Case Study in Neurodiversity-Affirming Care: A Toddler with Childhood Apraxia of Speech
At the beginning of the evaluation, Adam appeared to enjoy playing with zoo animals with mom and the therapist. He laughed and smiled readily and paired gleeful, albeit, infrequent, babbling with gestures like pointing and guiding his mom’s hands to the toys he wanted her to play with. However, after a few misunderstandings in which neither mom nor the therapist could figure out what Adam was gesturing for them to do, Adam became highly frustrated and emotionally dysregulated. He threw himself to the floor and, in between sobs, began to bang his forehead on the floor repeatedly. His mother was worried that this self-injurious behavior had started happening more and more frequently in recent weeks.
Why We Model Language and Honor All Communication, instead of Using PECS®
Today in a virtual Zoom therapy session, the parent asked me why I don’t use PECS® in speech therapy (with non-speaking or minimally speaking Autistic children). After watching her child laugh, dance, and have fun during therapy, after watching them imitate action verbs, and spontaneously communicate a desire, spontaneously point to my assistant and me on the screen, and smile at us all, it became clear to this parent that there are different kinds of therapy sessions. This kind isn’t all about compliance.
AAC: The Big Myth
It is so important that we start with the presumption that the person is a learner! Learning takes time and sometimes a good amount of patience. Always presume they are on their way to developing competence in learning this new language.
The Problem with PECS®
PECS® uses Operant Conditioning, which is a behavior technique that can be used to target and increase a behavior by pairing performance of the target behavior with a positive or rewarding outcome. Per Andy Bondy, inventor of PECS, “Skinner’s analysis of Verbal Behavior forms the basis for teaching particular skills at specific points in the training sequence and also provides guidelines for how best to design the teaching strategies.” PECS uses picture-based prompting and reinforcement tied to error correction in order to teach language skills. The method allows the trainer to artificially cause frustration through the withholding of highly desired objects or food until the targeted behavior is achieved, even if the communicator becomes upset or angry. It is not a natural or nice way to teach language.