PECS....目前比较有效的方法

binny

这个是从我一个读博士的朋友来的，她的课题是自闭症儿童的。这个训练系统是美国的。根据research的结果，效果不错。不知道中国有了吗？

PECs
[ by Jason M. Wallin ]

The Picture Exchange Communication System (PECS) is an augmentative communication system developed to help individuals quickly acquire a functional means of communication (Bondy and Frost, 1994). PECS is appropriate for individuals who do not use speech or who may speak with limited effectiveness: those who have articulation or motor planning difficulties, limited communicative partners, lack of initiative in communication, etc.

In my experience, PECS has a number of advantages over other methods of addressing communication:

Each exchange is clearly intentional and readily understood. When a child hands you a picture or sentence strip, the request or comment is quickly determined. The child is given an effective avenue for swiftly and easily meeting his needs.
From the start, communication is initiated by the child. Children are not drilled in rote responses to specific phrases or instructions, rather they are encouraged to independently seek out communication partners in naturally occurring settings.
Communication is meaningful and highly motivating. Reinforcement for communication is natural and strongly rewarding.
Materials are cheap, easy to prepare, and portable. A PECS symbol can be as simple as a hand-drawn picture, or a snapshot.
With PECS, the child has an essentially unlimited pool of potential communicative partners. Anyone willing to accept a picture is available, not just those who understand sign language or who are familiar enough with the child to understand him despite his articulation or motor planning difficulties. Children are able to generalize communication to a wide circle of people very quickly.
I know that the decision between PECS and sign language as an augmentative means of communication is often a source of concern for people dealing with non-verbal individuals or those with very limited verbal ability. Personally, I love the concrete and consistent visual nature of PECS and the fact that it doesn't require the more difficult motor planning that many signs do. I like, too, that PECS symbols are often very quickly acquired, and that they can be rapidly generalized across many aspects of the child's life, without having to teach staff, family, and peers a number of signs along with the child. However, while there is little to support the idea that PECS (when done correctly) will impede development of speech, and in fact there is some evidence that the use of such systems enhances the development of speech (Silverman, 1996), the theory among some is that sign may be more effective in developing speech. The thought is that sign, like speech, is a topographic form of communication (a form wherein each word requires a different behavior, specifically a difference in muscle use, be it the muscles of the hands and arms, or of the lips, mouth, and tongue), whereas picture exchange is a selection-based communication system (where a single set of behaviors, selecting and exchanging, is necessary). The more complex, topographical nature of sign may lead more naturally to speech than the use of PECS. I haven't the background to speak on this point much further, however.

When the team that works with a child has decided that a picture exchange system would be an appropriate means of augmentative communication, it is important that the child have access to and be successful with that means of communication throughout his day. The child should have his pictures available to him at home, on the bus, at school, at friends' houses, out in the community, everywhere he might be. Of course, you may use a smaller, more limited picture book at grandma and grandpa's house than at school, but the child should still have access to those pictures which are applicable to each situation, so communication is not just an "at home" or "at school" thing.

The Phases of Picture Exchange
There are typically six phases through which one moves when teaching a child to use a picture exchange system. While these phases should be approached and taught sequentially, there may be times when a student is working on two or more phases simultaneously. For example, if the child is discriminating between a fairly large number of pictures pretty well (Phase III), you may well want begin work on Phase IV and begin teaching sentence structure with the symbols. You can do this while still working on Phase III, trying to increase the child's discrimination skill.

Phase I
The first lesson we want to teach in the PECS program is to spontaneously request items or activities. To do this we first need to identify what exactly the individual wants, those things for which he would be willing to make a request. As soon as I can get it converted into a PDF file, I will include here a vocabulary selection worksheet to help guide a team through this initial stage of a PECS program.

This first phase usually requires two teachers or family members to work with the child. The first adult (the person with whom we want the child to address most of her first requests) entices the child with an object that she really likes. The role of the second adult is to stay behind the student and wait for her to reach for the item, and then to physically assist the child to pick up the picture of that item and hand it to the first adult. When the first adult receives the picture, he immediately gives the child the reward, along with an appropriate comment (e.g. "Oh, you want a raisin!"). As soon as possible, the physical assistance from the second adult should be faded out until the child is exchanging a picture for the item independently with the first adult.

Because the goal is for the child to initiate communication, for him to ask spontaneously and not simply respond to our requests, we as teachers and parents need to resist the urge to ask, "What do you want?" or to use other verbal prompts. We want the child, from the start, to seek us out.

Phase II
Once the child can reliably exchange a single picture, independently making a request of a single adult for a very rewarding object, the move is made into the second phase of the process. The child now is encouraged to use greater spontaneity and persistence, and to generalize the skill he has acquired. The child continues to request very motivating items or activities, only now he is required to move a longer distance to get to a communication partner or to get to the picture. He also begins to make requests in settings different from that in which he was taught the initial phase (different rooms, at the park, at the store, etc.), and with a variety of different people (parents, grandparents, teachers, siblings, schoolmates).

The child also begins expanding his vocabulary of symbols, requesting different reinforcing objects or activities. He is still encountering only one symbol on a board at any one time, however.

Phase III
In the third phase of the PECS system, we begin to ask the child to discriminate between a number of items on a board, making choices as to what items she may want, or activities she may want to try. The child begins by answering forms of the question, "What do you want?" but these are faded quickly so the child will make choices spontaneously as well as in response to a question. If discrimination is a new skill for the child, one should begin with a very small array, usually just two items. As the child becomes more comfortable with discriminations, a third item can be added, and so on, until the child is quickly and comfortably finding objects from a large array of pictures (maybe several pages with a dozen pictures on each page).

Phase IV
Once the child is easily discriminating between and making requests for a variety of items, to a variety of people, and in a variety of environments, the program begins to focus on sentence structure. The child is taught to use sentence strips to make longer requests. The child will start combining a picture for "I want" with a picture of the requested item or activity. The two pictures will be attached to a sentence strip and the entire strip would be exchanged with the communicative partner for the pictured item or activity.

Phase V
The fifth and sixth phases occur at the same time, focusing on different extensions of the child's skill with picture exchange. The fifth phase extends the sentence structure begun in Phase IV. Adjectives and other words can be added to the child's repertoire to help her further refine her requests. For example, she could move from " I want candy," to "I want three green candies."

Phase VI
The sixth phase of a PECS system is a fundamental shift in the child's communication and the expected outcome from the teachers or peers. Through the use of pictures for "I see," "I hear," "I feel," "I smell," etc. the child will be taught to comment on elements of his environment.

binfeng2000

谢谢.国内也是有用的.

千百度

PECS是什么啊,看不懂英文啊!

mmm

就是图片交流系统。

上海有一个机构，美国人开的，用的是结构化教学和图片交流系统。从我的观点，我不建议采用他们那一套，顶多做为训练的一个辅助部分用一下。

雨晨（爸爸）

支持4楼观点,总感觉此方法没有什么积极性,好象过于务实.

老枪

最讨厌PECS

黄花菜122

不能一概而论，对语言很差甚至基本没有语言的孩子，这套系统是有用的，等于为他们增加了一条沟通的渠道，也能缓解孩子无法正常表达导致的焦虑。

mmm

只建议作为训练的一部分。

其实随着干预的年龄越来越早，没有语言的孩子越来越少了。见过的几个完全没有语言的孩子，两岁多开始的强化训练，每天压肚子口腔按摩，一年以后都会说话了。

还有两个五岁也不开口的孩子，逼了逼，现在也都开口了。有些说不清，但是真的越来越清楚。我相信两年以后他们的语言会不错，观察中。。。

不知道用这套系统是否会抑制孩子语言的发展：他不想说，就不让他说，那他就更不说了。反正我看到的这个美国机构，看他们的教学方法，孩子进步真的很慢。无论老师还是孩子，都优哉优哉，谁也不着急，每天就完成那么几项，然后就下学了。孩子们都是外籍，大概以后有政府管着，家长们也不着急。我跟一个美国妈妈谈了谈，什么ABA、RDI、floortime，瞪着一双美丽的蓝眼睛，一问三不知。

老枪

网管大概和PECS渊源很深,我在6楼发了劳骚,IP就被封了,害得我只好重起MODEM.

多说一句再走人:PECS好处肯定有,但对没语言的孩子促进不大,手语要好一些.如果孩子语言最终出来不了,还得用手语或语言合成器---没见过聋哑人用PECS的.

mmm

我们是在使用了图片交流系统以后，孩子的语言丰富了，并且开始学会讲故事。这套系统对孩子的语言帮助非常大，所以我建议家长们把它作为训练的一部分使用。

自从孩子会讲故事以后，我就开始要求他描述事情，从描述最简单的物体开始，到叙述事情的发生经过。这个时候我就把图片交流系统停了。我认为在训练的过程中，应该有停止使用图片交流的时候。

但是我看到有的机构或家庭在训练中一直使用这套系统，我能感觉到其中的不妥。我看到那些老师或家长每天忙着拍照片，孩子不借助图片仿佛就不能完成一件事情。有个孩子当初和我们程度差不多，可是现在已经不一样了。他现在去趟医院，家里也要先给他看大量的图片。我们现在带孩子出去，只要跟他讲一讲要发生的事情，他就会明白，还会提出自己的意见。我建议那个孩子开始停止使用图片交流，但是这个建议没有被采纳。我感觉那个家长做图片已经上瘾了。

当然每个孩子的情况都不一样。建议家长们根据孩子的情况及时给与辅助或撤出辅助。