Episode 329- Tutorial: PECS w/ Judy Southey

Summary

ABA Inside Track – Episode 329

Tutorial: PECS with Judy Southey

Release Date: December 10, 2025
Host(s): Robert Perry Crews, Diana Perry Crews, Jackie McDowell
Guest: Judy Southey, MSc, SLP

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Episode Overview

This episode features a comprehensive tutorial on the Picture Exchange Communication System (PECS) with guest Judy Southey, a seasoned speech and language pathologist. The hosts and Judy dive deep into PECS, its history, practical assessment and implementation, the nuances of alternative and augmentative communication (AAC), and strategies for collaboration between practitioners and families. The episode is packed with step-wise explanations of PECS, research highlights, real-world anecdotes, and practical advice for both newcomers and seasoned professionals in applied behavior analysis and speech-language pathology.

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Key Discussion Points & Insights

1. Introduction to PECS and AAC

• PECS Origins & Endurance:
  • PECS was developed in 1985 by Andy Bondy and Lori Frost and "nothing has replaced it yet, which is impressive." (Judy, 02:05)
  • The strength of PECS lies in its robust research base and longevity despite advances in technology.
• What is AAC?
  • Definition: Alternative and Augmentative Communication refers to all forms of communication (other than oral speech) that are used to express thoughts, needs, desires, and ideas. Includes sign language, gestures, picture symbols, or high-tech devices.
  • Types:
    • Unaided: No additional materials needed (e.g., gestures, sign language)
    • Aided: Involving external devices or symbols (e.g., PECs, speech-generating devices (SGDs))
    • [07:29] “AAC stands for alternative and augmentative communication. It can be anything from sign language, gestures, symbols... or it can be a completely alternative system.” (Judy)
  • Advances in iPad technology have made AAC options more accessible, but technology alone is not sufficient—structured teaching is crucial.

2. PECS as a Protocol – Not Just Pictures

• Distinguishing PECS from Devices or Symbols:

  • PECS is a protocol for teaching communication, not simply a set of picture cards or a generic term for any symbol.
  • [23:04] “One of my pet hates being a lover of PECS is when people call symbols PECs… That's a picture and it's singular. It's not the system.” (Judy)

• Key PECS Features:

  • Affordability: Easy to implement with inexpensive materials (pictures, Velcro, laminator)
  • Focus on Bidirectional Communication: Emphasizes the back-and-forth nature of effective communication and the importance of a communication partner.
  • Shares Foundations with Other AAC: The “exchange” (physically handing a symbol) cannot be replicated with generic device use but can inspire device-based adaptations.

3. The Value of PECS in Diverse Contexts

• Suitability & Flexibility:
  • PECS works well for a wide variety of learners, especially young or minimally verbal individuals.
  • [09:38] “It also teaches everybody what communication is... The protocols of PECS really focus on teaching that communication is two way…” (Judy)
• No Strict Prerequisites:
  • [17:23] “Andy Bondy and Lori Frost maintain that there are no prerequisites for starting PECS.” (Judy)
  • Object-to-picture correspondence is not necessary for the initial stages; early phases teach the process of communication rather than symbol-object matching.

4. How to Conduct an AAC Evaluation

• Comprehensive Assessment:
  • No one-size-fits-all; evaluation should involve observation, interviews with families and teachers, and physical/occupational therapy input.
  • Key considerations:
    • The individual’s physical abilities (e.g., fine/gross motor, eye gaze),
    • Environments where communication will take place,
    • Needed vocabulary breadth,
    • Family/student priorities,
    • Ongoing re-evaluation as the individual’s skills progress [15:24].
• Continuous Process:
  • Recommendations and system choices should be revisited as skills improve or needs change.

5. Moving Between AAC Systems

• Hierarchy Myths:
  • Critiques the notion of rigid hierarchies (e.g., "master PECS Phase 3 before a device"); individual needs and contexts matter more.
  • [16:52] “It is often a big concern like we need to have prerequisite skills or we need to be at a certain level… Andy Bondy and Lori Frost maintain that there are no prerequisites for starting PECS.” (Judy)
• Speech Development:
  • PECS and other AAC systems do not inhibit the likelihood of speech emergence; research supports that structured AAC does not delay speech.

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Detailed Walkthrough: The Six Phases of PECS

Phase 1: Physical Exchange – “Pick Up, Reach, Release”

• Objective: Establish the fundamental communicative act—seeing what you want and handing over a symbol to a communication partner.
• Requirements:
  • Two adults: A prompter (behind the child) and a communicative partner (receiving the message)
  • 3-5 individually motivating reinforcers [27:18]
• Key Points:
  • Teaching the motor skill before true discrimination.
  • “Mastery” is attained when the learner consistently initiates an exchange independently across environments and with different people.

Phase 2: Distance & Persistence

• Objective: Increase independence and communicative persistence; the learner consistently seeks out the right communication partner.
• Strategies:
  • Gradually increase distance between learner, symbol, and communication partner.
  • Fade prompts so the individual travels further to make an exchange.
• Memorable Metaphor:
  • [36:13] “I walk in the store and I go, buttermilk. And I'm hoping someone's going to come running with buttermilk, right?... But I'm going to be way more successful finding someone who's in a store close and say, hey, where's the buttermilk?” (Judy)

Phase 3: Symbol Discrimination

• Objective: Learner discriminates between symbols—for example, choosing between “cookie” and “crayon.”
• Approach:
  • Start with a preferred and a blank symbol, then move to preferred & non-preferred, finally preferred vs. preferred.
  • Employ correction procedures and “correspondence checks” to ensure the right symbol aligns with actual choice/action.
• Challenge:
  • [40:07] “Phase three is where we are starting to teach the students that the symbol actually means something... probably the hardest level of PECS to train.” (Judy)

Phase 4: Sentence Structure

• Objective: Move from single-symbol requests to multi-symbol sentences (e.g., "I want cookie").
• Rationale:
  • Lays groundwork for later commenting and more complex communication.
  • Sentence strip is introduced here, not earlier.
  • “If a child comes up to you with a sentence that says, I want the iPad... you're going to know what it means.” (Judy, 53:21)

Phase 5: Responsive Requesting

• Objective: Teach learner to respond to questions (e.g., "What do you want?").
• Skills Targeted:
  • Understanding questions as communicative cues.
  • Distinguishing between spontaneous and prompted requests.
  • Sets up for responding to more generalized questions in varied social settings.

Phase 6: Commenting

• Objective: Expand communication to include comments and answers to questions, not just requests (e.g., "I see cat," "I hear music").
• Key Strategies:
  • Teach symbolic distinctions (I want vs. I see vs. I hear).
  • Introduce commenting in situations where the object/activity is visible/heard but not directly accessible (to avoid confusion with requesting).
  • [60:53] “When you request you get something and teaching that distinction... corresponds really well with tact training and mand training.” (Jackie & Diana)

Adjectives & Attributes (Advanced – after Phase 4)

• Expanding Detail in Utterances:
  • Add specificity (e.g., “I want chocolate chip cookie” vs. just “cookie”).
  • Use generic symbols over specific photos to promote generalization.

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Research, Implementation Hurdles, and Best Practices

1. Fidelity and Training

• Requires Proper Training:
  • Fidelity to PECS protocols is essential—untrained or improvized implementations are unlikely to succeed; errors are usually teacher-driven, not learner-driven [63:12].
• Collaboration Matters:
  • Buy-in from families and support staff is crucial.

2. Common Pitfalls

• Mistaking “PECS” for “Pictures” or “Device”:
  • PECS is the process, not the tool.
• Rushing to High-Tech Solutions:
  • Technology is tempting but not intrinsically superior.
  • PECS provides structure and foundational concepts often missing from device-based approaches.
• Reluctance to Progress between Phases:
  • [48:31] “The biggest success was the kids that managed to make it to the hospital more times…the more you practice something, the better you're going to get at it. And that's with anything you're learning.”
• Not Building Generalization:
  • Practice requests across many items, partners, and environments from day one.

3. When to Move On

• Re-examine the communication method after establishing commenting and more complex skills—this may be the right time for a speech-generating device.
• Continuous evaluation and individualization are necessary; there’s no “perfect” number of symbols or pace—successful PECS users may move on to other systems as their needs and skills evolve.

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Memorable Quotes & Key Moments

• On the universality of PECS:

  • “Pictures are universal...you can use any language as the written part on the picture. But pictures are universal.” —Judy (06:00)

• On prerequisites:

  • “There are no prerequisites for starting PECS...We’re just teaching them that if you see something you want, you hand over a magic ticket.” —Judy (17:23, 17:47)

• On family and team buy-in:

  • “If you don’t have buy-in by family, you’re not going to be successful. And then staff buy-in.” —Judy (20:26)

• On avoiding misinformation:

  • “A lot of people don't really know and it's okay to not know. It's okay to find out more.” —Judy (23:42)

• On the speed of acquisition:

  • “I’m fascinated by how quickly kids can move on if you really push them, versus how we just are okay with...moving them slowly.” —Judy (69:42)

• On device use:

  • “PECS has become kind of the Kleenex of AAC. Like you’re just like, it's all PECS. I'm just calling it PECS, whatever. It's a very specific thing.” —Rob (23:53)

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Timestamps for Key Segments

• [02:05] – PECS origins and continued relevance
• [07:29] – Introduction to AAC modalities and PECS as a protocol
• [13:16] – Components and steps for an AAC evaluation
• [17:23] – Clarifying PECS prerequisites (or lack thereof)
• [27:18] – How to start PECS Phase 1
• [36:13] – The “buttermilk in the grocery store” communication analogy
• [40:07] – Phase 3 discrimination and correction procedures explained
• [44:37] – Moving from discrimination to requesting with multiple preferred items
• [52:05] – Phase 4 (sentence structure) and rationale
• [58:39] – Teaching commenting and advanced phases
• [63:12] – Troubleshooting: red flags and errors in implementation
• [65:36] – Advice for BCBAs working without an SLP
• [69:42] – The role of practice frequency and pace
• [72:09] – Judy’s contact info for further questions

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Resources & Further Reading

Articles & Websites Discussed:

• Gans et al. (2014): "Interaction of Participant Characteristics and Type of AAC with Individuals with ASD" (AJIDD)
• Wanapasha et al. (2025): "Predictors of Successful Picture Exchange Communication System Training in Children with Communication Impairments" (BMJ Pediatrics Open)
• Robertson & Harris (2024): "How to Best Determine if an Autistic Individual is Using an Effective Communication System" (Autism Spectrum News)

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Advice for Practitioners

• Learn and practice the first three phases deeply; watch training videos if possible.
• Always conduct regular reinforcer assessments and print/laminate relevant symbols.
• Secure family and staff buy-in; without it, progress is unlikely.
• Seek consultation with SLPs or other specialists as soon as complexity increases or progress slows.
• Remember: Not responding to non-targeted communication is part of shaping PECS use, but always reinforce communicative intent.
• Monitor for teacher error versus learner limitations—make adaptations as needed (e.g., manipulate the symbol size, backing, or velcro strength).
• Collaborate across disciplines for best outcomes and ongoing system refinement.

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Final Thoughts

This episode offers an authoritative yet relatable deep dive into PECS and broader AAC strategies, debunking common myths, emphasizing the importance of structured teaching, and promoting ongoing collaboration. Judy’s experience and stories reinforce the flexible yet systematic approach needed for success in AAC, making this a must-listen (and must-read) for BCBAs, SLPs, educators, and families alike.

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Contact Judy Southey:
Email: [e-mail]

Snack Pairing: Sushi (for reasons not fully explained – send in your guesses!)

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Related Past Episodes:

• Episode 22: Introduction to AAC
• Episode 171: Professional Collaboration SLP Edition with Dr. Aaron Michaux
• Episode 220: Facilitated Communication
• Episode 259: Next Level Collaboration with Rose Griffin
• Episode 255: Scope of Comfort with Landria Seals Green

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Notable Quote for Reflection:
“PECS is the protocol. The point is the exchange—the social act, not just the symbol.” —Judy (22:46)

Transcript

[A]

Foreign.

[B]

Hey, everybody. Welcome to ABA Inside Track, the podcast that's like reading in your car, but safer. I'm your host, Robert Perry Crews, and with me, as always, are my fabulous co hosts.

[C]

Hello, Rob. It's me, Diana Perry Crews.

[A]

And it's me, Jackie McDowell. And guess what, everyone, we're in December, which means I get to go second in a few weeks.

[B]

This is by far the worst bit we've ever had on the show.

[A]

It's not a bit I'm excited about it.

[B]

It is a bit if you keep bringing it up.

[A]

I waited for eight years to be able to say my name second, and then I only got one year. So now I'm excited about the second year of doing it.

[B]

Second year putting your name. I mean, we could switch up. We could just randomize it. We could do all sorts of things.

[A]

That's too hard.

[B]

We could communicate. Which one of us is going to be the host that announces themselves on this podcast about behavior analysis and behavior analytic research in which each week we discuss a topic on by, say, communicating it with, like, pictures of some kind. If only there were a way to do so, to just not use our words, but just point to things or hand things over. Ah, if only there could be. I wish we had a fourth mystery guest who could tell us all about this for the next hour. Oh, wait a minute, there is. We are very excited to be joined in studio by Judy Southey, mscc, slp, which means speech and Language Pathologist, who is going to join us for one of our actually favorite kind of limited series tutorial where we're going to talk all about PEX or Picture Exchange Communications System. Did I get it right?

[D]

You did, and thank you for that introduction. Wow.

[B]

Well, Judy, thank you so much for coming in and for kind of doing another tutorial on this. I think communication is so key for many of our clients. And while I think a lot of folks would like to say, hey, let's just get an iPad, that'll do all the work for us, PEX still remains, I think, a very well researched and strong communication modality.

[D]

Yes, absolutely. It's actually been around since 1985 and nothing has replaced it yet, which is impressive.

[C]

Oh, wow.

[A]

I did not know that.

[C]

I've also been around since 1985 and a little bit more. Nothing has replaced me either.

[B]

All right, if you are listening to this episode and you come to our trivia, I think we're going to do a Brad Pitter Lasers, which came first? Pecks for the Nintendo Entertainment System.

[A]

No, Pecks are Jackie.

[B]

That'S just going to get less fun the more years we use that one though. So we're going to be talking about PECS in general as well as discussing some more of the fine tuned aspects that goes into pecs. A little bit about some AAC evaluations, other types of aac, what we know about when to use which aac. Diana is has a broken microphone.

[C]

I broke the mic.

[B]

You got the four. We only have four mic stands and one of them probably needs to be retired.

[C]

I pooped the bed.

[B]

Yes, but if you.

[C]

It's cool. I just won't talk anymore.

[B]

I think I can hear you. Okay. It's fine.

[C]

If.

[B]

Jenna, if you could share what articles Judy recommended we discuss today.

[C]

Judy has provided us with two articles and a website to check out.

[A]

Awesome.

[D]

Really?

[C]

Well, it's a blog post, but it's really awesome. So I'm going to try to make sure I can get that shared properly with everyone. The articles are Interaction of Participant Characteristics and Type of AAC with Individuals with asd. A meta analysis by Gans, Mason, Goodwin, Bowles, Heath and Davis that was published in the American Journal on Intellectual and developmental disabilities in 2014.

Also predictors of Successful Picture Exchange Communication System Training in Children with Communication Impairments. Insights from a Real Real World Intervention in a Resource Limited Setting by Wanapasha Young and Vitanavasinchai and Wong Kwan Wong. That was in the British Journal. Sorry, British Medical journal Pediatrics. Open.

2025.

[A]

Wow. Hot off the press.

[C]

Yes. The blog post is titled how to Best Determine if an Autistic Individual is using an effective communication system. That is from Autism Spectrum News. It's just Autism SpectrumNews.org and it was written by Robertson and Harris, 2024.

[B]

Beautiful. Well, why don't we kind of start off, Judy, by. If you would tell us a little bit about yourself, I'd say how you came to use pecs. But as a speech and language pathologist, I'm guessing it's more just about how you chose to look at, you know, more AAC as part of your practice versus, like where?

[C]

Who?

[B]

Pecs. No one's heard of this?

[D]

Yeah, absolutely. It was quite early in my career that I heard about pecs. I graduated from the University of Cape Town in South Africa in 2000 and got a job at a special needs school in Singapore. So why not go across the country and find a job? While I was working at the school in Singapore, I got PECS training by Laurie Frost, who was one of the developers of PECs. And as soon as I heard about it, listened to the protocol. I was like, this is the answer to everything. This is amazing. And then I got married and moved to London and had the opportunity of working as a pecs consultant for Pyramid Educational Consultants in the UK and went around the UK and Europe doing PECS training for people and really sort of solidified my love for pecs and then followed my husband to Boston and have been here ever since, working always with non verbal or limited verbal students who are using ASE and PECs to communicate.

[B]

So when you're using PECS in England, how do you communicate that you're in England and you have a U in words like color and stuff? Like, is it a separate pack? It's very different than the ones we use in America.

[D]

You know what? Pictures are universal. Isn't that great? If you can read as well, you will use a picture printing system that has the spelling that goes with your country, which is great because you can use any language as the written part on the picture. But pictures are universal.

[B]

So you just hold out your pinky when you're in England just to let everyone know, like, this is a British. I'm using British communication. Right.

[D]

The vocab might be cucumber sandwiches and tea, but it's okay.

[B]

Excellent.

[C]

And then I was just going to add in. Of course, you went through that fast, but you worked with Lori Frost and the Frost. Is it Bonnie and Frost or Frost and Bundy?

[D]

Andy Bundy and Laurie Frost. They're actually husband and wife.

[C]

Yeah, yeah, yeah.

[B]

I did not know that.

[D]

I. You love husband and wife.

[C]

You do. We love a power couple.

[D]

I love a power couple. And, yep, he has a psychological background, bcba, and she is a speech pathologist.

[B]

So I feel like I've seen Bondi sometimes at conferences, but I don't know if I've ever seen Lori Frost. And I was like, maybe they had, like, a partnership breakup, but, you know.

[D]

Yeah, no, as far as I know, it's been a few years since I have been in touch, but, yep, still going strong.

[B]

Beautiful.

[C]

That's cool. You're such a globetrotter.

[D]

Mm. I'm settled here now, though.

[B]

So. Judy, I know you mentioned that PECS was developed in 1985, but AAC itself is not just PECS. And I think when I first learned about AAC, I assumed that just meant, well, pecs. Well, I don't know why they have to have so many letters describing these things, but could you talk more generally about AAC as a communication? Is it a modality system?

[D]

Yes. So AAC stands for alternative and augmentative communication. So it can be anything from sign language, gestures, symbols that augment or help people who have limited speech, or it can be a completely alternative system. In other words, you have no speech and you need to use a completely alternative system. With the huge rise in technology, you know, and iPhones probably 10, 15 years ago now, of just being able to have iPads available cheaper and more, you know, accessible to the average person, there was a big rush to other communication systems on the iPad that made the technology much cheaper and easier to get for a wider population. But I think what's really important to remember is just because you give someone an iPad or you give someone symbols, it doesn't mean they're going to know how to use it and how to communicate. And where PECS is kind of different and special is that it's actually a protocol for teaching the system as opposed to just presenting somebody with a system and hoping they get to use it.

[B]

Okay, so when we talk about aac, we're including things like sign language. So we're talking about a technology that is, you know, hundreds of years old.

[D]

Yeah, absolutely. So it can be unaided, which means it's just coming from the person. Nothing external is needed. So pointing, gesturing, facial expression, or aided, where there's something else like a symbol or a device that is there to help.

[B]

Okay, and, and you sort of, you kind of already mentioned it a little bit, but why don't we, why don't we kind of jump down to sort of, you know, what are the benefits of PECs? Because I think you mentioned like, well, technology is improving so fast and I'm guessing you must hear people be like, how can AI be used as an aac? Maybe no one said that, but I assume someone has used the phrase AI plus every single type of anything at this point. Whereas PEX just feels like, oh, that's something we had before, you know, when computers were the size of a small garage. Nowadays it's old fashioned to use them. But kind of, what do you see as the benefits of PEX and why does it still have staying power?

[D]

So I think the big thing about the staying power of PEX is it's relatively cheap to produce. It's just involves symbols, a variety of items that a child or adult might enjoy and knowledge of the system. And I think the individual variation in so many young learners who are not yet communicating, we don't know how quickly they're going to develop language, if they're going to develop language, you know, how long it's going to take. What kind of language are they going to, you know, develop it? What's the limits for their communication? And I think if we throw iPads at everybody or huge complex systems, we might be wasting our time because they might outgrow those really quickly or start talking before with all that money and time that has been spent, it's worthwhile. So I think with PECs, it's still relatively affordable, but it also teaches everybody what communication is. And I think we really lack that in our communication as a field. As a speech pathologist, we rush to provide visuals and symbols and things without thinking about how we're going to teach the individual to use them. And the protocols of PECs really focus on teaching that communication is two way, that you can talk as much as you want. And by talk, I mean point to a picture, press a button, or use a word. You can do as much talking as you want, but if there's no one there to hear your message, you're not communicating. And we forget that sometimes. And often the population that we work with that need aac, they do have adults with them, they do have aides next to them, they do have people supporting them. And so we are there to read the message way too quickly. And we don't allow them to realize that that second person is really critical in the communication.

[B]

I think when you're working with folks and you're teaching communication systems, do you often find that, that sense of individuals just being like, well, I kind of speak their gestural language, which I guess that would be a form of communication, but not a very advanced form and often probably somewhat idiosyncratic to the environment, the context.

[D]

Yeah, absolutely. And I think we generally want to reduce behaviors and when somebody isn't able to communicate, the behaviors are often very high. So families get to know how to meet their kids needs very quickly. And the kids don't have to put much communication in to get their needs met because any whine point, gesture flop gets interpreted and their needs get met. And we're then reinforcing these behaviors and saying, okay, well that's how you get your juice and that's how you get your favorite show on the tv, but you're reducing the number of people that can understand these kids. So I think it's really, you know, important that we try to find a system that works with everybody.

[B]

All right, I'd love to speak more about kind of that, that process of doing, say like the AAC evaluation, because I've certainly worked with a number of people who've either done AAC evaluations or I've been in meetings, we're reviewing an AAC evaluation. And some folks, I have that sense the same way you're talking about, they really focused on communication first. Then they looked at sort of, you know, individual preferences. They looked at, you know, budgetary constraints. And I've seen other folks. So it's just like, well, we used all these different iPad programs to find the best iPad program that we could, which always just feels like you didn't need the evaluation. If you just want us to like say iPad program, just give us the program. I guess what technically is supposed to go into like an AAC evaluation from like beginning to end? How do you learn to do it? What do you do?

[D]

Yeah, I mean, sadly that there is no one AAC evaluation that fits all. There's usually just a combination of observation, interview with families and teachers that are close to the person you're looking for the AC device for and as well as access. So, you know, it is important to think about an occupational therapist having a say because if a student doesn't have a point, then a system where they having to touch or point, you know, isn't going to work or be as successful as you want. So you really want to look at access. So how are they going to access if they are a student who can only use eye gaze? You're not going to think about pecs because they don't have the motor skill to exchange a symbol, but they may be able to use an eye gaze system. So you can really discount different a see systems just by physical ability. You also want to look at the environment. So where are they using this device or this system? If it's going to be only in a care home, you're going to look at, you know, who is working with the student, what they're going to need to communicate. So really you're looking at the individual needs of the student, what environment that they are in, what physical or visual difficulties are going to impact their accessibility. And then you want to look at the vocab potential of what they might need to communicate about. So you know, if it's a student who may only at that point in time need to communicate that they're hungry, they're thirsty or they need a break, you're not going to need a system that has 500 buttons programmed into it. So you really want to look at, you know, the child as a whole or the adult, because they are adults who you know, need to use ASC is asc evaluation.

[B]

Something that you've seen more individuals as it's become kind of more of a kind of regularly occurring activity or a part of a lot of sort of communication assessments. Something that's being done like again and again and again over time as the learner is either gaining more access to, you know, more vocabulary or, you know, they've improved motor movements.

[D]

Yeah, you definitely don't want to determine something for a child at age 4 and say, well, this is now going to suit them to adulthood. You're going to do continuing evaluations as their language develops. I've just had a student right now who we didn't know could read and write, was using a device and I opened, you know, predictive text and he started typing things and we were like, well, okay, so maybe you can go beyond the symbols that are on there.

[B]

Thanks for doing your evaluation for really important.

[D]

And he's in third grade and he's non verbal and I'm like, okay, great. So we're, it was great for him when he started using it. It was a perfect, you know, ase choice, but we can keep going and we can keep pushing. So I think in, in public school environments we do three year evals. So every three years you are doing an evaluation. So with students who are using asc, it's definitely, you know, part of that evaluation, but it can be done, you know, and should be done more regularly if needed.

[B]

Wow. Are there readies?

[C]

Oh, of course. Well, I wanted to ask you because sometimes I feel like people feel that there is a big hierarchy in terms of when one should move from one AAC system to something else. So I've heard people say, well, they shouldn't start with a device unless they already are proficient at level 2 or 3 of PECS. Or people say, well, they shouldn't start PECS if they don't have picture object correspondence. Can you speak to your thoughts on that?

[D]

I can, and it's a very interesting question because it is often, you know, a big concern like we need to have prerequisite skills or we need to be at a certain level. And one of the other concerns which I'm just going to throw in there is a lot of parents are, well, how do we know they're not going to speak? Is this going to stop speech development, which is a legitimate concern. So as far as prerequisite skills, Andy Bonney and Laurie Frost maintain that there are no prerequisites for starting packs. You can be as young as you want. You can be as old as you want.

Yeah, you don't need to have object to picture correspondence because actually the first three phases of PECs teach communication. It doesn't matter what the symbol actually is. We are not expecting them to know that that symbol of cookie means cookie and the symbol of iPad means iPad. We're just teaching them that if you see something you want, you hand over a magic ticket. I mean, it's as simple as that.

[B]

So definitely you should rebrand really. Magic ticket communication system.

[D]

Yep. And then, you know, for devices, I think we are struggling with the.

Relatively low cost of technology these days in that people want to rush to get devices. And obviously speech generating devices have a voice and a lot of people feel more comfortable communicating with somebody when there is a verbal output because it feels more natural. And even AI, as you were saying, Rob, with the voices these days, I mean, you can get English, you know, UK English boy, age 5 as your voice and put it on the device so you can, which is really cool, which is really, really exciting.

[C]

And the scalability of the devices is much greater than pecs.

[B]

I wouldn't trust AI not to start making up things that the person wants to say.

[C]

Go ahead though.

[D]

So I think that whatever system we choose, it's really up to us that we are constantly thinking about whether it is working. And by working it's like, is the child gaining independence? Are they gaining skills? Are they able to use it in different environments with different people? Is the vocabulary meeting their needs and is the function of the communication meeting the needs? So if they're only requesting, we haven't done our job. So we really want to look at all of those factors when we determine whether they're ready to move on to a different kind or, you know, how soon we can start.

[C]

Yeah. But speaking of scalability, I, I hope that we can like take a few minutes to like go through the different levels and what that looks like. But because I feel like it is so well paced.

[D]

Yeah.

[C]

In the PECS system and I've, I've met kids who have a device and it has 48 icons on the front page and it doesn't seem to me that they have a lot of discriminability between those icons. Right. So I, sometimes I fear that it scales up too fast with a device and I don't know if it's harder to like decide how many slots are on some of those, like grids or boards, because it always seems to be a million.

[D]

Yes.

[C]

But I like that about, about PEX is that it starts at the very beginning.

[D]

Yeah, absolutely. Yeah.

[B]

So before we get into those, into those different phases. Judy, when you're doing your AAC evaluation, like we talked about some of like the benefits and, you know, prerequisites potentially for, for pecs or lack of prerequisites in a lot of ways, are there sort of like markers that you're looking for in terms of aha, pecs. That's the answer. Like, I know what I'm recommending first for this student or this learner to use.

[D]

So I think it's pretty personal right now. And one of the things that I really want people to know is that if you are not trained in PECS and you do not know the phases of pecs, you're not going to be successful necessarily. And I think people Recommend Devices or PECs depending on the training they've had, the exposure they've had. And that's kind of sad because we're limiting what is available to, to our caseload of students based on our own experience and our own knowledge. So I think what's really important is that we, we stay true to the protocols of PECs. We can individualize it if, if, if needed, but that we choose, we try things when we are confident in being able to teach them. And we also take the onus, you know, to learn about systems. If something is not working and say there's something else out there, what we're trying is not working, what can we try? I think PECS does work very well with young students. So I think age could be coming into it. Family wishes was definitely come into it, because if you don't have buy in by family, you're not going to be successful. And then stuff buy in. So I think those three, three things really will help to be successful.

[A]

Can I ask a question? This is going to be a dumb question.

[B]

I said, no, you can't.

[A]

But this is a question I've always wondered is.

Is it not possible to use pecs on a device?

[D]

So that's an interesting question because I've actually just sat down with an ASC specialist in the district that I work in and I was like, we could actually develop our own protocol for teaching alternative communication of any kind of. Because we could teach that social approach of going up to somebody, getting their attention and then pressing a button.

[C]

Right.

[A]

Because that's the main part of pecs.

[D]

Yeah, it is. So it wouldn't be PECS because you're not going to be using symbols, you're not going to be dismantling the symbol, handing it over. But that communication learning that you Go up to somebody and you pass a message and that you gain attention. Can absolutely be used. Then generalise to any asc, you know, system that you choose. So yeah, I. It's not going to be pecs, but it's got some.

[C]

Yeah, I think you're really onto something.

[D]

You are. Yeah.

[A]

I have been wondering this for like many years because I never understood that PEX was the actual like handing over the exchange.

[C]

I was change.

[A]

It's the exchange. I was like, oh, it's just all these pictures and so there's symbols on the. On the iPad and though that's pecs and then called.

[B]

It was just the system, you know, picture system.

[D]

Yeah. And. And interestingly enough, one of my pet hates being a lover of pecs is when people call symbols pecs. Do you have a pecs of a cookie? Right, Mike? That's a picture and it's singular. It's not the system. I have.

[A]

I've never done that.

[D]

Okay, good. I'm proud of myself. Yes.

[A]

I've never done it, but I will be honest that I have called AAC devices pecs. And I tried to walk through using an AC device using this.

[D]

Six levels of pecs.

[B]

Stop. We want you to stay in the episode. She's gonna storm off and keep this up.

[C]

You're not doing an anti tutorial, right?

[D]

No, I'm good. So don't do that because you're just reminding everybody that there is a lot of misinformation out there and a lot of people don't really know and it's okay to not know. It's okay to find out more.

[B]

So PEX has become kind of the Kleenex of aac. Like you're just like, it's all pecs. I'm just calling it pex. Whatever.

[C]

It's like.

[B]

No, it's very specific thing.

[C]

We're talking the Velcro.

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[D]

Bye.

[B]

Hey, everyone. So sorry to pause our conversation with Judy, but I wanted to remind all our listeners that ABA insidetrack is ACE and KWABA approved. And by listening, you're able to earn one learning credit. All you need to do is finish listening and then go to our website, ABA InsideTrack.com or click the link in your podcast player. And you'll need to go put some key information about yourself if you'd like a CE and one of those pieces of information is going to be our code words. We've got two of them. These are both from Judy and the first is buttermilk. B U T T E R M I L K. It's a milk of some kind. Do you mix butter with milk and it makes buttermilk? You can make pancakes out of them, I think. Shows what I know about cooking. Anyway, buttermilk. And back to the show. Let's get into why, you know, the specialty of pecs. We've got the phases involved in pecs, and so it's not just a matter of like, here's a book of pictures. I've laminated them nicely. Now you can pecs all you like.

[A]

With the little stick figure. Yeah, I love the stick figure. Doing all the things like going to the bathroom and getting the fridge.

[C]

Maya Johnson pictures.

[D]

Yeah. Yes. So, I mean, if you want me to go jump right into some of the early things, phases, let's just go through them all.

[B]

Because I think most people either are coming to pecs as they're working with an individual who uses the picture exchange already somewhat fluently, and they're just expanding their vocabulary, their detail in their communication. Whereas others are just sort of like, well, I've got this cool little book and it's got lots of pictures and there's some amount of point and it just turns into sort of like lots of gestural communication. But since there are pictures, pecs, question mark, you know.

[D]

Yeah. So I, I think the best thing to, to realize is all you need to start pecs is someone who understands the protocol, knows what they're doing, at least three to five reinforcers. So you want strong reinforcers that, that, you know, this Child or student you're working with is going to want, and you're going to need to print symbols of those things. So that's. And a little bit of Velcro. That's probably all you need to get started. What you really wanting to do is make sure that the child at the very beginning wants what you have. If they are not interested in what you have, you're not going to have the motivation for them to even think about learning a skill. Because right now, when they want a cookie, they either go and help themselves, they go grab it off the shelf, or they scream until someone gives it to them. That's way easier than picking up a symbol, finding a person, and handing it over. So they're going to continue with whatever communication has worked for them in the past to get what they want. Unless, you know, we set it up so that we can have success. And that means find things that are gold. What they want is first. One of the little downfalls on the first two phases of PECs is you do need two adults or two people to train. The reason for that is the prompting to gain independence is physical as opposed to verbal. Most of the time when you're using speech generating devices, there's just one person sitting next to the child and they're gesturing at the symbol they're wanting them to press. And that becomes tricky because it's very hard to fade that out of that situation and to gain independence. So what Andy Bundy and Laurie Frost, through years of studying, found was that if you almost were a puppet, where there was an adult behind the child doing the prompting, the communicative partner that they were requesting from had nothing to do with the task that you wanted. They were just there to receive the communication. And so then there was no confusion between, you're using my hand to hand over the symbol, but now you're also responding by giving me the thing you want, and it becomes really confusing.

[C]

That makes sense.

[B]

It's like teaching pronouns. You're like, no, no, you say I, I say you.

[D]

Yeah, exactly. So what you're going to do is set up the the environment where you've got a communicative partner that's the person the child is asking for things from. And then you've got a prompter who's physically prompting the child to do the motor movement. And the motor movement is three parts. You pick up a symbol, you reach towards the person who has the item you want, and you hand that symbol over. So that is phase one. Phase one is a motor skill. It's Just pick up, reach, and release those three parts of. Of communicating. Now, we know that with presumed competence and the fact that our kids are really visual learners, they might actually pay attention and know more than we think they know. We are making sure that the symbol matches the item.

[B]

I was going to ask.

[D]

We're not just using a blank or a, you know, whatever we have at hand. We want to make sure that if it's a cookie, we holding the cookie symbol is in front of them. If it's juice, we holding, the juice is in front of them. If it's a light spinner, it's a picture of a light spinner. Because we hope and know that it's possible that they are paying attention to the symbol. It's not a prerequisite for phase one. We don't need them to look at it and pay attention to it or even be able to, as Diane mentioned earlier, match that picture to that object. We don't need that. But we are just making sure that it matches so that in case they are paying attention, we're not messing around with them.

[C]

We're not wasting our time.

[D]

Wasting their time. Because when we get to phase three, we're going to need to make sure they do know what it means. The first communicative function in PECs is requesting, because that's where we get motivation. It's much more motivating for all of us. And I always say, if you went to a foreign country and, and you were desperate for the bathroom, like, you know, you're going to learn how to say bathroom in that language much quicker than if it's just like, oh, look, or that's beautiful. So a comment.

[C]

Tell me about your structure of government.

[D]

Yeah, so the commenting, you know, it will come. But the first thing we need to know is how to get our basic needs met, really. And that's why APEX starts with requesting. So with phase one, you're wanting to get as many exchanges as possible. You're wanting to practice the skill because it's a motor skill of you see something you want, you hand over a symbol. And the nice thing about the protocol is that it really encourages generalization from the beginning. So do this in the kitchen, at home, in the gym, in the playground, in the art room. So you're exchanging everywhere from the beginning. You're exchanging for as many items as you can from the beginning, and you're exchanging with as many different people as you can from the beginning. So you really have built in generalization. So you're not just saying, are we going to communicate with my one on one aid. And I'm a great communicator with them, but I don't know how to use it out of my cubby in a different situation or a different environment. So that's really nice from phase one.

[B]

So the high frequency of that motor response, ideally across lots of different items in lots of different spaces with lots of different people. Would you ever move on if a child was, say, doing high frequency of exchanging, but it was only for one item and only with one person in one spot? Or is it sort of like, we've got to spread this out more?

[D]

So you absolutely can. And I think what's really important to know is that there's practicing packs and using packs so you can teach, you know, phase one discreetly. You can sit down and say, okay, I'm going to get data for 25 exchanges and then we're going to use pecs across the day. So when they go to art, we're going to get one exchange for the paint because that's what they're using. And when we go to library, you're going to get one exchange for a book. And then when we go to the playground, we're going to get one exchange for the swing because we want them to see that they can communicate across the day. But we're not going to get mastery by doing it once every few hours. We're going to get generalization, but we're not going to necessarily get mastery. So I like to sort of explain to it to everyone it's you practice packs by sit down and do as many trials as you can, but you also use it across the day. And you want to be doing both those things from the beginning.

[C]

Okay.

[D]

You don't need to master a set number of items before you move on. You just need to have independence. So the prompter who's prompting the child needs to start fading so that the child is doing each part of that pickup reach and release by themselves. You don't want them to still need prompting, but that might happen within a setting of 20 exchanges. But then an hour later when you're doing it again, you might need full prompting once again to get started for the first two or three and then the connection happens. So I think mastery of phase one is really, whenever you hold up a reinforcer and there is a symbol in front of the child, they know how to pick up breach and release.

[B]

Okay.

[D]

Without a physical prompt.

[C]

Okay, great.

[D]

Yeah. All right, so that's phase one. Phase two is increasing persistence. It's really making the kids whine, it's the kid in the grocery store who says, I, you know, I want candy, I want candy, I want candy. And never stop shouting, I want candy. We want our PECS users to keep persisting and how we're going to do this is increase the distance between the communicative partner who has what they want and the child and their symbol. Because we don't want kids to say, you're holding the bubbles. I love bubbles. I'm picking up my symbol, I'm walking to you with bubbles. But then I see my toy over there. I'm going to drop that symbol and go over to the next thing. We want them to persist. And so you're going to gradually increase the distance systematically from, you know, a foot away, turning your back slightly, not paying, you know, attention to making sure that they hold onto that symbol and they gain your attention and they hand over the symbol. And this is where we're talking about devices. We are actually starting where I'm working right now, putting, excuse me, symbols on their devices so that they walk up to you and get your attention, excuse me, as a pecs exchange almost and then press their message on their device. So that's kind of what we're trying at the moment to try to get this communicative intent that is missing in so many of our device users because we don't think about teaching it so systematically as the Pix Protocol.

[B]

And then also, if you have your speech generating device, it makes a noise people are naturally going to look over and they're probably not going to be like, well, you don't really get my attention the way I want you to let me do that. They're just going to respond to the.

[C]

Yeah, and I was not know that it was intended for them and oh, just be confused.

[D]

I mean, to put it into a, you know, an example that we can all identify with is I imagine I'm making a new recipe and I need an ingredient, say, and it's a rare ingredient, maybe buttermilk. It's not something I buy in the grocery store often.

[A]

I've got buttermilk at home.

[D]

Don't you worry, girl.

[C]

Sorry. I just make it when I need it.

[D]

All right, all right. It's not an ingredient. I might have frequently. So I'm rushing to get this one ingredient and I go into stop and shop or big Y or whatever. And I walk in the store and I go, buttermilk. And I'm hoping someone's going to come running with buttermilk. Right. I may get Someone who responds. But I'm going to be way more successful finding someone who's in a store close and say, hey, where's the buttermilk?

[C]

Oh, my gosh, I love that example.

[D]

So I think with our speech generating devices, we kind of teaching kids to just scream it out loud and everyone's responding to it so they think it works. And pecs is different because we're saying, go find the right person. And that what phase two really is, go find that right person, hand over your message, and you'll be more successful.

[A]

Okay, I want to try that.

[C]

I really love that.

[A]

My challenge this weekend is to go into the grocery store and just switch, scream out an ingredient and see what happens.

[C]

Someone will come check on you.

[B]

They'll be like, are you okay? They're not going to, you know, oh, no, I screamed the word. I think I wanted to.

[D]

Watermelon. Yep. I mean, and I think, can I.

[B]

Call someone to pick you up, please?

[D]

Yeah, I think this is where really, you know, also a reminder why we need buy in from parents and everyone in the child's environment. Because when we're teaching PECs, we're teaching a language.

As such, and if. If we're teaching them that sometimes screaming works, sometimes helping yourself works, sometimes, you know, gesturing and pointing works, and sometimes handing over the symbol works. We almost trying to teach four or five languages at the same time. Now, I do absolutely believe that multimodal communication is critical. We need to accept all forms, teach a child some science, teach them, you know, gestures, teach them pecs, teach them buttons, whatever. But when we are training pecs, we want to probably try not to respond to the other ways they are attempting to communicate because we wanting to replace the behaviors with one system, and that is the exchange of the symbol.

[B]

So that would be a time you might cut back on the multimodal communication.

[D]

Yeah. And I mean, I do think we do owe it some to the kids we're working with to respond so often. If I'm training a new student in pecs and they're signing more, I will verbally say, I can see you want more of something. What do you want more of? And then wait for the exchange. So I am giving them that verbal reinforcement that I heard you. I know you're trying to communicate with me, but I just need you to do one more thing.

[C]

Sure.

[D]

So, yeah, just something to consider when we.

[C]

You don't want to extinguish the existing response item.

[D]

So, you know, mastery of phase two kind of never happens in that we're never Going to have the distances between the student and they book and whichever adult that they might be communicating for. This is something we continually work on. Okay, so if mom is in the kitchen and we happen to be doing a home visit with a student in the TV room, and you think they want to go and ask mom for something, we can show them you can travel between rooms, but that distance will always be changing and always be, you know, new. So we can keep working on phase two right through, but we want to make sure that we have some traveling, some persistence, some movement, you know, in multiple environments before we move on.

[B]

Okay.

[D]

But not really mastery, as in, okay, we've checked off this and now we never have to do it again.

[B]

Go walk a whole mile. That's how we know it's time for phase two.

[D]

Just throw Jackie in as many grocery stores shouting, watermelon. Is this watermelon? Yes. So once we've got mastery of phase one of the physical exchange, so the pickup reach and release for a number of items, and we have some traveling happening and some persistence happening, then we are going on to phase three, which probably is the hardest level of pecs to train. It's a little complicated. Phase three is where we are starting to teach the students that the symbol actually means something.

[A]

Right?

[D]

So it's really. Now, you know, that cookie picture on there means you're going to get a cookie. That iPad picture means you're going to get the iPad. So you have to really start discriminating, really. And this is where you may take some time in getting mastery, depending on prerequisite skills. This also might be the time where you're like, okay, maybe there is some intellectual components. Maybe pecs wasn't a great choice. So with regards to what do they need as prerequisite skills for phase one and two, they need no prerequisite skills. Skills other than, like, the physical ability to pick up a symbol. But phase three, you might start questioning if it's taking a long time. But my first thing is always, are you sure you're doing it right? Are you sure you're following the. The PICS protocol for teaching discrimination? Right. So there are different levels. And, you know, I think I do urge everyone who is wanting to, you know, use this and say, oh, how do I do that? Read more and watch videos of it. There are some online because it is a little tricky. But really the first thing you're going to do is pair the symbol of whatever it is they want with a. With a blank symbol so that they start realizing that there is A picture on it. It's not just a piece of paper.

[B]

If I just lift my arm and hand a square of something that's not the same as.

[D]

And for some, for most students I've worked with, I would say just over half with pecs, just having that blank. And what your response would be is, if they hand it over to you, go, that's nothing. And then you can gesture to the right one a few times of like, that's nothing, often gets them to pay attention and start looking.

[B]

Extinction burst. Fine, I'll give you a different one.

[D]

So that's the first step. The next step is to put a symbol, the symbol of what they want with a symbol of something irrelevant or non preferred. So, you know, a tissue, a paperclip, you know, a pen. And then that's what you always have those guys who's like, oh no.

[C]

And then paperclip, I'd love to have that pencil. Thank you. Yeah.

[D]

If you're doing, you know, food, make sure you check with them. And there's not a food item that they want them to eventually eat. But like often olives or pickles can be something.

[C]

Oh yeah, not my kids pickles, but.

[D]

Their favorites love them. So, you know, again, you're doing reinforcer assessments, you're checking what do they like, but also what do they really like? Hate. Do they push it away? If they push it away, you can use that.

[B]

Okay.

[D]

And when you're training this, you want to actually have that item because when they give you the non preferred symbol, you want to hand over that item because that's what they know you want.

[B]

To just praise them for. Great job.

[D]

Yeah, great job. Or you don't want to go, oh no, you don't want that one, you want this one. Right? Because if you say you don't want the pickle, you want, you know, the iPad, you, as the communicative partner are now putting in a verbal prompt that's going to be really hard to get rid of. And you want the pickle.

[A]

The iPad.

[D]

Yeah, right, exactly. No, you didn't want the pickle. And then you're going to get into this whole question of are they independent? Do they know what these mean? Like, are you, you know, doing some kind of facilitated communication because you're showing them the right one. Oh, sure. So you really don't want to, you know, make. Yeah, make a, you know, an impact on how they communicate.

[B]

Judy, if they pick the pickle, I know they don't like the pickle. I hand them the pickle and they give Me the oh, I'm shoving that away response. Is it the same as the nothing where I'm just like, oh, guess that's a big shrug. And then they see if they grab the other.

[D]

So that's a great question because actually what you do then is a correction procedure that was developed by Andy Bondi and Laurie Frost as part of the protocol. So there is a four step correction procedure that you do. So you hand it to them, they push it away, you then point to the correct picture and you say you wanted the cookie. So you model show, then you do a little distraction. So you either tickle, look out the window, turn the book over, you know, whatever you do just to distract them from what you've just shown them. And then you represent the preferred and the non preferred item. If they go for the, you know, wrong one again, you go through the correction procedure again and then you, on the distraction part, you actually remove the non preferred. So there's only one symbol again. Okay, so you don't want, you, you end on errorless, that they can't make the mistake more than twice. So you're modeling, showing, you know, and, and through the correction procedure can start, develop some independence.

[B]

Okay.

[D]

And then you go on to okay, now they're doing preferred to non preferreds usually because there's a strong rejection of the thing they don't want. But now we need to move on to like what if they are two preferreds there? Because we're going to need to fill their book with all the things they like because that's what a communication system is, having a book filled of all the things I can ask for.

[C]

Right? Like a kid in a candy store.

[D]

So you're going to have two preferred pictures there and instead of doing an error correction procedure, you're going to do what's called a correspondence check. So what you're checking now is do they have that object to picture matching? So you're going to have both items, cookie and candy. I don't know why I'm doing food. Maybe it's like because it's that time.

[A]

It'S nighttime slash dinner time.

[D]

So cookie and candy available. You're going to probably have it on a tray next to each other. They're going to hand over a symbol and you're not going to name it. Very important at this step is if they are good listeners and you say cookie, they might just reach for the cookie because they heard you say it.

[C]

Right?

[D]

So you want them to actually make sure that the symbol that they're giving over is the item they take. So they're going to hand over a symbol. Doesn't matter which one, because they're choosing, it comes from them. And then you're going to say, sure, take it. If what they gave you is what they're reaching for, let them have it. And then label it. Oh, yeah, you reach for the cookie. You asked for cookie. Great. If they reach hand over cookie, but reach for the candy, you're going to block access. And then you're going to do that error correction procedure. Okay, you wanted, you know, cookie. That's the picture you gave me. Show them the cookie, put it down and get the cookie. Not during the correction procedure. You then represent, you know, the two symbols and let them. Yeah, so that's really the hardest part of pecs, to be honest, is getting that discrimination. And again, going back to, you know, devices, do we build that in. Do we actually build in, like, error correction for when they make a mistake? Probably not. I think it just becomes a gesture of, like, you know, I think this is the one you want. And the hard part with that is you're not giving them the opportunity to communicate because you don't really know what they want.

[C]

Right.

[D]

I mean, we can't predict what it is that they want. And it might be that I wanted the cookie all along, but you're making me work for it now. I actually want the candy. So doing that correspondence check and allowing them to actually take you double check in what they press or what they're reaching for, what they're exchanging is the thing they want.

[C]

And then if they had done that, you'd done the error correction. And then the next time it was re presented, they handed you the candy symbol and you're like, oh, you did want the candy. Because motivations can change in the moment. So it's really hard. I love the correspondence check piece. And I mean, full disclosure, Judy trained me how to do effects. And. And the error correction is a little bit different than, like, other DTT error corrections we've done before. And I just loved the correspondence check. And right now I have students who are attempting to do some work where they're teaching, like, a yes versus no response. And we built in the correspondence because they're like, well, well, then they'll just take the thing and I'll know that they meant yes when they take the thing. I'm like, well, but what if they wanted the other thing?

[B]

You know?

[C]

And so we built it in, like, very much like this. And it's much more complicated than you think because you're trying to like, judge motivation in the moment. And it's really important, like you said, that we're not speaking for them, but we're helping them speak for themselves.

[D]

Yeah, absolutely.

[B]

So when you, when you, when you describe the correspondence plus the discrimination, I can see why in, you know, some of the studies that, that, that we reviewed, just getting past level three was like. And success, even though there are more phases to go.

[D]

Absolutely. And the ones that they count as success, as getting to mastery of phase three. And that was all they wanted. The other thing that often is questioned is how long is it supposed to take? How long does it take to get from phase one to phase three? Well, I think if you are doing it enough and the pecs protocol does mention when training, you should go from phase one to phase four within a month. And this is interesting because just his eyes are huge. Well, also this study, which was fascinating to me because they lacked resources and they only had one pecs trainer. Like it was a year.

[C]

Yeah.

[D]

For most of these kids it was.

[B]

Like, it was like maybe six trials at the hospital.

[D]

Once a month they had parents, do.

[B]

Your best, you know, get as many as you can.

[D]

And still they got, you know, I think, you know, 40 something percent mass at phase three. I believe that had they done more frequent, had they had the resource to do more frequent practice, more frequent training, which they found that too, because the biggest success was the kids that managed to make it to the hospital more times, the kids whose families understood them and did it at home. So obviously the more you practice something, the better you're going to get at it. And that's with anything you're learning. So I do think we tend to be a bit slow in moving kids forward with packs. I think we take a lot of time to get the vocab increased, to try a whole lot of different things, to constantly do reinforcer checks and check that can we add new things in. And also, even though it's requesting, in life, you don't just request the things you want, sometimes you have to request the things you need. So things like if a child loves yogurt. Yes. You've got the symbol for yogurt and they're requesting yogurt. But what if they eat with a spoon and we don't give them the spoon, we give them the yogurt this time and now they have to ask for the spoon. They're still getting that reinforcing item, but they've now expanded their vocab to spoon and yogurt or open. Yeah.

[A]

Or cmot, everyone.

[D]

Yeah, yeah. So I think, you know, we can really work harder and better to, to increase vocab and increase practice, like building.

[C]

In a lot of incidental teaching opportunities into the pecs system.

[B]

So if you're a month in and you maybe have, you know, you haven't even finished phase three for like stimuli, it's probably a you clinician problem, not a pecs isn't working for this kid.

[C]

Probably.

[D]

Probably, yeah. And I think, you know, working with BCBAs is also thinking about functionality and behavior. So what is like the biggest issue at the moment? Like, where do we see the meltdowns? If it's because they can't open things themselves, let's throw open in there from the beginning because that seems to cause the most behavior. If it's when things are, you know, too loud and they don't like noise, then maybe we're teaching them to ask for headphones from the beginning or noise canceling headphones, because that's the thing that's going to really help, you know. So we also, we really need to work together, you know, as clinicians who are working with students to say what is causing, you know, what are they needing to communicate about most and how can we bring that into whatever system we're using?

[B]

Okay, so however many communicative responses you think are appropriate to train, there's like 100% more you probably could be training if you took like five minutes and sort of thought about the environment, thought.

[C]

About the context and collaborated is what she's saying.

[D]

Collaborated.

[B]

Collaborated, yes.

[D]

And I think also the other thing we need to think about is back to. You can be working on a new skill like phase three discrimination, but you can be using phase one and two as mastery across the day. So you can be requesting all the things you like one symbol at a time. But maybe we build in. Okay, we're doing those that forcep error correction and the correspondence checks these times of the day to. We'll work on phase three discrimination. So you've got mastery of phase one and two. Keep going as many exchanges as you can across the day. But let's build in the teaching time. Then they're gonna master phase three and you're gonna be okay. Now what? We're gonna go into phase four, which would be the next phase. So we all know that a single word doesn't tell us much. If a child says piano, they could be saying, I hear a piano. My dad plays the piano. I love pianos.

[C]

Give me that piano.

[D]

Give me that piano. We don't know, so with pecs, we know it's requesting, cause that's all we've taught them. But we wanting to move beyond that one day, we wanting to get them to comment as well as request. And so phase four really adds that sentence starter. So it's adding the I want, which a lot of people don't like to add because it doesn't give us any more information. If you give hand over a cookie, you're going to get a cookie. If you hand over I want cookie, you're still going to get a cookie. It's a lot of extra work for it. The only reason you're doing that is once you've taught requesting like I want a cookie, you can switch that sentence that it's I see a cookie, I smell a cookie, mom likes cookies. And so, yes, it's redundant in that it's still requesting. And it's a lot of extra motor skill to add to the sentence strip, which we introduce at this phase to request in a longer phrase, which a lot of people are like, well, I don't want my child just to go, I want, I want, I want. It's really just built in there so that we can get to the further levels of pecs where we work on commenting.

[B]

So it's a little bit like phase one, where it's like, I'm just handing, handing, handing. It's more. I'm just getting in the habit of using the sentence strip.

[C]

Right, because now you're building the sentence now.

[D]

Yeah. It also does link into making sure that other people understand you. So if no one has had pecs training and a child comes up to you with a picture, you're not gonna know what to do. But if a child comes up to you with a sentence that says, I want the iPad, or I want music or I want the bathroom, you're gonna know what it means. So it is helping your listeners who may not be trained to understand. You know, it might help if you're going to McDonald's. Like, yeah, if you go to McDonald's and hand over nuggets, they're probably gonna know you're asking for nuggets, but they definitely gonna know you're asking for nuggets. If you say I want nuggets, sure. They're like, look, nuggets.

[B]

Yeah, we do sell those. Yes.

[D]

Yeah. So phase four is teaching that sentence level still within requesting, because that's truly where motivation lies. And these young guys, we're teaching it for getting the things they want. That's what motivates motivates all of us, really. So phase four is just learning to systematically drop the sentence stutter. We call it the i1 symbol down onto a sentence strip. Dropping the actual item down on to the sentence strip and taking the entire sentence strip off and exchanging that. I have seen people try to introduce that sentence strip from phase one. It's a lot of extra motor skill to teach when you're training something new. It's not recommended.

[A]

Right.

[D]

To use it. So it's one symbol at a time. Phase one and two. Phase three is two symbols and then three symbols as you're building up the discrimination. But the sentence strip should only be introduced at phase four. One, because it's visually new. So now it's like, oh, I got something new on my book, let me start using it. And two, it's make sure that they really understand how communication works before you increasing the motor skill. Yeah, yeah. So phase four is teaching that once you get to that sentence level, it kind of. There's a phase of pecs that isn't actually part of the six phases and that is attributes or adjectives. This is being specific. So one of the articles we read was talking about being able to be specific. Like, I can ask for cookies. Great. And well, but what if I want an Oreo cookie today and a chocolate chip cookie tomorrow? Like, wouldn't it be great to be able to my whole life? Yeah. These are important distinctions and just a little sort of anecdote. We. There's a lot of discussion as well as do we use some symbols of these items or real photos of these items? And it's gone backwards and forwards as everything does between, you know, this one's better, this one's better. Lately, I think the feeling is specific photos are too specific. And some kids are really attentive to visuals and may notice something in the photo that even if we've taken a photo of their cup, something was in the background, the shadow was slightly different. And even though we think it's exact, it's not. And so we're not actually helping, we're just confusing it. Also, you know, is better to use symbols because of attributes because if I've just taught a generic symbol of cookie, now I can add in chocolate chip, Oreo, strawberry, whatever, frosted, whatever it is. So I can now increase mean length of utterance by adding the specific, you know, item in.

[C]

It's the, er, cookie.

[B]

That's a great point about the picture and the specificity because I know in one of the meta analyses, you know, looking at like, well, who does best with PECS and who does best with speech generating devices? You know, things like, you kind of assume like, wow, preschoolers do really good with pecs because they're learning to communicate. But then there was a distinction between like children with an autism diagnosis and children with an autism diagnosis and intellectual impairment. And it's, oh, could it potentially be like, we don't know, were they training real pictures? So was it maybe this, like, odd, you know, that's kind of like weird masking effect or something like. Well, they didn't communicate as well because the, the real, the, the real pictures were more distractors and they were meaningful communicate. We don't know. They don't say anything about that. It just, that's just the finding that big broad, you know, error bars of who, who, who did what better based on all those studies they looked at.

[D]

But yeah, absolutely.

[C]

It was a really cool way that they displayed those data. Yeah, though. And they broke it down by demographic and age and. Yeah, all sorts of variables. It was really neat the way that they chose to display those. So people should go check it out. Yeah.

[B]

So we've got the adjectives.

[D]

Yes. And so, yeah, phase four is obviously the I want, then we go on to adjectives. But at the same time, you can also be training phase five and six. So phase five is also a stepping stone phase. They found when they were developing the PECS protocol that it was difficult to teach kids commenting without asking the question, which it is. So if you say to somebody, what do you see? You're going to expect a response. I see something. If you say to somebody, what do you hear? You're going to expect, I hear something. So up until now, in the perfect pecs world, we've never asked the question, what do we want? What do you want? We've just taught them, I'm holding the thing you want do give over the symbol. So phase five is another little stepping stone where you're starting to teach them. If I ask the question, what do you want? You can also say, I want the cookie or I want, you know, the markers. So that when we get to phase six commenting, we can say, what do you see? What do you hear?

[C]

Okay.

[D]

So it's really like just teaching them to respond to a question, really. In a society, when you're straight up.

[C]

Requesting, there's a motivator there. Right. And your response is really evoked by that. But when you're being asked a question, now you're answering a question. So that's the sd, right, is what do you Want. What do you see? What do you hear? Yeah, that's a man. Really interesting.

[A]

The answer is an interverbal.

[C]

Yep, you're right, Jackie.

[D]

And the other. The other interesting thing is we are now having to face discrimination issues again, because the symbolic representation of I want, if you're using board makers like cans reaching out to a blue block or whatever, it is so cute. It's like, yeah, but I think a block is red. I see could be eyes looking. I hear, could be an ear. So now you've got I want and I see on the textbook in front of them. And you've got cookie and music, for example. And if you say, what do you see? Most of the kids, the very first time they do this, are going to go, I want.

[C]

Right.

[D]

Because that's the only one they've ever seen. So we have to do that error correction again between the sentence starters. Now, where it's I want versus I see that we fixing. Like I said, what do you see? This is how you respond. I see you know something. And when you're doing I see and I hear you want to make sure they can't get it too. So using books, pictures in. On posters or things where you pointing and saying, what do you see? But they don't actually get that item. So I see a bird in that book. I'm not actually getting a bird. You don't want to be like, holding up their favorite toy and say, what do you see? Oh, I see a koosh ball. Yeah, there you go. And then give it to them because then you're really confusing things.

[C]

Yes.

[D]

So you want to make sure I do want.

[B]

I don't care what I say. I see that and I want it.

[C]

Yeah.

[D]

So you're wanting to make sure that. That the sounds you're listening to or the. The books you comment about aren't actually given to the child. They're just talking about them and having social interaction. Yeah, I see a bird in there, too. He's flying or he's in a nest or he's red. So you're having social connection when you make a comment. But when you request you get something and teaching that distinction, you know, kind of is.

[A]

I like that. It corresponds really well with tact training and man training.

[C]

It sure does.

[A]

Right?

[C]

Yeah.

[D]

Yeah.

[A]

So, yeah, so that's what you're doing.

[B]

I mean, Judy, do you find. As you move on to those later steps. So after the initial discrimination for I see, I want, I hear that it's kind of like, you know, any multiple exemplar training of at some point I've taught enough discriminations that it's just you're off to the races of like. And now we can teach almost any combination of items and senses and interoperable questions and it kind of just all magically happens.

[D]

I think at this point, this is where reevaluating what ASC we're using might come into play. This is the point where are we ready to move to a more complicated device might happen. So this is really a good point in pix training where you'd be wanting to look and see. I haven't had very many PACS users who've got to phase six and just stayed there because it's enough. If they got to phase six and they able to comment and request. I'm thinking I need to push them more. And this is where that presumed competence. They can do more than I'm allowing them to do. And that's where speech generating devices become a very useful tool because there is preexisting vocabulary in there. I'm not having to print the symbols I think they're going to need. There is stuff in there and they might find it themselves. So, you know, I do find, feel like if we've got to this phase and they're, they're making comments and they're requesting, let's see what else is out there.

[B]

All right, so the more you're moving up into 4, 5, 6, you're starting to, okay, when am I doing that? You know, the extra evaluation. What am I going to come back and see the time for?

[D]

Yeah, and if they're making comments, they are starting to get motivated by social interactions. And therefore a speech output may be more motivating because they may be able to communicate with peers who can't read or whatever because it speaks out loud. So this is what we have to think about at that point.

[B]

Okay, very cool. So, Judy, I guess when it comes down to training practicing PECs, you know, you're collaborating maybe with the BCBA, you're sort of overseeing the overall case and you're sort of making sure they know how to do pecs. Are there any sort of just like red flags that you would suggest clinicians are looking out for to say this is, you know, these are the signs that maybe PECS is not right for the learner versus here's how I think you're totally screwing this up for the learner. It's your problem. Get better.

[D]

Yeah, I mean, I would say most of the time it's teacher error and not user error. When it comes to any system that you're teaching for communication, unless it gets to the point of discrimination where you have done error correction over and over again and they do not seem to care which symbol they attach, they are not paying attention visually. And then you might say, I need a visual consult. Maybe they have visual impairment that we didn't know about. Maybe there's something more going on that I've had kids where we've had to then move to real objects of reference because they needed the 3D and the 2D was difficult.

[C]

I actually remember that.

[D]

So, you know, we may need to problem solve at that point because I wouldn't be satisfied saying, they're not going to learn to communicate. I'm going to be, we need to change the system so that we can meet their needs where they are. But remembering that all the teaching in the protocols of distance persistence, like handing over the symbol, getting someone's attention, that can happen no matter what we're using for the symbols, whether it's, you know, 3D items, whether it's symbols, whether we saying, oh, they see better with a black background than a white background, which can be as simple as that. So that's where, you know, collaboration with visual consultants and ots. Sometimes the Velcro is too flat, the symbols too. Velcro, yeah. It requires too much hand strength. Right. It's too hard to get your hand over the symbol. So we might use, you know, thicker poster board or foam board to mount it so that it's just easier to take off. So there are adaptations you can make to the representation of the symbol while still staying true to the protocol of teaching, you know, through the phases.

[B]

Okay, well, Judy, I think now that we've kind of gone through all of the phases, why don't we move into the dissemination station and kind of talk about some summary points for, for listeners.

[A]

That's the train, Judy.

[D]

Okay, just so you know, we got.

[C]

On the train, we were on the train this whole time, and now we pulled into dissemination stage.

[B]

We were on the learning train and now really embark on the.

[C]

You haven't figured it out if the metaphor really works.

[A]

But it's sticking.

[D]

But it's sticking.

[B]

I mean, we've done it this long, we're not changing it now. Bad brand management, Bad brand.

[C]

So I, I, I want to know that if you imagine that you are a BCBA and you don't have an SLP who works where you work, but you feel like this would be a good potential approach for your client, what.

[D]

Do you do.

So I would make sure that you are familiar with the first three phases. Let's just keep it simple. Phase one, two and three. That's a great starting point because you're going to get to that discrimination. Go. They've masterpiece there. Let's get some more help. Let's keep going. Or maybe this isn't working. So make sure you're comfortable with the first three phases. Make sure you have identified reinforces for your student. Make sure that you've printed the symbols and have access to a symbol system, printing system and laminator and Velcro and.

[C]

Everybody'S got the laminator.

[D]

Buying from family, like buy in from family and people say this is what we were going to start. This is what, why this is, you know, what we're looking at and trying.

[C]

If it gets rocky or complicated, then reaching out, finding a way to consult with an SOP.

[D]

There's videos of the faces on YouTube. You can watch, you can see it in action. You can buy that book. You can buy. Yeah, you can get the manual online. The manual online. I think, I think, yeah, I think videos are the most important, to be honest. If you watch it being done, you really get an idea of how to do it. And the other thing is be confident. Every study is showing, you know, doing pecs is not slowing down speech development. So you're not going to mess up them developing speech. You're not going to slow down communication development because you're teaching two way communication. You're teaching go up to somebody and you know, if you end up adapting it to gaining attention of I tap for attention and then I pass a message. It doesn't matter what your message is. It could be a sign, a gesture, a point button. But you've thought, go up to somebody.

[C]

Yeah.

[D]

So there are so many, there are so many skills you can teach when you try it that are going to be functional for whatever communication system they ultimately end up using.

[C]

I feel like it's a little bit like the studies that show that if you take notes by hand that you learn the information better than if you were only like typing on a screen. I don't know if it's. I feel like there might be like some similarities in terms of like neural pathway development that's happening when you're doing that physical exchange and making it a social interaction that you might not get in other formats.

[D]

Yeah. I mean if you look at young babies, like peekaboo games, games where there's a motor and a like social response are so motivating.

[C]

Yeah.

[D]

Like it's the early things you learn when you're communicating, you know, speech is way harder.

[B]

And Judy, I know more in terms of as. As an slp, are there sort of still questions about, like, pecs in terms of the research that you want to know? Like, those meta analyses, I feel like they had some questions, but they seemed very small in terms of, you know, more practice is better and more resources means parents have more time to practice. Like, nothing too. Wow. Groundbreaking. There's so many more questions that raise. And pecs has been researched for so long, but. But are there still areas of pecs? You're like, I want to know this, or, like, where's the study on that?

[D]

I really want to know how many symbols you need to master before being successful in the later stages. Like, is it okay to only be able to ask for three or four things? Because I do have a lot of students that don't like more things than that. And it's like, well, is it better to have them competent communicators for four things that they can ask for? Or like, communicators who have access to hundreds of symbols but can't use them functionally? So I think just, you know, what is the gold standard of number of symbols that we need and then speed of teaching? Like, I'm fascinated by how quickly kids can move on if you really push them, versus, like, how we just are okay with your speech therapist coming in once a week and for 15 minutes. 15 minutes, if you're lucky, and moving them slowly. You know, I did work at a Peck summer camp under Fun Laurie Frost and Andy Bonney, like, in Maryland way back when. And like, the gold standard. I was just one of the, you know, the aides in. In the camp. These kids came in for a week, and we were. Our minimum data was 150exchanges a day while they were at camp from 9 till 2.

[A]

It makes sense. I mean, like, if you count all the exchanges your kids give you all day long.

[D]

Right.

[A]

It probably exceeds.

[D]

And these kids were moving to phase four within that week. So I think we do service sometimes because, you know, and so that's. I do sometimes hold back before I start training. Packs is have I got the resource to give what the student needs to not hold them back? Because we can go as slow as we want from our point of view. But are we being fair to that child or to that student? Yeah, like, we need to be able to push them forward. And really. So I think studies on just speed of acquisition, number of trials needed for mastery and what mastery really is and then maybe just, just moving on to speech generating devices. And when do we do that?

[B]

Yeah, when's that switch over?

[D]

Yeah, when does that switch over?

[B]

I think that the studies sort of looked at like, well, I think older students seem to like the, do better with the speech generating devices. But then they're like, but is it because they already knew how to communicate? Maybe they'd done some of these things in the past. They didn't get into some of the details. Well, why? They just think technology is cool at that age.

[D]

Yeah. And I, and I think that as a generation thing now where there's a big impact on like iPads are bad for their vision. We spending too much time behind screens. Like, what about the anxious generation? Right.

[C]

Oh, yeah.

[D]

You know, all of the impacts of sort of social media and technology on, you know, on our kids. So maybe it's going to go back to like, you know, devices are no longer like the first thing we do. Let's, let's think about communication before we think about, you know, and I think pecs, because it has a protocol of teaching communication. It's really, you know, nothing has replaced it. As I say, like, it's, it's working.

[B]

All right. PEX is going to be the, the touch grass communication system for hip.

Well, Judy Southey, thank you so much for coming on the show. We really appreciate a very deep dive. I hope even folks who are like, I know pecs, I use it all the time are like, me. And they're like, ooh, I don't think I remember that portion of it. Or oh, I'm glad I don't actively teach PECS as much because I'd be feeling very guilty.

[A]

So same. That's what me. That's me right there.

[B]

Double check your PECS knowledge and don't call symbols packs. Yeah.

[D]

It is a takeaway. Don't call symbol specs.

[A]

If you want to be friends with your slp. Do not call symbols packs.

[D]

Oh, that's not my. So please do that too.

[B]

Judy, do you have a contact information if folks sort of want to like, reach out? Maybe like, hey, do you have any good video, like, which is the one that you think is the best for this, that people could reach out?

[D]

Yes, absolutely. Do you want me to give it to you now or do you want to post?

[B]

I try to remember to post them as well, but if you just give it now as well.

[D]

So my email is Judy Southy. So my full [e-mail] which shows my age.

[A]

Hotmail.

[D]

Yep, yep, Yep. For nearly 50 but anyway. And yeah, I would love to have people reach out. I'm always happy to problem solve, answer questions.

[C]

Yeah, it's very generous.

[B]

Thank you. Once again, we want to thank Judy Southey for coming on to tell us all about the basics of pecs as well as a lot more than just the basics of pecs. We really appreciated her being able to take the time to come visit us in studio as well. I unfortunately had to run to an appointment at kind of a Hard Stop, so I was not able to do my final thanks with Judy here or let her share her own code words. But we do definitely want to thank her for being here and we want to give you that second secret code word. It's watermelon. W A T E R M E L O N the big green gourd filled with water and melon I E Watermelon. A few more things before we wrap up, of course. Unfortunately, I'm doing this recording a little bit after the fact, so Diana's not here to do her pairings, but I'll. I'll try to do them justice. Diana likes this last section of the show in which she explains a few episodes that you might like. If you liked this one, and I'm sure you did, and if you did well, you could also Listen to episode 22, our first episode on AAC. Episode 171 Professional Professional Collaboration SLP Edition with Dr. Aaron Michaux. Episode 220 on Facilitated Communication, which unlike pecs, is not a good form of AAC or communication of any kind, despite the name. Episode 259 Next Level Collaboration with Rose Griffin where again we Talked with another SLP BCVA, all about, you know, language and speech and episode 255, scope of comfort with Landria Seals Green. Diane always wants to recommend a nice snack to go with any of these recordings and she's not here to tell us the meaning of this. So I guess this is one where you just have to write in and we'll tell you if you were right. Her snack suggestion is sushi, perhaps because of something to do with raw fish or because there's so much sushi or because you don't have to communicate. If you go to one of those rotating sushi bars, you just press the button or grab sushi without using communication. I don't know. The sky's the limit. We'll have to ask her in a future episode. But please write in with your thoughts as to why sushi is your pairings snack. Please enjoy some final thanks very much thanks to all of you for listening. Please remember to rate, review and subscribe if you have not if you want even more ABA InsideTrack go to abainsidetrack.com or check us out on patreon.com abainsidetrack where you can get all of our episodes a week ahead of time as well as at the 5 and $10 levels. Get extra access to bonus features like our yearly book club polls, our quarterly listener choice polls, as well as free CES for both the book club and the listener choice episode. That's a lot of CEs depending on your level or you can just join for free and kind of get access to things on the website there as well. Again, that's patreon.com ABA InsideTrack thanks to Dr. Jim Carr for recording our intro and outro music, Kyle Sturry for interstitial music, and Dan T.H. abbott of the podcast Dr. For his amazing editing work. We'll be back next week with another fun filled episode. Until then, keep responding by.

[D]

SA.