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.

After the session I sent the following letter:

Dear Parent,
It was a pleasure working with you and XXX today. Below (at the bottom) is the link to the article about why PECS® is problematic.  I don’t use PECS® in therapy because ABA – Applied Behavioral Analysis (withholding foods, drinks, personal objects, or activities in order to motivate someone’s behavior) is disrespectful to Autistic children. It causes frustration and meltdowns. ABA is basically all about increasing compliance. XXX is compliant when he is able to be compliant.

Kids do well when they can. ((k0811gre.pdf Ross Greene, Kids Do Well If They Can, Phi Delta Kappan, Vol. 90, No. 03, November 2008, pp. 160-167.))  If XXX had the ability to communicate everything he wanted to, he would already be doing so. The way we teach communication is to model it (naturally in the context of the student’s daily activities) while honoring and accepting all of the child’s communication attempts (verbal, AAC, gestures, sign, behavior) as valid. Then we expand their communication attempts by modeling the language for them. Rather than using the PECS® and withholding things from XXX, I have attached several small pdfs which will help you understand how to model language using AAC in a natural context. ((https://www.theaaccoach.com/free-downloads))

When we interact with Autistic children, we honor all communicative attempts, including:
Don’t withhold the bubbles until he says “bubbles.” Give him the bubbles and model the language in a natural context.
Research to support modeling language in a natural context via AAC, rather than using PECS® (outdated and disrespectful):

“Aided modeling interventions share several components: (a) they are implemented during opportunities that arise out of natural contexts, (b) they augment the spoken input the child receives, and (c) they employ modeling to expand vocabulary.” ((Kathryn, Drager. (2009). Aided Modeling Interventions for Children With Autism Spectrum Disorders Who Require AAC. Perspectives on Augmentative and Alternative Communication. 18. 114. 10.1044/aac18.4.114.))
https://pubs.asha.org/doi/abs/10.1044/aac18.4.114

“A systematic review of research on the effects of interventions that include communication partner modeling of aided augmentative and alternative communication (AAC) on the language acquisition of individuals with complex communication needs was conducted. Included studies incorporated AAC modeling as a primary component of the intervention, defined as the communication partners (a) modeling aided AAC as they speak and (b) participating in the context of a naturalistic communication interaction. This review used a best-evidence approach, including nine single-case studies, with 31 participants, and 70 replications, and one quasi-experimental randomized group design study, including 63 participants. The results of the review indicated that AAC modeling intervention packages led to meaningful linguistic gains across four areas including (a) pragmatics, marked by increases in communication turns; (b) semantics, marked by receptive and expressive vocabulary increases; (c) syntax, marked by multi-symbol turn increases; and (d) morphology, marked by increases in target morphology structures.” ((.Sennott SC, Light JC, McNaughton D. AAC Modeling Intervention Research Review. Research and Practice for Persons with Severe Disabilities. 2016;41(2):101-115.doi:10.1177/1540796916638822)) https://journals.sagepub.com/doi/abs/10.1177/1540796916638822

Here is a free AAC app for iphone. They may have it available in other formats as well. 
https://apps.apple.com/us/app/letmetalk/id919990138

PECS® is about compliance, not communication. If the child doesn’t say the word, then the things that he wants are withheld from him, which causes frustration and anger. Sometimes it results in a meltdown because he is overwhelmed and feels that his communication attempts are being ignored.  We can use pictures paired with words to increase his communication without making him earn things. We can model the language while showing him the picture cards or the picture on the iPad. 

Quick examples for to how to model AAC throughout the day:

Respectful and empathetic therapy does not force compliance through the earning of snacks, check-marks, behavior charts, stickers, access to favorite or personal items and objects, activities, or similar. Respectful therapy does not include aversion therapy (punishment) for any situation, including withholding attention or affection, favored foods, activities, or objects. We don’t train human beings like parrots (“Say the word and get a cracker”).

XXX will gain more language skills. It will take some time and lots of modeling while interacting with him in a natural way every time he tries to communicate (verbally, body language, behavior, sign, and AAC), but today I already see that he knows so much more than what standardized testing showed (prepositions and verbs, for instance). Today was a wonderful session. ?

PECS article – The Problem With PECS
https://therapistndc.org/the-problem-with-pecs/

I look forward to seeing you soon in another session.
– Julie

(Then I downloaded virtually EVERY SINGLE PDF handout from The AAC Coach and attached them to the email.)

A Couple of Sample Goals – Targeting Language using Spoken Language and/or AAC

1) When provided with low-tech AAC pictures paired with words or core vocabulary from an AAC app on an iPad, the student will self-advocate for personal needs (such as restroom; asking for help with wiping nose; help with schoolwork; indicating sensory distress and/or being overwhelmed; asking for a drink of water or food item; asking for a break.)
If the student is not using spoken language but indicates that they need help, model the language using a combination of spoken language and low tech or high tech AAC (The communication partner points to the AAC photos/words as they verbally model the language for the student’s need, simultaneously with meeting the need.

2) Student will communicate environmental needs for successful learning and/or self-regulation to his instructor (I need a quiet place to work right now; eye contact is uncomfortable; it’s really loud in here for me; I need to stand or move for
a few minutes; I need to calm down; I need a break; I need access to something) using spoken or typed communication, low tech AAC paired with pictures/symbols, or high tech core language AAC.
Again, the communication goal is not to produce spoken language, but functional communication that works for the student’s immediate needs. If the student needs language modeled, the instructor models the spoken language and use of the AAC. The communication partner does not violate body autonomy by using hand over hand, nor do they demand spoken communication or that certain words be parroted or spoken.

3) Target any other language goal that a therapist would generally write for a student with delayed or disordered receptive and expressive language to increase the student’s functional communication in their educational, home, and community environments. (Semantics, Syntax). (P.S. – Dear Therapist: Having students randomly label a certain number of picture/word cards, parroting words or sentences – “Say XYZ,” or making them request access to things all day long is not functional communication.)

To cite this article:
Roberts, J. (2021) Why We Model Language and Honor All Communication, instead of Using PECS®. https://therapistndc.org/why-we-model-language-instead-of-using-pecs/




Julie Roberts, M.S. CCC-SLP