach crossing distances and persisting later. So, my step four is...

Step 4: Teach your little one to select the right picture. Up until now, you’ve only had one picture out at a time. The next step is to teach her to discriminate between two pictures and select the picture that actually represents what she wants to request. I usually do this in three smaller steps: 
  • Put out a picture of a desired object (e.g., bubbles) and a blank picture; see what she does. If she starts reaching for the blank picture, guide her hand toward the correct picture and help her hand it to you. Do this repeatedly until she starts selecting the desired object picture on her own, consistently. 
  • Put out a picture of a desired object (e.g., bubbles) and a picture of a undesired object (for example, a washcloth--assuming your little one doesn’t groove on washcloths).  If she gives you the picture of the undesired object (the washcloth), hand that object (the actual washcloth) to her. This natural consequence may lead her to the understanding that she needs to hand you the picture of the desired object (bubbles). If not, physically guide her to choose the picture of the desired object and hand it to you. Repeat until she consistently hands you the picture of the desired object.
  •  Put out pictures of two desired objects (bubbles and ball) and give her whichever one she requests via picture exchange.  If she begins to get frustrated, move back to helping her select the correct one.
Step 5: Add in new pictures, one at a time, making sure your child can discriminate among them and pick the one she really wants. If she starts having difficulty, move back to fewer pictures.  

Step 6: Find a place to keep the pictures. Many people keep them in a three ring binder, using Velcro to secure the pictures to pages that are kept inside the binder. This is nice, of course, because the binder is easily portable, and for some people, this is essential. Other people keep the pictures on their fridge, since this is a central location that works well at home, where the pictures are used most often.  There’s no magic place—do what works best for you and your family. 

And that's it! Bondy and Frost recommend many mores steps, and, if you are planning to use pictures on a long term basis, you'll want to check out their recommendations here. But in the short term,  pictures can be a great way to build a bridge to communication, easing frustration for everyone involved.  Good luck!

Looking for more information on using pictures with children? Stay tuned until next week, 
when I post my answers to Frequently Asked Questions about pictures and language. If you have a question now, leave it in the comment section, and I'll do my best to answer it next week! 

Tuesday, September 6, 2011

Using Pictures To Help With Beginning Language: Part One

As a pediatric speech-language therapist, I use pictures to help with language development all the time, in a variety of ways and for a variety of reasons.  I’ve already written about how I turn vacation pictures into photo books to increase vocabulary, grammar and narratives skills.  I’ve also written about how I use pictures to help children learn to use creative two word phrases. Today, though, I’m writing about the use of pictures at a beginning level--to help children request the things they want, using one picture at a time.  This type of picture use, formalized by Frost and Bondy in 1985, is often called the Picture Exchange Communication System (PECS). The idea is simple but powerful: teach children to exchange pictures with a communication partner to allow them to request the things they want.

Many children can benefit from this type of picture use, but the children for whom it is most applicable include children who aren’t yet talking at all or who have a very small vocabulary, children who are very visual learners, children who are (or could be) highly frustrated by their difficulty communicating, and/or children who have a very hard time producing speech sounds.  This means that teaching a child to communicate using pictures is probably the most appropriate for:
  • Children with autism
  • Children who are transitioning to a new language due to international adoption
  • Children with a speech sound disorder, such as severe apraxia of speech or dysarthria
  • Late talkers who are not responding to other types of language facilitation strategies
There is a carefully defined, formal way to teach the actual Picture Exchange Communication System, and you can find it here.   My process is similar, but I am a bit more lax in general, and I take certain liberties to modify the approach depending on the child.  That being said, here’s the general method I use as I work to teach children to communicate using pictures:

Step 1: Find an activity your child loves. And I do mean *LOVES*-- so much that she’s willing go the extra mile to get more of it.  It should also be an activity that is easily started and stopped.  Check out my post on communication temptations for a detailed explanation of how to set up the activity to create lots of opportunities for practicing picture use. 

Step 2: Take a picture of the object your child wants. Laminate it (sorry, Sean—in this case it just has to be done).  

Step 3: Teach your child to exchange the picture to request the object. This is, often, the hardest step.  To accomplish it:

  • Get your child engaged in the activity. Ensure she is interested and motivated. Then stop the activity.
  • Put the picture out next to the object that she wants.
  •  As your little one reaches for the object, gently help her to grab the picture and hand it to you.  Do this as quickly as possible, ignore tantrums, and give her the object she want the minute the picture touches your hands.   The quickly part of this step is very, very important.  At this point, I’m not looking for a child to look at the picture, recognize what it is, or even really understand what is happening. I just want her to tolerate me teaching her to exchange the picture. 
  • Don’t say anything until the picture touches your hand. This can be very hard to do—our natural inclination is to verbally direct the child as we go—“get the picture!” “give it to me!”   So why say nothing? There are two potential problems with using verbal speech to teach your child to exchange a picture with you. First, many children who are learning how to use pictures to communicate simply don’t yet have the receptive language to understand your directions; it will only confuse and frustrate them more. Second, if you  tell your child what to do (“give me the picture!”), your child may become reliant on that verbal direction and will only exchange the picture when you tell them to do so. Instead, we want them to learn to independently go get a picture and bring it to you to request things they want. The physical prompt of helping a child exchange a picture is more easily faded out than the verbal prompt of telling him what to do.  This is most often true for children with autism, so this part is the most important to remember when working with children with autism.
  • Do say the name of the picture the minute the picture touches your hand.  This is a very important step, for all language learners.  At first, children may only learn to exchange the picture with you.  But, if you consistently pair the action of handing the picture to you with the verbal word that goes with the picture, your child will most likely start saying the name of the picture on her own (eventually making the picture unnecessary!).  I have seen this happen more times than I can count….and it is why I do not believe that using pictures with young children prevents them from learning to talk. Instead of being a roadblock to verbal communication, pictures are a bridge.

    Note: This step is most easily done with two people—one adult who holds the object of desire and receives the picture and one who physically guides the child to pick up the picture and hand it over.  However, this can be done with one person- I have done it many times. 

    The key to this step is to do it quickly and repeatedly, until your child learns to hand over the picture on her own. At first, you'll need to help her do the whole thing. After a while, though, you can give her chances to give you the picture all on her own. To do this:

    • Place the picture next to the object she wants and wait. She may reach for it on her own and hand it to you—hooray!  Some children will reach this point very quickly. 
    • However, some children need extra help. You may need to touch her gently on the elbow to cue her to reach for the picture. Or, you may need to help her do the whole thing again.  Do so...and then give her a chance to do it on her own again a bit later.
    • Eventually, with practice and consistency, she will start doing it on her own.  And that’s when you can move to step 4.    

    Looking for step 4?