1.  First words should be chosen based on the individual child's interests and motivation. 

2.  Select words the child will use frequently.

3.  For children who are just beginning to speak, select words the child will be able to articulate or approximate intelligibly or agree on an acceptable approximation.

4.  For signing children, select words that are iconic (sign looks like the object).

5.  Avoid first words that are too general or have little communicative value (e.g."more, yes, no, please").

6.  For children who sign, avoid words that will look too similar (e.g. "eat, drink").

Choose a response form based on the individual child

1.  Verbal- For children who are echolalic, even if they are not currently using verbal communication in a functional manner. The reason for this is that the child is exhibiting a behavior (saying words) that we can use to teach him to functionally communicate.

2.  PECS- For children who respond well to pictures or icons. PECS can also be used at the beginning of mand training for children who are vocal but not imitating to teach them the function of communication but they should be faded quickly once the child is requesting vocally. PECS can also be a good choice for children who have difficulty imitating or producing the series of movements that signs would require or respond negatively to hand over hand prompting. (although desensitization is an option) Photos, icons labels or objects can be used. 

3.  Picture Communication Boards- For children who respond well to pictures/icons. These are typically developed around specific activities and allow for a wider variety of communication than may be taught imitatively with signs.

4.  Signs- Either alone or combined with PECS to allow the child access to communication in all environments. Signs can also be a good choice for children who respond poorly to visual stimuli. It may also be a good choice for children who have strong motor imitation skills. Signs may also be a good choice for families who find it difficult to create, organize and keep track of the PECS symbols in multiple settings.

5.  Voice Output Devices- For children who respond well to visual stimuli as well as auditory stimuli. Care must be taken that the child does not use the device for self-stimulating behaviors rather than communication.

6.  Object exchange- For children who have demonstrated an inability to discriminate between pictures. 

Advantages of Object Exchange

1.  Child may easily learn to associate the sample item to the desired item since they are so similar.

2. "Listeners" do not require special training other than what to do when the child gives them the item.

Disadvantages of Object Exchange

1.  Difficult to keep objects accessible to the child.

2.  Difficult to find sample items for many things

3.  Difficult to transfer to other functional language

4.  Limited to primarily teaching the child to request nouns.

Advantages of Picture Systems

1. "Listener" does not need special training.

2. Simple match to sample makes initial acquisition easy.

3. No special training required for individual responses, scanning and pointing, or giving are the only motor responses needed.

4. More static- Pictures are visible for longer periods of time.

5. Can serve as visual prompts for vocal responses for children who are just learning to talk.

6. Do not require physical prompting once the initial responses are taught.

Disadvantages of Picture Systems

1.  Requires environmental support- must have pictures available to communicate

2.  Difficult to "capture" an interest or desire at the moment to teach the child to request because the picture must be made first.

3.  Pointing systems require a "listener" close by. Many responses (points) may go unnoticed and therefore not reinforced in some settings making it difficult to bring the response (pointing) under stimulus control of the desire for the item (EO). This problem is overcome with PECS where the child is taught to deliver the picture to the hand of a person.

4.  Pictures/symbols/icons may be difficult to find and teach for more abstract concepts

5.  It may be more difficult for some children to combine symbols to express a variety or word combinations.

6.  Difficult to transfer to functions of language other than requesting (manding).

7.  Pictures must be created and kept organized, always handy, but away from other children who may lose or destroy them.

7.  Child is able to interact with peers or siblings if they will attend to the child's communicative efforts.

Advantages of Sign Language

1.  Easy to prompt, especially if motor imitation is already strong in the child's repertoire

2.  Stimulus and response often resemble but do not match each other providing a built in prompt

3.  Signs are free from environmental support- child always has communication available (we can't lose their hands!)

4.  There is a single stimulus and single response relation, like speech. In other words, the movements for each sign are different as compared to PECS where the movement of each "request" is the same. 

5.  There is some research indicating children who begin with signs tend to produce vocal speech more quickly than those who use PECS. This would be difficult to control in experimental conditions since all children are so unique. The author has seen children appear to be "prompting" themselves for the syllable structures involved in specific words by performing the same number of movements as syllables when they are first becoming vocal.

6.  Sunberg and Sundberg (The Analysis of Verbal Behavior, 1990) found that signs were more quickly acquired, resulted in more accurate productions, resulted in more spontaneous communications and were more likely to be maintained and generalized than picture selection systems (pointing).

Disadvantages of Sign Language

1.  Parents and teachers must have special training in sign language.

2.  Parents and teachers must use sign when they are talking with the child.

3.  Parents and teachers must shape each individual sign.

4. Signs are fleeting- Unlike pictures, they are "produced" then gone.

5. Children who have difficulty sequencing fine motor movements may have a great deal of difficulty learning signs.

6. Signs for favorite items and activities may need to be "made up".

7.  It may be difficult for the child to interact with other children and adults who don't know sign language.

8.  It may be difficult to prompt children who find touch aversive.

9.  It may be difficult to fade the prompt for some children who might continue to "deliver" their hands to an adult when they want something.

10.  If those in the environment don't recognize the child's signs, many requests may go unrewarded (not reinforced). This would make it difficult for the sign to come under control of the child's request for an item (EO).

Questions to Consider

1.  How does the child respond to touch? While some children can be desensitized to the hand-over-hand prompting required for teaching both signs and PECS, this will take time. It is important that the instructor remain paired with reinforcement so desensitization should take place slowly. 

2. Is the child able to imitate movements with relative ease.

3.  Will the environment support the chosen response form?

4.  How fast is the child learning new requests (mands)? Will the environment be able to "keep-up" with creating the necessary pictures?

5.  Are the child's current requests (mands) primarily food items and objects or do they enjoy many activities that would be hard to represent by a picture?

6.  How many different environments is the child in during the day and with how many different people will he need to request (mand)?

7.  Is it possible to keep the chosen response form accessible to the child throughout all environments?

8.  Is interaction with typically developing peers part of the child's current program and if so, can they be taught the response system chosen?

9.  Are all the "communicative partners" in the child's life willing to learn and use the chosen response form?

10.  How does the child react to sound? Is it likely he will "stim" on a voice output device if that is chosen as a response form? 

11.  How many different activities or toys is the child interested in? 

12.  Will the child be able to transport the response form easily between different environments?

Which System?

When there is no clear indication of which system is best for an individual child and family, the author recommends that the parent choose two items to teach as signs and two to teach with PECS. Make sure all of the items are things the child requests quite frequently (equal reinforcing value). Introduce the systems chosen and see which the child acquires more quickly. Then choose that system as the child's primary system of requesting.

No matter what system is chosen, other forms of augmentative communication may serve to increase the child's awareness and interest in what those around him are saying or doing. For example, some children may attend well to song boards made with icons or placemats with icons involving mealtime. The parent "points" as he/she "talks" with these systems. The pictures actually serve as a "prompt" for what the parent is saying but no response is required of the child. Some children begin modeling this behavior and begin using the pictures in a functional manner to both comment (tact) and request (mand).

If a child is using PECS as their primary system, it may also be helpful to introduce signs for words that are hard to picture such as prepositions and actions. These signs often "look" more like the actual action or location than does a picture and may be more rapidly acquired.

No matter what system is chosen, continue pairing words, sounds and talking with reinforcement! Engage in teaching behaviors that will increase the child's ability to produce sounds and words as well as those that will insure he wants to communicate with those around him.


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