INTERNATIONAL JOURNAL OF BASIC AND APPLIED SCIENCE

Insan Akademika Publications

P-ISSN: 2301-4458 E-ISSN: 2301-8038 Vol. 01, No. 02 Oct 2012

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Teaching a Non-Verbal Preschool Student to Use a Modified Picture Exchange Communication System: Effects of Fading Prompts on Rate of Communication and Generalization to a Communication Board
Johanna Rauch1, T. F. McLaughlin2, K. Mark Derby3, Lisa Rinaldi4
1

Gonzaga University, East 502 Boone Avenue Spokane, WA 99258-0025 jrauch@zagmail.gonzaga.edu Gonzaga University, East 502 Boone Avenue Spokane, WA 99258-0025 mclaughlin@gonzaga.edu Gonzaga University, East 502 Boone Avenue Spokane, WA 99258-0025 derby@gonzaga.edu

Spokane Public Schools, North 200 Bernard Avenue Spokane, WA 99202 LisaR@spokaneschools.org

Key words
Developmental delays, Fading, Non-verbal child, PECS, Prompts

Abstract:
The purpose of this study was to evaluate the effects of a Picture Exchange Communication System (PECS) and fading prompts to increase rate of communication and to teach generalization to a full communication board. One non-verbal preschool student with multiple developmental delays served as our participant. A combination ABCDEF single case and multiple baseline experimental design was used. A refers to baseline or no intervnetion and the additional letters evaluate the various interventions that were employed. This study demonstrated that PECs and fading prompts was shown to be responsible for increasing both spontaneous, independent communication and correct responses.
2012 Insan Akademika All Rights Reserved

Introduction

Typical toddlers can use spoken language to communicate their wants. However, some children are non-verbal and do not have a functional mode of communication that is easily understood by those who can fulfill their wants. This type of condition can be found across a wide range of ranging from todlers who have autism to those who deaf. As a result, these children can resort to behaviors that they do know how to perform that have worked in the past to communicate and gain attention from people. These behaviors can include, but are not limited to: crying, screaming, and refusals. Many times, these behaviors are understood as problematic rather than communicative in nature, and thus become subjects of behavior interventions to eliminate the behavior (Olney, 2001). Some alternative modes of communication for these non-verbal children are sign language, picture

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exchange systems, and communication boards. It is important for all people to have a functional mode of communication so that their needs can be met as independently as possible (Miller, Light, & Schlosser, 2006). The Picture Exchange Communication System (PECS) is a type of alternative and augmentative communication that gives non-speaking people a mode of communication by using pictures to convey information and messages (Beukelman & Mirenda, 1999; Bondy & Frost, 2001; Stoner, Beck, Bock, Hickey, Kosuwan & Thompson, 2006). Employing PECS has been shown to an effective and functional mode of communication to teach to non-verbal children because it teaches kids the power of communication through requesting, which is meaningful because the student gains access to items--rewards for such communication (Bondy & Frost, 2001; Flippin, Reszka, & Watson, 2010). Sign language could be a functional mode of communication to teach these nonverbal children. However, some non-verbal children have problems learning to imitate (Mirenda & Erickson, 2000). Also, pictures with words, though only two-dimensional representations of real items and situations, are more widely understood than employing sign language (Mirenda & Erickson, 2000). Communication boards are another form of alternative and augmentative communication. They are made up of many pictures (much like the PECS icons) organized on one board (Fitzer & Sturmey, 2010; Mirenda & Erickson, 2000). Makin (1996) reported that it is important for children to have a mode of communication that is appropriate for their development and that the adults who communicate with them use that same mode of communication. With a communication board, the icons are organized on one tool, which allows adults and even other students to easily remember how to access the words on the board. This familiarity with the tool allows the concept of conversation to be developed through adult and child use of the very same tool. Children who are diagnosed with pervasive developmental disorder, not otherwise specified (PDDNOS) have acute developmental delays in the areas of receptive and expressive communication and social interaction or they have stereotypical behaviors associated with other developmental disorders (such as autism) but do not qualify for diagnosis for those other disorders (American Psychiatric Association, 2000; Heward, 2013). Communication can be a huge struggle for many of these children (Fitzer, & Sturmey, 2010; Flippin et al., 2010; Heward, 2013; B. Williams & R. Williams, 2012). Therefore, those who work and care for these types of toddlers need procedures that have been shown to be effective with such children and you in improving their communication skills. The purpose of this study was to teach a non-verbal child to use picture icons to communicate want, snack, and all done by fading prompts. The goal was to increase communication from that child as well as assist that child in generalizing to a communication board that was being used by other students in the classroom. A final goal was to attempt to provide a replication to earlier work demonstrating the efficacy of PECS. 2
2.1

Method
Participant and Setting

The participant of this study was a 3-year and 10-month-old boy diagnosed with pervasive developmental disorder, not otherwise specified (PDD-NOS). He was chosen by the classroom teacher due to his lack of communication. For example, prior to the study, the participant did not use any understandable verbal words with any consistency other than the word no. In the two months prior to the study, the first author worked
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every day in the participants classroom and had only heard the participant say no and on one occasion heard the participant say the word bus. Prior to the study, the participant only had three signs in his repertoire: please, thank you, and all done. The participant struggled with imitation and was having trouble differentiating between the sign for please and the sign for thank you. Other students in the class were using the full communication board, but for this particular student, the classroom teacher and the researcher decided that it would be a better idea to teach the participant a few icons first before presenting the whole communication board which is a stimulus with over 50 icons in a small area. This communication board could be overwhelming to this particular participant who is also considerably cognitively delayed as well as communicatively and socially delayed. Prior to the study, the participant would often play with one item, not engaging in activities with other students. If the participant wanted an item, he would use pointing to ask. During snack, the participant would sit at the snack table without asking for more snacks. If he wanted more, he occasionally moved his cup toward the teacher. If he was done with snack, he would often leave the table without raising his hand and using the sign all done. During transitions or times when he had to work (i.e. craft), he would often scream, whine, say no repeatedly or run from the adult making the demand. The study took place in a self-contained special education preschool classroom. The classroom was located in a public elementary school in an urban city of the inland northwest. This classroom was for children ages 3-6 years old who qualified for services based on developmental delays in one or more of the following areas: social/emotional, cognitive, communicative, physical, or adaptive. The children may also qualify based on a diagnosis that most likely correlates with developmental delays. This preschool classroom housed two sessions, one in the morning (with 10 students) and one in the afternoon (with 12 students). The morning session ran from 9:00 a.m. to 11:30 a.m. The afternoon session ran from 12:30 p.m. to 3:00 p.m.. The participant attended the morning preschool sessions. There were always three adults in the classroom: one teacher and two instructional assistants. During this study there were four adults in the classroom, the teacher, the two instructional assistants, and the researcher, who was also completing her student teaching in this particular classroom. Occasionally, a specialist would visit the classroom for about 40 minutes per session: the speech and language pathologist would visit on Mondays and Thursdays, the occupational therapist would visit on Tuesdays, and on Wednesdays the preschoolers would all go to group physical therapy in the cafeteria. Preschool sessions ran from Monday to Thursday. The study was conducted every day during free play (9:00 a.m. to 9:30 a.m. ) and snack time (11:00 a. M.. to 11:25 a.m. ). The study was mainly conducted by the first and fourth authors with the help of the instructional assistants on occasion for reliability checks.

2.2

Materials

Fig.1: Icons for want, taste, and all done that were developed by the first author for this case report.

Materials included three picture icons, one for want, one for snack (which actually said taste), and one for all done (see Fig.1). These icons were taken from the full communication board that is used in the classroom. The icons were made using computer software called Boardmaker Plus! (Mayer-Johnson, 2009). They were enlarged (to four square inches) and covered with clear tape so that they were more visible,
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tangible, and durable for the use of the participant. Another square piece of white paper with no icon on it was used for differentiation. Other materials included the classroom toys (mostly the buses which were preferred items for the participant) and the snack materials (placemat, napkin, snack food items, a cup, and a bowl if necessary). During the last phase of the intervention, the whole communication board was used (see Fig.2). This board was also made using Boardmaker Plus! (Mayer-Johnson, 2009).

Fig 2: Icons used in the classroom and as part of this study

2.3

Dependent Variables and Measurement

There were two dependent variables that were measured in this study. First was the number of times the participant communicated independently. The second measure was the percent correct responses to prompted communication. These data were recorded using an event recording sheet created by the first author (see Figure 3). An independent or prompted communication with an icon was tallied in 5 minute increments. Each session lasted 15 minutes long (three 5 minute increments).

Data Collection Sheet Session ______________________________________________ Condition ____________________________________________ Primary Data Collector _________________________________ Reliability Data Collector _______________________________ Interobserver Agreement ________________________________ Notes _______________________________________________

Fig.3: Data collection sheet.

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Independent Communication: Student touches appropriate picture to communicate with a teacher or instructional assistant in the classroom without being verbally prompted. Communication with Verbal Prompt: Student touches appropriate picture to communicate with a teacher or instructional assistant in the classroom after being asked a question (i.e. Do you want the bus? You need to tell me. or Are you all done? You need to tell me. or Do you want snack? You need to tell me.) Verbal Prompts: Teacher or instructional assistant says: Do you want the bus? You need to tell me. or Are you all done? You need to tell me. or Do you want snack? You need to tell me. Timing was kept by the first author who used a wall clock. Communication to be recorded was defined as pointing to or handing the proper icon to a teacher or instructional assistant. If communication was initiated by the participant (non-prompted) it was recorded as independent communication. If the researcher prompted a response, the participant had to respond correctly by pointing to or handing the correct icon to an adult within 10 seconds of the prompt. For the want icon, the researchers prompt was Do you want the ______? You have to tell me. For the snack icon, the researchers prompt was Do you want snack? You have to tell me. For the all done icon, the researchers prompt was Are you all done? You have to tell me. In any sessions which included hand-over-hand assistance, each exchange was recorded as a correct prompted response. Data were collected during a total of 46 sessions.

2.4

Experimental Design and Conditions

A combination ABCDEF single case and multiple baseline experimental design was used (Kazdin, 2010). These were the various conditions: A--baseline, B--verbal prompt, model, and hand-over-hand, C--verbal prompt and model, D--verbal prompt, E--verbal prompt with all three icons, F--verbal prompt with whole communication board.

2.4.1 Baseline During baseline the participant sat in front of the proper icon and a blank square piece of paper that was the same size and material as the icon. The two pieces of paper were side by side in random order. The researcher made sure to change the icons placement between sessions. During free play (want icon baseline), the researcher moved the icon and blank whenever the participant moved. If the participant was engaging in play, the researcher would sit next to the participant and prompt a response five times for each 15 minute session. During snack (snack icon baseline), the researcher sat at the center of the table, and the participant sat around the table with the other students. The teacher presented the food items and prompted a response at least five times for each 15 minute session. However, because the participant would frequently finish his portion of snack rapidly, the researcher would often prompt a response more than the minimum five times. At the end of snack (all done icon baseline), the researcher prompted a response at least once for each 15 minute session. Since there is only really one occasion for the participant to request to leave the table after snack, there was not a minimum of five prompts per session.

2.4.2 Modified picture exchange communication system: Phase B Verbal prompt, model, and handover-hand. During phase B, the participant sat in front of the proper icon and a blank. The researcher verbally prompted the response by saying, Do you want ____? or Do you want snack? or Are you all done? then saying, You need to tell me. The researcher then modeled the proper response by saying, My turn and then pointing to the proper icon and saying, I want___ or I want snack or Im all done. Then the researcher would say, Your turn and an IA or the researcher would take the participants hand and physically move it to the proper icon while saying, I want___ or I want snack or Im all done. The participant would then
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gain access to the item or the snack or would then be excused from the snack table. After most proper manding occasions, the researcher would give the participant verbal praise (Good asking or Nice talking).

2.4.3 Modified picture exchange communication system, Phase C: Verbal prompt and model During phase C, the participant sat in front of the proper icon and a blank. The researcher verbally prompted the response by saying, Do you want ____? or Do you want snack? or Are you all done? then saying, You need to tell me. The researcher then modeled the proper response by saying, My turn and then pointing to the proper icon and saying, I want___ or I want snack or Im all done. Then the researcher would say, Your turn and give the participant 10 seconds to respond correctly. If the participant responded correctly, he would then gain access to the item or the snack or would then be excused from the snack table. After most proper manding occasions, the researcher would give the participant verbal praise (Good asking or Nice talking). If the participant did not respond correctly in 10 seconds, the researcher or IA would give hand-over-hand assistance. If this occurred, the researcher did not record it as a correct prompted response.

2.4.4 Modified picture exchange communication system, Phase D: Verbal prompt. During phase D, the participant sat in front of the proper icon and a blank. The researcher verbally prompted the response by saying, Do you want ____? or Do you want snack? or Are you all done? then saying, You need to tell me. Then the researcher would give the participant 10 seconds to respond correctly. If the participant responded correctly, he would then gain access to the item or the snack or would then be excused from the snack table. After most proper manding occasions, the researcher would give the participant verbal praise (Good asking or Nice talking). If the participant did not respond correctly in 10 seconds, the researcher would then model the correct response by saying, My turn and then pointing to the proper icon and saying, I want___ or I want snack or Im all done. Then the researcher would say, Your turn. If this occurred, the researcher did not record it as a correct prompted response.

2.4.5 Modified picture exchange communication system, Phase E: Verbal prompt with all three icons. During phase E, the participant sat in front of all three icons. The researcher verbally prompted the response by saying, Do you want ____? or Do you want snack? or Are you all done? then saying, You need to tell me. Then the researcher would give the participant 10 seconds to respond correctly. If the participant responded correctly, he would then gain access to the item or the snack or would then be excused from the snack table. After most proper manding occasions, the researcher would give the participant verbal praise (Good asking or Nice talking). If the participant did not respond correctly in 10 seconds, the researcher would then model the correct response by saying, My turn and then pointing to the proper icon and saying, I want___ or I want snack or Im all done. Then the researcher would say, Your turn. If this occurred, the researcher did not record it as a correct prompted response.

2.4.6 Modified picture exchange communication system, Phase F: Verbal prompt with whole communication board. During phase F, the participant sat in front of the entire communication board. The researcher verbally prompted the response by saying, Do you want ____? or Do you want snack? or Are you all done? then saying, You need to tell me. Then the researcher would give the participant 10 seconds to respond correctly. If the participant responded correctly, he would then gain access to the item or the snack or would then be excused from the snack table. After most proper manding occasions, the researcher would give the participant verbal praise (Good asking or Nice talking). If the participant did not respond correctly in 10 seconds, the researcher would then model the correct response by saying, My turn and then pointing to the

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proper icon and saying, I want___ or I want snack or Im all done. Then the researcher would say, Your turn. If this occurred, the researcher did not record it as a correct prompted response.

2.5

Reliability of Measurement

Interobserver agreement was taken by one of the instructional assistants in the classroom periodically throughout the study. This was done for about one-third of the total number of sessions (16 of the 46 sessions). Both the first author and the instructional assistant sat or stood near the participant during these sessions. Both also used the same data recording sheet. After the sessions were over, the first author calculated the interobserver agreement which was computed by dividing the smaller number by the larger number and multiplying by 100 so as to get a percentage. Interobserver agreements ranged from 50% to 100% with an overall mean of 93%.

3
3.1

Results
Baseline

During baseline, the participant had an average of 0.1 independent communications per 15-minute session using the PECs during baseline across all three icons. His average percentage of correct responses to verbal prompts was about 24% across all icons.

3.2

Verbal prompt, model, and hand-over-hand

The participants average number of independent communications increased during this phase of the intervention to about 0.6 participant initiated communications per 15 minute session. His average percentage of correct responses to verbal prompts also increased to 100% (since hand-over-hand responses were counted as correct responses).

3.3

Verbal Prompt and Model

The participants average number of independent communications increased during this phase of the intervention to about 0.7 participant initiated communications per 15-minute session. His average percentage of correct responses to verbal prompts also increased from baseline to about 50%.

3.4

Verbal Prompt

The participants average number of independent communications increased during this phase of the intervention to about 1.3 participant initiated communications per 15-minute session. His average percentage of correct responses to verbal prompts also increased to about 53%.

3.5

Verbal prompt with All Three Icons

The participants average number of independent communications decreased a little during this phase of the intervention to about 1.2 participant initiated communications per 15 minute session. His average percentage of correct responses to verbal prompts stayed at about 53%.

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3.6

Verbal Prompt with Whole Communication Board

The participants average number of independent communications increased during this phase of the intervention to about 2.1 participant initiated communications per 15-minute session. His average percentage of correct responses to verbal prompts increased in this phase to almost 71%.

Fig.4: Number of Independent Communications per 15 Minute Session

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Fig.5: Percentage of Correct Responses to Prompted Communication per 15 Minute Session

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Discussion

There have been benefits to this study even beyond the increase in independent communication and correct responses to prompted communication. The participants behavior has notably changed during free play and snack. During free play, the participant seeks out play with other peers much more frequently. He used to play alone and often with the same toy throughout free play before this study was conducted. He has also more frequently sought out the researcher during free play, using eye contact, physical touch and often vocalizations. During snack, the participant makes eye contact with the teacher more often and raises his hand more frequently to initiate the process of manding for snack. Also, during the generalization portion of the study (with the whole communication board), the student began pointing to and asking for drink at the snack table as well. These benefits were not recorded as data, and may not serve as functional products of the intervention. However, the change was a welcome and noticeable one for the adults in the classroom. This case would have been more powerful and conclusive if data were gathered for more time and employed more participants. For example, we only employed a male participant, so our results would have had more power if both a male and female participant had been employed. However, the findings of this study did serve to demonstrate that the use of PECS and the systematic fading of prompts are effective for increasing communication across different demographics, settings, and instructors. Also, this study could have had better results for this particular participant if there had been more opportunities for him to communicate with the all done icon. Given that it was used at the end of snack, when only one communication was needed to escape the demand of the snack table for each session, the failed to experience the correlation between touching the icon and escaping a demand. The hope for our participant is that through more experience and use of the full communication board, he will have more access to independent and functional communication that matches his current abilities. The results of the final phase of the intervention have shown that at the end of the study, the participant had the emerging skills that were necessary to be able to generalize to a full communication board. The classroom teacher had been planning on using the full communication board with the participant for a couple months prior to the beginning of the study, but had not had the opportunity to create one for him. By the end of the study, the first author had just finished making a usable full communication board for the classroom teacher to use with the participant in the near future. By request from the participants parents, the classroom teacher had also made plans to help the parents gain access to a full communication board for the participant to have at home which to match the one in use at school.

Conclusion

This study demonstrated that using PECS and systematically fading prompts can be an effective method for teachers, parents, and other care providers wishing to increase both spontaneous, independent communication and correct responses to prompted communication. The present reported outcomes replicate and extend the use of PECS to increase communication (Flippin et al., 2010; Miller et al., 2006; Stoner et al., 2006).

Acknowledgement
This research was completed in partial fulfillment for the requirements for an endorsement in Early Childhood Special Education from Gonzaga University and the State of Washington. Requests for reprints should be addressed to jrauch@zagmail.gonzaga.edu or mclaughlin@gonzaga.edu

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References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders DSM-IVTR (4th ed). New York: American Psychiatric Publishing. Beukelman, D. R., & Mirenda, P. (1998). Augmentative and alternative communication: Management of severe communication disorders in children and adults (2nd ed.). Baltimore: Paul H. Brookes Publishing Co. Bondy, A., & Frost, L. (2001). The picture exchange communication system. Behavior Modification, 25, 725744. Fitzer, A., & Sturmey, P. (2010). Language and autism, applied behavior analysis, evidence, and practice. Austin, TX: Pro Ed. Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the picture exchange communication system (PECS) on communication and speech for children with autism spectrum disorders: A metaanalysis. American Journal of Speech-Language Pathology, 19, 178-195 Heward, W. L. (2013). Teaching exceptional children: An introduction to special education (10th ed.). Upper Saddle River, NJ: Pearson Education. Kazdin, A. E. (2010). Single-case research designs: Methods for clinical and applied settings (2nd ed.). New York: Oxford Press. Makin, L. (1996). Quality talk in early childhood programs. Journal for Australian Research in Early Childhood Education, 1, 100-109. Retrieved from ERIC database Mayer-Johnson (2009). Boardmaker plus! (Version. 6). Pittsburg: DynaVox Mayer-Johnson. Mirenda, P., & Erickson, K. A. (2000). Augmentative communication and literacy. In A. M. Wetherby & B. M. Prizant (Eds.), Autism spectrum disorders: A transactional approach (pp. 333369). Baltimore: Paul H. Brookes Publishing Co. Miller, D., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A literature review. Journal of Speech, Language, and Hearing Research, 49, 248-264 Olney, M. (2001). Communication strategies of adults with severe disabilities: Supporting selfdetermination. Rehabilitation Counseling Bulletin, 44, 8794. Stoner, J., Beck, A., Bock, S., Hickey, K., Kosuwan, K., & Thompson, J. (2006). The effectiveness of the "picture exchange communication system" with nonspeaking adults. Remedial and Special Education, 27, 154-165. Williams, B. F., & Williams, R. L. (2012). Effective programs for treating autism spectrum disorder: Applied behavior analysis models. New York: Routledge.

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