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Developmental disorders, Part 2: Autistic spectrum disorders
Published in Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy, Primary Child and Adolescent Mental Health, 2018
Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy
An individual on the autistic spectrum tends to have difficulties with social communication — both verbal and non-verbal. The level of verbal language varies greatly — some young people with autism may use very few if any words; if so, it is often difficult to assess the intelligence quotient. Such an autist may nevertheless understand what other people say to him. Whether he does or not, he may prefer to use alternative means of communication such as a form of sign language, or visual symbols such as the Picture Exchange Communication System (PECS).9 Other autistic individuals may have good language skills, superficially within the normal range, but nevertheless a literal understanding of language combined with a lack of appreciation of the influence of context on meaning that handicaps their social interaction. Difficulties may arise, for example, with common phrases or sayings such as: ‘Pull your socks up!’ or ‘Get a move on!’ as well as sarcasm and other jokes. Even as innocent-sounding a phrase as ‘Wait a minute …’ may lead to frustration or fury when the adult takes longer than a minute (see also Case Example in Box 32.18 below).
Techniques: Regional
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
The Pecs 2 was a modification that aimed to also block the axilla. It involves a Pecs 1 block and a further volume of local anaesthesia infiltrated either between the pectoralis minor and serratus muscle or between the serratus muscle and external intercostal muscle. It is also performed using ultrasound guidance. It was developed to extend Pecs 1 blocks to be able to be used for operations involving axillary clearances, by blocking the long thoracic nerve and intercostal nerves.
Determination
Published in David Woolley, Adam Woolley, Practical Toxicology, 2017
Potential toxicity to wildlife is assessed by standardized laboratory tests using nontarget organisms such as birds, bees and other insects, and fish and aquatic invertebrates; effects on environmental bacteria are also assessed. Values for LD50 and LC50 are derived together with No Observed Effect Level (NOELs) and NOECs, and these are compared with the PECs. A predicted no-effect concentration (PNEC) is derived from the PEC to arrive at a tolerable concentration that should be associated with no effects. The overall goal is an indication of the overall toxicity of the material compared with the PECs to get an estimate of toxicity set against likely exposure levels. Internationally agreed-upon trigger values are used by the European Commission to decide whether the risk is acceptable or not.
Transitioning from a low- to high-tech Augmentative and Alternative Communication (AAC) system: effects on augmented and vocal requesting
Published in Augmentative and Alternative Communication, 2020
Unlike other types of visually based communication systems or methods, PECS is an instructional protocol that teaches functional communication using evidence-based teaching strategies (e.g., most-to-least prompting, time delay, and backward chaining) that are derived from applied behavior analysis(ABA). The results of several studies have shown that the PECS protocol facilitates the development of functional communication skills in individuals with severe communication impairment (Charlop-Christy, Carpenter, Le, LeBlanc, & Kellet, 2002; Llaneza et al., 2010; Sulzer-Azaroff et al., 2009). Additionally, studies have also reported that some participants show an increase in natural speech production in the later phases of PECS, especially Phases IV and V (Charlop-Christy et al., 2002; Ganz & Simpson, 2004; Preston & Carter, 2009; Tincani, 2004).
Maintenance and generalization of skills acquired through picture exchange communication system (PECS) training: a long-term follow-up
Published in Developmental Neurorehabilitation, 2019
Anneke Jurgens, Angelika Anderson, Dennis W. Moore
Teaching parents to implement and use PECS with their child in the home and community environment is an important component of the program to reinforce generalized use and promote social validity, through functional use of the skill.22 A critical component of the PECS training protocol is active re-structuring of the child’s natural environment to create many communicative opportunities throughout a day for the child to practice and develop fluent communication skills.22 Embedded in each phase of the PECS training protocol is the stop, drop, and talk approach (that is, whenever a communicative opportunity arises, the communicative partner must stop what they are doing, drop to the child’s eye level, and do a PECS trial) to encourage the use of PECS in daily life at every opportunity. This system, therefore, requires parents to use the intervention in a child’s daily routines outside of formal structured PECS training sessions. The PECS is, however, a highly complex manualized program utilizing a variety of technical teaching procedures and adherence to the PECS training protocol is essential to ensure a positive learning experience for the student and their parents/carers, as well as to successfully improve the communication skills of students with communication difficulties. Parents who have difficulties with the program’s implementation may not experience the best outcomes for their child and may be likely to discontinue its use.23
Transferring picture exchange requests to receptive identification for children with ASD
Published in Developmental Neurorehabilitation, 2018
Jennifer Ninci, Mandy Rispoli, Leslie C Neely, Samantha Guz
The Picture Exchange Communication System (PECS) is a commonly used mode of augmentative and alternative communication for individuals with ASD who have impaired or absent speech.21,22 PECS consists of six phases.23 In the first phase, the learner is taught to exchange one picture for a preferred item. Prompting of the picture exchange is contingent upon a learner initiation towards the item (e.g. reaching for an item). Once the learner has provided the picture to the communication partner, the partner immediately reinforces the exchange by providing the requested item to the learner. The second phase focuses on teaching the learner distance and persistence. This phase is focused on teaching the learner to generalize the picture exchange by practicing the exchange in different locations, with different communication partners, and with distance placed between the system and the communication partner. Phase three of the system teaches the learner to select from two or more available pictures. The pictures are also moved to a PECS binder (typically a three ringed binder with multiple inset pages). The pictures are organized in the binder using hook-and-loop fasteners for easy removal and storage. In the fourth phase, the learners will start to construct sentences using their system by adding sentence frames to a strip (e.g. “I want”) followed by the preferred picture. Finally, in the fifth and sixth phases, the learner is taught to respond to questions (e.g. “what do you want?”) and to comment in response to questions (e.g. “what do you see?”) using the system.