The Paper

Communication to Reduce Stress Caused by Not Being Able to Communicate

Parents of Non-Verbal Children Diagnosed with Autism Learn to Use PECS as means of

Communication to Reduce Stress Caused by Not Being Able to Communicate

Children diagnosed with autism spectrum disorder often have communication deficits. Being able to communicate with others in the environment is crucial to express their wants and needs. Parents of children diagnosed with autism can become overwhelmed by not knowing what their child wants or needs. It is important for parents to teach their children a functional way to communicate using a method and approach that can be utilized across settings and people. Picture Exchange Communication System (PECS) has been widely used as a method of communication. For this paper, we will discuss and analyze how teaching non-verbal children diagnosed with autism to use PECS as a communication tool will help parents to decrease the stress levels associated by the frustration of not being able to communicate.

Autism spectrum disorder is a developmental disorder in which several of deficits are noted. These deficits include lack of communication skills, challenges making friendships, creating social interactions with peers and family members, and behavioral problems (Scheuermann, & Webber, 2002). Applied Behavior Analysis (ABA) has been widely used as a scientific based therapy for children diagnosed with Autism (Cooper, Heron, & Heward 2007). ABA therapy applies the techniques and principles to a socially significant problem behavior and helps to make a meaningful change on a child’s life. Children diagnosed with autism can benefit from intervention services as early as possible. Early intervention services can be beneficial as initial treatment. When children receive behavioral services such as applied behavior analysis, several of areas of deficits are addressed within the therapy. These areas include but are not limited to social skills, behavioral problems, expressive communication, receptive communication, pragmatic communication, and daily living skills.

When children have delays in communication and are non-verbal, Verbal behavior is used to teach the skills in the areas of deficits. Verbal behavior has been widely used in applied behavior analysis. Children who have not yet acquire language are taught the verbal operants. The verbal operant are mand, tact, echoic, intraverbals, point-to-point correspondence, formal similarity, textual, and transcription (Cooper, Heron, & Heward, 2007). Verbal operants are important to teach children who have not yet acquire language because they can help a child to effectively communicate and express their wants and needs in any setting or individuals once they become generalized. Verbal behavior can help to teach children various ways to communicate with people within the environment.

There are many components that contribute to communication aspects of an individual. Components that are anything an individual can , speak, and or write (Skinner, 1992). Verbal behavior is not only limited to language itself, it is comprised of other variables that together constitutes to the term that was coined by B.F. Skinner as “Verbal Behavior” (Skinner, 1957). Verbal behavior is an important aspect of children diagnosed with Autism who are non-verbal as it can help to learn ways to communicate with other people in the environment (Barbera, & Rasmussen, 2007). In addition, it can help to create that listener and speaker relationship (Cooper, Heron, & Heward, 2007). The speaker learns to express and mand for their wants and needs, while the listener can listen and help the speaker with their needs. When using the listener and speaker relationship, the speaker requests of mands for what they want or need, the listener helps the speaker and provides what was requested. The speaker will learn to associate that when wanting or needing something, all they have to do is request it and they will get it. Thus, reinforcing that behavior and the child will learn to acquire more language.

Luyster, Kadlec, Carter, and Tager-flusberg (2008) conducted a study to assess the language and the development in toddlers who were diagnosed with autism. There was a total of 164 participants in this study all toddlers. Questionnaires and clinical visits in which participants were assessed and videotaped were required for this study. Parents were given the Vineland Adaptive Behavior Scales and booklet questionnaires inventories to answer. A hierarchical regression model as well as the ADOS-G was used to evaluate the results of the study. It was concluded that individuals diagnosed with autism demonstrated delays in the areas of expressive and receptive communications with a prediction of non-verbal abilities and cognitive regression (Luyster et al., 2008). As we can see from the above study, children diagnosed with autism have several of delays in communication. Joint attention deficits, not being able to express their wants and needs, and not being able to process the information or context of others. Children with these deficits can benefit from intervention programs to help them acquire language and increase those areas where there are skill deficits. It is important that children learn language as it can help the child become more independent (Luyster et al., 2008).

There has been several studies done to further evaluate the deficits and language impairments that children diagnosed with autism have. Kostyuk et al., (2010) conducted a study to evaluate further language impairment of children diagnosed with autism compared to children that have normal development of language. A literature review was conducted primarily to investigate what other researchers have concluded about the language impairment on children diagnosed what autism. Using PubMed as an initial cite to research for sources and keywords such as autism, normal language development, and language acquisitions, researchers were able to find articles that discuss the predicting variables and links to language impairment in children diagnose with autism. It was concluded that younger children diagnose with autism demonstrate communication deficits. Children are most affected by pragmatics, non-verbal language, and phonology (Kostyuk et al., 2010). Based on this literature review conducted, children who are diagnosed with autism demonstrate several of characteristics that contribute to the limited language repertoire. Finding a functional way to communicate for non-verbal children is vital. Manolitsi & Botting, (2011) conducted a research on how children diagnosed with autism have language abilities and impairments. The participants were children diagnosed with autism and a second group of children with specific language impairment (Manolitsi & Botting, 2011). Participants were given a pragmatic language assessment as well as the non-verbal cognition test. The results concluded that there was a difference in the receptive skills across both groups of participants. Manolitsi & Botting, (2011) discussed that children with are diagnosed with autism have increased likelihood of having limited receptive communication skills.

Children who are non-verbal can improve their language repertoire. Over the course of the years, children can learn to acquire language and or look for a functional way to communicate. Sigman & McGovern, (2005) conducted a study on what the improvements of language skills and cognitive skills were over time in students diagnosed with autism. Participants were evaluated over time from preschool to their adolescent years. Using standardized assessment, the participants were assessed in their overall cognitive abilities. It was concluded that participants increased their overall cognitive skills thorough lifespan and a small portion of the participants increased their cognitive abilities and language skills in the early stages of their life . (Sigman & McGovern, 2005).

Communication deficits in children diagnosed with autism can be quit challenging for the child because they are not able to express themselves in a way that allows them to connect with the environment. It is also challenging for the parents of children diagnosed with autism because they do not know how to communicate with them, providing them their wants and needs, or simply not knowing why they are crying and if something is hurting. Davis & Carter (2008) discussed that parents of children diagnosed with autism often times present higher than normal stress levels. A study was conducted to analyze the association between the increase of parents stress levels of children diagnosed with autism. It was conclude that parents of children diagnosed with autism are more stressed and have higher risk of depression (Davis & Carter, 2008). Hutchison, Feder, Abar, & Winsler (2016) conducted a study to determine the relationships between the parental stress, the style of parenting, and the overall functioning of children diagnosed with autism and ADHD. Parents were to fill out stress questionnaires and participants were to participate in the Peabody Picture Vocabulary Test (PPVT) (Hutchison, Feder, Abar, & Winsler, 2016). Using a Pearson correlations to analyze the data, researchers examined parenting styles, relationships between parenting and the stress encounter by parenting styles. It was concluded that parenting styles had a huge impact on the stress expressed by parents. It was also concluded that parenting styles can in fact hinder the overall functioning of the child (Hutchison et al., 2016).

The Picture Exchange Communication System (PECS) has been widely used since 1984. When using PECS, we are using it as a mean of communication and be able to teach a child diagnosed with autism how to communicate with others in the environment in a functional way. Frost, (2012) discussed the five phases of PECS and how each phase serves as a stepping stone for the next phase. Phase I of PECS is all about children learning what to do with the picture. Learning the handing over the visual to a peer in order to receive what is on the picture. The second phase is the same as phase I but a bit more challenging as the visuals aids will not be placed so close to the child and they will need to move around to achieve that exchange. Phase 3 and 4 are about learning to distinguish the visuals and how to form a sentence. The last phase of PECS is when everything comes together as the child has already learned to merge phrases together and now will be able to request for items and answer questions (Frost, 2012).

As we can see from the description about of how PECS work, it is a great tool to utilize and learn how to communicate with children diagnosed with autism as they are acquiring an alternative, yet functional way to communicate. Flippin, Reszka, & Watson, (2010) conducted an analyses of the usefulness of PECS. Reviewing previous work on the usage of PECS. It was concluded that PECS in fact can be a potential mean of communication for children diagnosed with autism (Flippin, Reszka, & Watson, 2010). To further analyze about the benefits of using PECS, Greenber, Tomaino, & Charlop, (2014) conducted a study on the on way to elicit vocalizations in children diagnosed with autism. PECS training was used with participants to evaluate the vocalizations throughout the PECS training. In addition, children who were non-verbal learned to elicit vocalizations at the end of the PECS training (Greenber, Tomaino, & Charlop, 2014). Thus, it was concluded that children diagnosed with autism and who are non-verbal can in fact learn to use PECS and teach them to make verbal response and learn to communicate (Greenber, Tomaino, & Charlop, 2014).

PECS has many benefits when used and taught properly. Parents can help their child become more independent and teach them a functional way to communicate. A study was conducted to evaluate how PECS can be used as a form of communication. Schwartz, Garfinkle, & Bauer, (1998) conducted two studies on children with diagnosed with autism that had severe language deficits. Participants were young preschool students and it was concluded that they in fact are capable of learning how to use PECS as a means of communication (Schwartz, Garfinkle, & Bauer,1998). In addition, children were observer during activities and were noted to use PECS and learn to communicate while manding for their requests (Schwartz, Garfinkle, & Bauer, 1998). PECS can in fact be a functional way to teach non-verbal children how to communicate and express their wants and needs to their peers, family, and parents.

As we can see from the above information, parents who have children diagnosed with autism face many challenges. These challenges are due to the many skill deficits in children including but not limited to being non-verbal. These challenges with communication can be helped by teaching an alternative way to communicate such as using Picture exchange communication system (PECS). Parents learning to used PECS can help themselves to decrease parental stress that they may encounter in addition to the communication skills that they are helping develop in their child. Learning the 5 phases of PECS can be tricky for some parents, but it’s crucial that they thrive for the best and learn the phases as they build on each other.

PECS has been a widely used as a method of communication for children who are non-verbal. As PECS advances on to different phases, parent participation is crucial. Brignell, Song, Zhu, Suo, Lu, & Morgan (2016) emphasized that language is a functional way to communicate. It should be taught to children diagnosed with autism as is a skill that will be utilized throughout life (Zhu, Suo, Lu, & Morgan, 2016) Several of studies were conducted on parents implementing the usage of PECS. It was discussed that PECS is an effective way to teach children to communicate. The pictures used in PECS can be useful and a meaningful way of communication and interchange demand (Carr & Felce, 2007; Chaabane, Alber-Morgan, & DeBar, 2009; Paden, Kodak, Fisher, Gawley-Bullington, & Bouxseing, 2012). These can later be generalized to different settings and people in the environment.

Pastor-Cerezuela, Fernandez-Andres, Tarraga-Minguez, & Navarro-Pena (2016) discussed that parental stress can be higher if the child has a lower functioning level. It is important that parents help their children acquire a functional way to communicate and be able to utilize that throughout their life. Brown & Elder (2014) suggest that children diagnosed with autism have challenges in producing sound. Children need to find a way to express their wants and needs and without a functional or alternative way to communicate, behavioral problems and stress will be higher (Brown & Elder, 2014).

Conclusion

Parents who have non-verbal children experience higher stress levels by not being able to communicate with their children. Not understanding what their child wants or needs can be stressful for parents and it is crucial that they help to teach their children a functional way to communicate. PECS is a method that helps non-verbal children how to mand for items (e.g., milk, cookies, water etc.) in addition to helping them form sentences (e.g., I want milk). Parents who help to teach their children to use PECS are not just teaching them a functional way to communicate, but they are also teaching them a life changing skill. This skills can be generalized across settings and people.

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