Unlocking Communication: The Story of PECS with Dr. Andy Bondy & Lori Frost
In this episode, we’re joined by Dr. Andy Bondy and his wife, Lori Frost, MS, CCC-SLP, who are the co-founders of Pyramid Educational Consultants, Inc. They’re also the creators of the Picture Exchange Communication System (PECS). Together, they share about the origins and updates of PECS, their work around the world, and the release of the 3rd Edition of the PECS Manual.
We explore the importance of everyday language when discussing effective teaching strategies, the power of collaborative teamwork, and the need for truly individualized support. Andy and Lori also provide a forward-looking perspective on the future of PECS and emphasize why embracing cross-cultural understanding is essential for effective communication.
Join us for this insightful conversation that offers evidence-based communication practices designed to empower parents, educators, and clinicians.
Unlocking Communication: The Story of PECS with Dr. Andy Bondy & Lori Frost
All Autism Talk
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Richie Ploesch
Laurie, Andy, thank you so much for being here today. It's a pleasure to have you.
Lori Frost
Pleasure to be here.
Andy Bondy
Thank you.
Richie
So I think a lot of our listeners have heard of PECS and used PECS either as clinicians or parents, myself included. But for those who haven't, can you give us an introduction of PECS and sort of how it came to be?
Lori
Sure. I'm a speech language pathologist and over 30 years ago I went to work in the Delaware Autism Program and Andy was the director of it. What was unique to me at that point in my career was doing only push-in services. So I was in the classrooms sometimes for a half a day to a full day, which was really, really eye-opening for me to understand communication in the context of a classroom all day. I was assigned a caseload primarily of preschool children and was surprised to find that I was working primarily with children who didn't talk. So I went back to all of my training and started thinking, well, okay, if they don't talk, I'll teach them to talk by imitating me. Well, what I found out right away is imitation is not easy for kids on the spectrum. So then I said, okay, if I can't get them to imitate sounds I'm making, let's try some alternative form of communication.
Richie
Hmm.
Lori
So the first one I had tried, given that I had a history of working with children with hearing impairments, was sign language. And sign language was also difficult because of the fine motor skills. If I tried to physically guide the fine motor skills, I ran into problems. So the next thing I tried was picture-based communication. And I had a history of working with picture boards. So I made picture boards, put them in front of the learners and tried to teach them to point to pictures on the picture board. Well, isolating an index finger for a two or a three year old is difficult. And from their perspective, I think what was going on was why am I doing this? She has that car I want, why can't I get it? Yes.
Richie
I just want the car.
Lori
So I was first of all wondering, well, are these kids not discriminating between the pictures? Well, that's easy fix. He wants the car, I'll just cut up the pictures and only put the car and picture in front of him. He had a hard time picking it up.
Richie
Hmm.
Lori
So Andy, I asked Andy to come in one day and watch what was going on and help me problem solve. Went through the whole history with him and he said, well, can you help him pick it up? And I said, well, yes, I can help him pick it up. But then I want him to give it to me as a communication partner. And that's when Andy, the behavior analyst, the expert in teaching strategy said, let's try me sitting behind him, helping him to put the picture into your hand so that you are solely his communication partner, not also the person helping him to give the picture. And that was essentially the beginning of the picture exchange communication system.
Richie
Great. So, wow. So the start was really just this one particular client who couldn't give this the car to ask for the car.
Lori
He couldn't point to it, so I taught him to give it to me. And what I really liked about that is I was separating the role of the communication partner and the helper.
Richie
Wow. Wow, that's amazing. Andy, that, do you remember it the same way?
Andy
I think sitting behind was a little bit more fortuitous than a clever idea on my part. I was just trying to watch and stay out of the interaction. So I was watching a number of failed attempts of a picture in front of him and you know, Laurie was holding the cars and clearly wanted the cars, but trying to get him to interact with a picture was the issue because he was focused on the cars. So I was sitting behind him watching. And again, the traditional methods then were all about pointing. But it was pretty clear that even when Laurie was trying to guide him to point, know, his finger may have been doing the pointing, but his eyes certainly weren't because they were looking at the cars. So sitting behind him, I had a different perspective. And, you know, realizing he needed to he needed to interact with her. It really wasn't about meaning of the picture so much as he had to do something to her. So from sitting behind him, they had isolated a single picture. I just reached from behind him, helped him pick the card up, gave it to her. I tried to stop that, know, being, providing some assistance as quickly as I could. And all of sudden he's just like, every time the card's in front of him, he's just giving it to her. He was happy. He finally had somebody around to understood him.
Lori
And I think what was also relevant was people said to me, why don't you just tell him, give me the card? Well, this was a two year old who wasn't great at following directions. And having, I would try to demonstrate picking up the card. He wasn't a good imitator. So it was really helping him to give me the card by helping him put the picture, pick up the picture. That's what made the difference for this guy. And he got lots of cars that first day.
Richie
Yeah, absolutely. And that's how it started. Thank you for sharing that. I had never heard that before. I appreciate that insider information a little bit. It's nice to be able to peek into the history, so to speak. Can you share a little bit about how you would teach this system to a child or to somebody who's needing it?
Andy
We found was, again, this child picked up this little interaction very quickly. So we had other children entering the program. They didn't have speech. They didn't have sign. They didn't have any functional communication skills. But if you watched them, saw very quickly there were things that they like. Now, the next child, he could care less about cars. You know, he was a cookie guy. OK, so he used cookies and the next one, you he was into crayons and paintings. So, so we had to be flexible right from the beginning, trying to figure out what do you want? It's not about what I want. You know, it's about figuring out what does the child want and then convincing them you're around nice people. What a nice people do. They give you the things you want. That's what a nice person does without making you work too hard.
Richie
Yeah.
Andy
So that's what we started to do. We would quickly get to know a child, get to know what the child liked, have pictures available. And the key was just having a single picture. Yes, we know kids have to eventually learn to discriminate, but that's a different skill. Learning what to do with a picture is not the same as picking out which picture I need right now.
Richie
Hmm.
Andy
So that was the key to developing the steps, the phases and pecs was separating those skills. One was interact with somebody. Okay, cool. Can you ask for something else besides cars? Can you ask for a ball that you like or the cup that you like? All the time trying to teach the kids, you could get many different things. And by the way, from many different nice people before you learn to pick out which picture you need. So that was kind of the unique part of PECS was separating those skills instead of trying to do just picture discrimination and the person and an object and where does the picture go and doing it all at once. You know, like if a child made a mistake, which one did he made a mistake on? He picked up the wrong picture or he gave it to the wrong person or get, and that's where-
Richie
Right.
Andy
-If you will, my view on behavior analysis was try to isolate what's going on so we could address it directly. But Laurie started to do student after student was realized, oh, OK, we got this little language going. He seems to be asking for something. Can he ask across a room? How do we switch from asking to telling?
Richie
Yeah.
Andy
I want to, you know, I want the pencil. It's very different than I see the pencil. But how do we move in those directions? So that's what happened over months and months was Laurie is starting to try to figure out how to what skills were needed. And me and the other behavior analysts, one of the best teaching strategies to get that done quickly. So it's this back and forth between us. It was not, I don't want anybody to think that, know, Laurie and I sat in a room said, hey, we need phase two. What do you think should be in phase two? That is not what happened. It's like the kids were teaching us these were good things to learn. And then we can replicate with another student. Yeah, he picked up that same order about different things with different people. But the language unit, if you will, was very similar. So that's how PECS got put together was watching kids figuring out effective teaching strategies.
Lori
And I think what was career changing for me was starting to listen to Andy teach staff about analyzing the conditions surrounding a particular behavior. When I was taught as an undergraduate and a graduate student, you teach vocabulary, and that was the global goal. And the way we traditionally taught vocabulary was teaching children to either receptively identify a picture or to name pictures. And it never occurred to me that there's variety in the outcomes for using a particular word. So cookie could mean I want the cookie or cookie could mean I see a cookie. And for a lot of my really young learners, I want the cookie was much more powerful than saying I see the cookie.
Richie
We're talking about cookies and I just want it to be known I'm a cookie guy and not a car guy. I don't know if anyone's keeping track but I'm thinking about your second student and I mean.
Lori
Okay, well then what we would start doing is teaching you how to get access to a very specific car, the color, the make, the model.
Richie
Right. So I'm hearing this and I'm hearing what sticks out to me the most in all of this is individualization. Right. It's not just here's what it is. So can you tell us a little bit about the importance of individualization and why that is what that means for the learner?
Lori
Yes.
Andy
Absolutely. The big part of the first step again is figuring out what do you want, what do you like, what do you enjoy? And understanding that changes. Different contexts, different situations, different times of day, those motivational factors change. So we always have to be sensitive. We can't say, even to this first little boy, you're going to ask for a car 100 times today and like it too you know, it would make any sense. You know, and I'm sure you like cookies, too. But if that was all that you had all day long, you know, you'd be pretty tired of it. So we have to watch that. We also have to watch, you know, how kids interact with things. We would see some kids had a very nice, you know, pincers, grass could pick things up really easily. There are the kids that were going at from the side. They didn't-
Richie
Eventually I get tired of cookies, yeah.
Andy
-have that nice thumb, you know, pointer finger control and stuff like that. So you might have to adopt the materials for that learner. Essentially, my firm belief is, I cannot teach a child enough, I understand what the child's doing right now. I don't know where to go if I can't figure out what you're doing. So that takes careful observation. Not me demanding things, it's me observing things. Once I start observing things, then I said, OK. Let's see if we can move that along a little.
Richie
Hmm. So you, Laurie, you started talking about, maybe Andy started talking about it and Laurie, you got some of the credit here, a big part of it, right? The piece from the exchange to how do we expand the communication part, right? Can you tell us a little bit about that part?
Lori
Yeah, sure. A lot of this evolved with my combining my knowledge of typical language development with what Andy was teaching us, the background on how to teach, how to generalize, how to analyze what's happening before and after the behavior. So I started doing this with a variety of other children and when they learned how to pick up a picture and give it to me, my next thought was, well, what if I'm not sitting right in front of him with my expectant look on my face? So that's when Andy taught us, well, let's teach him to, we call it travel. Travel, I'm gonna go get my picture. I'm responsible for my pictures. I know where they are. I'm gonna go get one. And I'm gonna go find someone that I know will be able to provide me with something that I really like.
Richie
Hmm.
Lori
-So we called it distance training, distance and persistence. The persistence is if I go to one person who doesn't really have what I want, they're going to say, I don't have it. I need to find the person who actually can give me access to what I want.
Andy
With that example, by the way, again, the tendency might be for a child to go to somebody who doesn't have it. And then that person says, go to Bob. He has your toy. And so the very next time, who's that child going to? Well, they're not going to Bob. They're going to go back to you because you were so helpful. How do I teach the kid to from the beginning look around? Bob has my toy. Go straight to Bob. So it was problem solving like that, that we had to overcome to keep the kids as independent as possible and not relying upon everyone else solving all the little problems.
Lori
I eventually got to the point where it was, well, he likes a lot of things. I need to teach him the difference between all of these pictures. And that's where Andy was key in teaching all of us who were then doing pecs how to do appropriate discrimination training, but in a meaningful context. So rather than just put in a bunch of pictures and say, touch apple, touch cookie, touch car, we taught them that when you want an apple, give me the apple picture. When you want a car, give me the car picture. But I was still wanting to expand beyond, I mean, when children learn single words, there's a point in which they start combining words. So we started teaching them to say, I want the car, I want the big car, I want the big blue car. And then we started teaching them things like, I see the car, I see the car driving. So what was nice was Andy was leading the teaching strategies. But the speech pathologists in the program, we were happy because we were expanding vocabulary. We were teaching both requesting and commenting. We were teaching how to ask a question, answer a question. So we were checking all of our boxes with the picture-based communication system.
Andy
Just to clarify, one day Lori comes into my office and says, I'm teaching the kids how to put together, I want ball. And so I created this thing that the kids could put the pictures on and they can still hand that off to me. We now call it a sentence trip. Laurie invented the sentence trip. There was no such thing before. But that was, okay, so what's the best teaching strategy? How do we teach kids to go from handing over a single picture to putting two pictures on a sentence and still hand that over?
Richie
So amazing.
Andy
And then once we saw that, Laurie started to realize, well, now the kids are hanging around me a little bit more while I'm looking at the pictures so we can teach the kids to point to the pictures while I'm talking. That led to a completely different strategy. What happens if we pause in the middle of that? I want…And that's all in four seconds, folks. And you're irritated that I'm pausing for four seconds, but that's what it takes, four or five seconds. just like us, some of the kids were a little bit like, well, just, you know, cookie, give me the cookie. And we started to get some speech. Now, not every kid does it. It doesn't make the kids speak, but, know, it gives them that opportunity. And then you can have your party when it happens. And if it doesn't happen, you move on.
Richie
Yeah.
Andy
He still used the pictures to get the item. Maybe it's not quite as exciting as speech and pictures. But he's successful. The kids don't fail when they use pictures. They simply get a little bit more if they're doing both.
Richie
It's so amazing. mean, we're talking about this. I just want to pause for a second because we're talking about sentence strips as like, you know, they're as if they've always been here and they've always been used. And I'm thinking about myself and my first classroom and how many of my students were using sentence strips. And at no point in that time that I expect that I would be having this moment. So just a, just to pause and say thank you both. Yeah.
Andy
Yeah.
Lori
Yeah, I think they found ancient sentence strips in caves now
Andy
-With our velcro on to all clothes that we used to wear too.
Lori
Yes, yes.
Richie
Yeah, yeah, absolutely.
Lori
But I think also what's relevant is with the advent of speech generating devices and apps on tablets, they all have a message window, which is the same thing as a sentence strip.
Richie
Hmm. I want to get there in just a second, Lori. I think that brings up a great point about technology and we would be remiss if we didn't get to that. But before we do that, the thing I'm hearing a lot from the two of you is this collaboration really across functional individuals, right? Cross functions, if you will. And I'm just curious about your insight in the importance of having sort of a diverse team of not just a speech pathologist and a behavior analyst, but also the parent and whomever else may be there. Just curious your thoughts on that.
Lori
think what was life changing again for me was being in the classroom where I was watching the teaching staff. I got to sit in Morning Circle and teach communication during Morning Circle. I got to do it on the playground at recess and in the cafeteria. I worked with a lot of occupational therapists who helped me with kids who did not have great grasps. So they were having trouble picking up the picture or using a pointer when they needed something in particular, the behavior analysts in the program, starting with Andy, really taught me a lot about, it's not just that it's an undesirable behavior. First of all, who's defining undesirable? And if it's a dangerous behavior, here's ways we can change it that don't involve anything that's scary or unethical. That kind of collaboration has, I think, really, really allowed me to become a better speech pathologist.
Andy
And I think part of what I learned from working with speech pathologists is that their knowledge of the order and sequence and what to expect mentally. I mean, for me, classic stories, a behavior analyst finds out that Billy's favorite item is a snake and he's two and a half years old. And so I'm going to teach him snake. When I go to a speech pathologist, she's laughing at me and go, what's so funny about that? He's not going to say it. It doesn't matter how motivated it is, that behavior is not in the repertoire, so you can't get it under innovative control. You know, so it has to go back and forth. We work with teachers who talk about, you know, here's what's in the IP, here's what's the family want. You know, these are very important skills. How do I start introducing color and size and shape?
Lori
Yeah.
Andy
Okay, so, you know, it's not from, it's a list. It's observing a child living a life and having everyone observing that life going, this is important. this is important. And that's where, you know, the collaboration is necessary. You know, I cannot proceed by myself and a speech pathologist shouldn't proceed alone. Those are crucial lessons.
Lori
It made me realize that in graduate school I learned a whole lot about what to teach, not very much about how to teach.
Richie
Hmm. I'm writing that down. That's a, that's an interesting, that's an interesting thought. No, I mean, it's so true, right? I, I think it's so important. And, the thing, the other thing that I'm hearing from each of you, and I'm curious to your thoughts on this as well. One of the things that I always thought was important was making sure that the parents were involved because having communication, you know, as an example, having communications with the speech pathologist is great and being able to get your needs met there is fantastic. But if that's all you ever have, how hard for an individual to say, man, I really want a cookie, but I don't have, this isn't the right place or time, or I don't have my system, or I don't have any way to get it, and now I'm frustrated, and I'm just thinking of it from my perspective. If I could only use my voice in certain settings, that would be really frustrating. And so I think that's an element too.
Lori
Yes. Yes.
Andy
Well, my example is, imagine as a parent, you know, of a child attending a typical school, and the teacher says, Andy's doing a great job of reading in school, but he won't be able to read at home. You just look at the teacher going, what are you talking about? You know, so.
Richie
Hmm. Yeah, that's not a functional, that's not a life skill then.
Andy
Well, what is that? It's a parlor trick, if you will. And so for us, if we're going to teach pecs, well, of course it has to show up in all the environments. It's not for us to do at school or in an office in the school, things like those are interesting. But that's not the point. The point is, if I'm teaching you communication skills, you're using it in all these environments with all the people you're interacting with. yeah, the parents are, you-They're essential. They're not a dad. Oh, yeah, let's get the parents involved. No, no, no. From the very beginning, it's like, oh, how do we get the parents involved?
Lori
And in the United States with our system of individualized education programs or IEPs, we develop very, very behavior-specific goals for all the steps within PECS, but we always wrote in generalization parameters. And one of those was this has to happen at home and in the community too, and other parts of the school building. And that was what we considered critical to successful communication.
Richie
Yeah. You, I have so many questions, but my first, sorry, my next question is, you you mentioned in the United States, you're doing this work, this pecs is used all over. It's not just here. Right. So how, I'm curious, how is it different here in our, in the United States school system versus elsewhere? And what are some of the, I don't know, compare and contrast for us a little bit.
Lori
Yes.
Andy
Yes. Yes. Our first observation is the kids are the kids. Sorry, the kids are the kids, and I'm sorry, the parents are the parents, because the parents are stressed everywhere. So they're in different systems and different schools and different philosophies of what to do and how to do it and what they look like. And you take your shoes off when you go into the class. There are a lot of different skills in different places. And some use chopsticks, some use forks. So you have to do all that.
Richie
Absolutely.
Andy
But we also found out that language is not the same. Sometimes syntax and structure, it's rather than I want cookie, it's more like cookie give me. so, okay, so wait a minute. So the set's going this way and the picture's going that way. So then we had to stop and think and talk about, okay, so what's the teaching strategy? Is that a forward chain or a backward chain? And what's the right order and where does it go? So we would sit down.
Richie
Interesting.
Andy
And our whole point is like, if you think about just in English, formally it's I want ball. But what are little kids actually saying? It's probably more like wanna ball. We don't think wanna ball is a word. So we write it down as I want ball. we- Yes. So what we all do, that's what we're all saying is that your expectations should be for what the newest-
Lori
Hey, we give him credit in speech pathology.
Andy
-speaker in your culture does. What's that phrase? You know, so don't simply translate that our phrase, our carrier phrase in English is I want, I need to know in your language, what is it that little kids say to attach to distinguish, you know, that want from see or feel or hear all those other things? What are those phrases? Because guess what? Every single culture, it changes as the kids get older.
Lori
What I find fascinating too is as we're teaching children to build sentence strips, in English we use a forward chain. Several of the languages that are using PECS now, it's a backward chain. And that kind of specific teaching strategy and knowledge about it and celebration of it, I think that's very, very powerful in getting success.
Richie
Hmm. Well, and I think that's the beauty of it, right? You can modify it to meet the need wherever the need is, whomever it is, whatever the want is, ball, cookie, any of the things, right? And you can make the adjustment to make it functional for that individual and their family and their immediate team, right?
Lori
Yes.
Andy
Early on, found the reality is economic factors influence how you teach, what you teach, what materials you use. So for us, printing in color 30 years ago wasn't a big deal. We were in countries where they were no color printers. So staff would take black and white.
Richie
Yeah.
Andy
printed out things and get a crayon or an ink pen and draw it in. We went to school one day and a teacher drew this perfect miniature Coca-Cola bottle. We were just like, wow, that's really stunning. So what we found was those material issues that we might think are barriers for us, they're not. When we make pictures in this culture, boom, they go and do it. And the parents go do it. I mean, we were environments, know, parents had communication books with hundreds of pictures all, you know, hand drawn, but they figured out how to protect them so they would last and not disintegrate, you know, very quickly. And it wasn't a pain to them. It was so valuable that their child could now communicate that, you know, it was a tiny little effort to support that communication skill.
Richie
Andy, I'm afraid to admit that at some point in my career, maybe in my earlier years, there was a time where the color printer didn't work. And so we printed in black and white and then cut it out and then colored it with a marker or a crayon or whatever, and then laminated it so that it would last forever. And you could always tell the beginning of the year PECS word versus the end of the year PECS word, one is held together with duct tape and the other looks beautiful.
Lori
Yes, but that's beautiful. That's beautiful because it means it's been used. And the secret to laminating is use five millimeter lamination thickness, not three.
Andy
Absolutely.
Richie
Absolutely. Yeah. Yeah. That's a whole, we could have a whole separate podcast episode about laminating glory. so, so, and Velcro, right? Yeah. so you mentioned this earlier and I want to get to it. You mentioned technology and, and, know, PECS has been around for a while and technology has changed during that time. How, how is, how is the, the PECS system keeping up with technology?
Andy
Hahaha!
Lori
Yes, and Velcro.
Andy
Let me just make a little comment that Laurie will elaborate on it. When we develop PECs, we were doing that in the mid late 80s. First publications are coming out in the early 90s and lots of other people start to have publications on PECs. are over 400 publications on PECs from something like 70, 80 countries around the world cannot keep up with the literature. There were 70 in the last two years. So I can't even track them all. But when we were developing this, there were electronic devices out there. They were $10,000. They were clunky as anything. They weren't portable. But the technology existed because that technology did not develop in autism. It developed in other parts of AAC.
Richie
Hmm. the big, the, yeah.
Andy
And then people said, well, maybe kids with autism can start to use it. So the technology was there. And then guess what? The first modifications for kids with autism were published in the early 90s with replication starting to spread. So it fascinates me that people think, oh, because the iPad is new, it means the technology is new. know, the device is different, but the idea that you can have an electronic communication system built in that quote would speak, that's been going on for over 40 years and the publications are parallel. sorry, have to admit some people say, know, PECS is old, you have to use new technology. You if you look at the history, it co-developed. It wasn't that we were the ones pulling the dinosaurs off of the hills and stuff.
Richie
Yeah.
Lori
I think what I'm seeing now some of what I'm seeing now worries me. I'm seeing a one size fits all approach in lots and lots of schools, so every student gets the same app on their iPad. And I'm also seeing the premise that children should have access to all the vocabulary on the device from the very moment they start using it.
Richie
Hmm.
Lori
And when I go back to how typical language development occurs, they start with a single word, then they learn two words, and then they learn the difference between those two words. So when I see device abandonment, it's usually because the response effort is so high and I can't get to the right picture or there's only two pictures on the whole device that I want and it's 17 button pushes to get there. I think there are better teaching strategies that we could bring.
Richie
Hmm.
Andy
-make sure to teaching kids to use speech generating devices. But what I say to a lot of people with the early, the very young kids is the research now supports that the majority of children under four Andy, five, who use PECs with fidelity start talking. And they're not gonna need any kind of alternative or augmentative communication. We don't have that same research base with speech generating devices. In terms of the size of that impact, if you look into research with STDs, with young kids, with autism, the repertoire sizes are very, very modest. And what's interesting is if you look at the most successful ones, they use the PECS protocol with a device. See, having a device or an app on a device, doesn't guarantee the teaching technologies there. So the science is in the technology, but all of our learners need the science of teaching. You can't separate the two.
Richie
Well, I'm using my phone to say I want a cookie and there's no one in the room to hear it, who am I communicating to? It doesn't necessarily matter. It's not functional communication at that point,
Lori
And what happens when your battery's dead?
Andy
Think about this as a parallel for a moment. I have a young child, he cannot read. He cannot read at all, so I want to teach him how to read. doesn't know letters, doesn't know anything about how to read. And I put a keyboard in front of him. And I start trying to teach him how to read with a keyboard. Is there a reading specialist in the country that would say, that's a really good idea? Not one.
Richie
Right.
Andy
Every single one of them say, oh, you need to teach them how to recognize the letters and respond to the letters we call that visual discrimination. And then we'll put it on a keyboard. But sorry, there are people that are putting the device loaded with pictures in front of a kid as if that were sufficient to teach them to discriminate pictures, to interact with pictures, understand the different functional use of the pictures. I'm kind of stunned.
Lori
Richie, what has been powerful for me to watch is what I've learned from behavior analysis about you have to look at how difficult the behavior is, how many steps there are, the response effort. And I teach people to write a task analysis for how many button pushes to say cookie. And if it's more than five or six, I see abandonment. And what that means with some of the more popular apps is there's going to have to be a lot of customization. And that then leads to more device abandonment because the teaching staff realistically don't have time to do that much customization. Sometimes it's the speech pathologist with a caseload of 50 in a school program who's supposed to be customizing 30 devices. It's just not possible. So what we're seeing is it's just, you know, I tell people count the number of button pushes to say what this child wants the most and then figure out, can I simplify that any sequence.
Andy
If you will, as the issue of categorical discrimination versus individual discrimination. No typically developing speaking child learns categories of food and animals before apple, fruit, horse, pig. You learn apple, fruit, horse, pig, and then you learn there are different categories. No one teaches animals and fruit.
Richie
then you're under categorize.
Andy
And by the way, an example of a fruit is an apple. But guess what? Kids who are given devices, that's essentially what they're asked to do. You want to find the apple picture? You have to go find the fruit page.
Lori
And once you're on the fruit page, have to do different discriminations between, I mean, you go to food, then you go to fruit, then you go to, so, yeah.
Richie
Right, right. then and then it's, you know, depending on how many fruits there are, it's not on page one, you got to get to page two or three, right? You know, Apple may be at the top, but it may not be. Yeah, right. Yeah, it's so interesting. You know, I learning more about the depth of the response effort on both sides to your point, Laurie, I think on both sides, right, that the teacher or the speech pathologist and the learner and the student, right?
Lori
Yes, it's another couple of button pushes.
Andy
Apple Apple.
Lori
Yes.
Richie
There's gotta be there's there's response on both and there's effort for both. But if it's too much for either one, the system is just not going to work.
Lori
Yes. And I can completely understand in a public school setting, a speech pathologist has a caseload of 60, 70, and maybe 15 of those, and that's usually a lot more than that, are using speech-generated devices. There is no time to do that kind of customization.
Richie
Right?
Lori
But one of the things you talk about, have to understand categories to use some of the more popular apps. What we start doing in the PECS protocol as children get more and more pictures is we add pages to the book and I start categorizing those and putting picture labels. put pictures, you know, I will categorize each of the pages.
Richie
I love you had an example with an arms reach Lori. love that. It's great. Keep going.
Lori
I carry it everywhere I go, not really. But I will start categorizing. Here's your verb page, here's your fruit page, and the front is here's your most frequently used pictures. I'm gonna let you ask for a break, ask for help, tell me stop, tell me go, and then some of your more powerful pictures. But we do start categorizing within the PECS book, and that helps categorization then with the speech generating device.
Andy
Part of that issue also is our early observation of kids progressing through PECS and acquiring speech. What we were seeing was that most of the kids who acquiring speech, had about 80 to 120 pictures in their book. That's still handleable. while I say, as Laurie said, most of the kids are acquiring speech, there are some kids who start on PECS who continue to grow picture vocabularies and do not acquire speech. We do not know why. We don't know why the ones who are speaking start to speak. We don't know why the ones who aren't. We really don't know. But observing that, now you have a child, for example, who is more and more pictures going into a communication book without speech. Well, of course you have to start thinking about other systems. Now, of course an electronic system will be able to have a much, much, much larger vocabulary But one of the things that we observed was, for us, pictures were in a communication book or a device as a function of the child's use of it. Just because a device has 3,000 pictures in it doesn't mean he has vocabulary with 3,000 pictures.
Richie
I they're using all 3000. They could be using five of the 3000.
Andy
Yeah. Yes. mean, again, my analogy to that, you know, to the reading example before, you know, you have a young child learning to read. It's very successful. He could read 80 to 100 pictures. You have him start carrying around the Webster dictionary just in case he's going to need a word. I'm sorry you're laughing at so and everybody else. You would all think that's absurd, but I'm sorry there are people making that argument. He should have access to 3,000 words, pictures. And it's just like - Where is that coming from?
Richie
Yeah, so I know that both of you have have done a lot and and we appreciate our field is better for it. But what's next for you too? I know you're you're continuing to do new things and grow right? What's next? Lori, you're laughing.
Lori
I'm laughing because we're getting old. We want to retire.
Richie
No, we don't want that yet!
Lori
Hah - to me, I want to do more of the same. love traveling. love, I mean, going to Russia and seeing a group of mothers who've been the sole providers of PECS training for their learners. They're the ones cutting out pictures at night, traveling to the different countries to learn the different cultures and the different nuances of language so we can modify how we're doing PECS to make sure that we're honoring the differences in their language and their syntax skills.
Andy
Big part of what create is for us, you will, pecs is a part of a part of the solution. know, pecs is part of functional communication, which is part of a bigger process. We call it the pyramid. It's just a way of addressing all the things that a child will need to become reasonably independent, you know, getting a job because somebody has to pay taxes and being happy or miserable like the rest of us. And so we are concerned about how do we create those environments cross-culturally? How do we do it for kids in France and Poland and China and Japan? How do we get teachers to see, know, this is a long process. You're trying to take a child who's two or three now and is going to become an adult. Tax is part of the journey for some kids. It's not for other kids, but guess what? Functional communication sure is. How do we get people to see that asking for help and a break and you know I need to get away from you I need some quiet time stop talking how do we get them to see that all these are essential for everybody not because they have autism but because they're human beings so that's what we're trying to do is trying to cross-culturally see how people could create these teaching from our side but learning from the kids' side, environments that are sustainable over time.
Lori
One of my ending goals though is I want everyone to realize that communication doesn't happen in the speech room only or in the classroom only. It's something that happens from the moment we wake up to the moment we go to bed. So I can't just isolate one 30 minute segment to teach communication.
Richie
Yeah, that's not that. That's not it, right?
Andy
Yeah, and saying touch red is not a good T2 strategy.
Richie
Laurie, Andy, this has been a treat for me. Thank you so much. Thank you for being so generous with your time. Thank you for the work that you're doing and continue to do.
Lori
Pleasure.
Andy
Thank you very much, Richie. We appreciate talking to you.
Richie
And we'll have to have you back as we hear more about your international projects. So interested.
Andy
Yeah, I would love to.