Augmentative and Alternative Communication
(Picture Exchange)
(Picture Exchange)
Augmentative and Alternative Communication programs (or AACs for short) can serve a lot of different populations with many different needs. Essentially, should a person not be able to speak for whatever reason, they can use an AAC to get their needs met in a different way. AAC devices can be low-tech (using pictures or letters that a person can point to or exchange) or high-tech (using highly sophisticated technology--think Stephen Hawking)
Picture exchange is a one AAC system which uses pictures instead of words. While most people are able to use words to communicate, some children and adults have difficulty producing words. For these people, using pictures is the easiest, broadest way to communicate. I have seen both kids and adults' language improve using some sort of picture communication and love seeing their amazing progress from non-communicative to being able to say exactly what they want.
From the PECS (Picture Exchange Communication Systems--a picture exchange method) website, "PECS begins by teaching an individual to give a picture of a desired item to a “communicative partner", who immediately honors the exchange as a request. The system goes on to teach discrimination of pictures and how to put them together in sentences. In the more advanced phases, individuals are taught to answer questions and to comment."
Picture exchange is incredible for so many groups of people. There are children who are speech delayed who will eventually learn to speak, but just need some help getting their needs met while they develop their spoken language skills, children who will use picture exchange throughout their lives, and also those who use picture exchange as a stepping block to a more technology-driven AAC device. A few quick examples:
Picture exchange is a one AAC system which uses pictures instead of words. While most people are able to use words to communicate, some children and adults have difficulty producing words. For these people, using pictures is the easiest, broadest way to communicate. I have seen both kids and adults' language improve using some sort of picture communication and love seeing their amazing progress from non-communicative to being able to say exactly what they want.
From the PECS (Picture Exchange Communication Systems--a picture exchange method) website, "PECS begins by teaching an individual to give a picture of a desired item to a “communicative partner", who immediately honors the exchange as a request. The system goes on to teach discrimination of pictures and how to put them together in sentences. In the more advanced phases, individuals are taught to answer questions and to comment."
Picture exchange is incredible for so many groups of people. There are children who are speech delayed who will eventually learn to speak, but just need some help getting their needs met while they develop their spoken language skills, children who will use picture exchange throughout their lives, and also those who use picture exchange as a stepping block to a more technology-driven AAC device. A few quick examples:
- A 2 1/2 year old child with a speech delay who has only a few words (up, go, and car) could use PECS to ask for different kinds of foods, toys, and activities while he builds up his spoken language vocabulary. This will help this child learn that when he communicates he is able to get what he wants, it reduces frustration for both the child and his parents and caregivers, and it helps provide multiple opportunities for language stimulation while using the picture during exchanges.
- An 8 year old with severe autism with no spoken language and few readable gestures. Picture Exchange will allow this child to communicate basic needs and request preferred objects and activities (like apples or computer time). This communication skill may be used to help eliminate dangerous or destructive tantruming behaviors or self-harm behaviors as it removes frustration.
- A 5 year old child with cerebral palsy who has age-appropriate receptive language skills, but cannot communicate verbally might use picture exchange as a precursor to using a speech generating device.
In a picture exchange system, a child or adult would present a communication partner a picture to express their want. For example, if a child gave me a picture of an apple, I would know that they wanted an apple. As a bridge to spoken language, in therapy, I would also incorporate spoken language and gestures to ensure a multi-modal approach to language. A script of how an exchange might take place is as follows:
Child takes apple picture out of picture book
Child gives apple picture to clinician
Clinician helps child point to the picture, "Oh, you want an apple."
Clinician holds up apple, "I want apple."
Clinician gives apple to child, "Here's your apple."
Child takes apple
Please notice that in this example, the child exchanged the picture, heard the word "apple," and saw the real apple. We've used three senses to communicate (touch, hearing, and sight), received three different expansions of the word apple, and the child successfully communicated!
Typically, someone using picture exchange would have a book of pictures of objects and activities. Depending on the language abilities of the user, one person might only have one or two pictures to choose from but another might have 600 pictures to choose from. Additionally, depending on the language abilities of the person, other grammar principles might be used including nouns, adjectives, adverbs, etc.
Typically, one would start with one picture exchanges (the "waffle" picture gets you a waffle) then increase to two pictures ("I want" and "waffle" would get you a waffle), then additional pictures and concepts (I want a big, green waffle quickly).
For some users, as you increase the number of pictures, they decide that talking really is faster and the picture exchange is just a bridge to using spoken language. Picture exchange in this sense is fantastic because some users start getting the concept that if they say (or exchange), "grape," they give me a grape. They start to understand that they can manipulate the world around them.
Because Picture Exchange allows children to communicate their desires, it can help tantrums and increase socialization opportunities. (Reference) Imagine taking a 7 year old child who cannot speak on a field trip to the zoo. What do they want to see? What animal do they like best? When you eat your lunch, what do they want to eat first? How will they tell their friend their favorite part? Does their friend want their apple? Think about all of the things that we think and communicate all day long. That same child without picture exchange may not be able to communicate or socialize with anyone all day long. With picture exchange, that child may be able to answer all those questions to not only their teacher, but also the friends from their class. Think about that child returning to it's mom at the end of the day. Can you imagine how happy that mother would be if she could ask a question about what her kid saw and that kid could answer with even one picture?
There are informal picture exchange programs and also formal programs of picture exchange like PECS (Picture Exchange Communication Systems) which require specialized training in order to be able to properly utilize. Typically in my therapy, I use a more informal approach, unless I think that the child and parent really need a more rigorous program. Meta-analysis has shown that that utilization of PECS is promising in therapy and can result in gains for children with autism. (Reference)
One last note, parents frequently ask me about using sign language instead of picture exchange when their child is speech delayed, but the problem with sign language is that when you communicate through sign, you need someone to communicate with and you need to be able to produce the signs accurately. If your community and support system is willing to learn sign to help your child, sign can be an amazing communication method. Parents should be sure to teach signs for specific objects and be careful not to use one or two signs for everything (For example, make sure to teach "cracker, juice, hot dog, carrot, and bubbles" instead of only using the sign "more" to request additional food or play. Another example is using the sign for "please" to mean, "please give me some food," "please let me play," "please let me stay up late," and "please let me wear the blue shirt")
References
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