As I mentioned before, my twenty-month-old sweetheart is nonverbal. He makes sounds—he’s been known to say “Dad Dad Dad Dad Dad” when he’s happy, “Mamamamama” when he’s sad, “Abada!” and “Abadoo!” when discovering something, and also makes general baby babble. However, he has no words widely recognized by a non-aboriginal language. This classifies Nate as nonverbal.
When he was twelve months old, Nate started to talk. Out of the blue, he gained three words: book (“booh”), ball (which pretty much sounded like “ball”), and kitty (“kit,” in reference to his brothers Jonathan Dangerous and Archibald J. Cat, Esq.). He had the words for about two weeks before they faded. At that point, we didn’t know he was autistic, so we figured he’d parked the words somewhere in his wee little brain and they’d come out to play again. They didn’t—and they haven’t in the eight months since.
If you think about it, language is a pretty tricky thing to teach. Not only does it require a visual/verbal link with items but it also demands that your tongue make some pretty fancy shapes in order to get those words out. Since our cheeks aren’t transparent, it’s not as if Nate can watch how I say things in order to copy me. That’s beside the point though. Nate has shown no interest in naming things that he wants. He knows he wants them but he just can’t figure out how to tell someone who can help him. Out of frustration, he starts banging his head on the floor because he can’t communicate what he wants.
Enter PECS. No, Nate’s not gaining some guns at the gym. He’s learning to talk—through pictures! The Picture Exchange Communication System is a super, amazing, and helpful way for Nate to share what he wants. We started this system a few weeks ago in therapy and, while we’re at the very start of using the system, it’s already made a huge difference.
Nate got a bright, colorful binder from his pal, Miss Lisa. It’s covered in Velcro strips and has sturdy plastic pages, which hold his PECS cards. To start, Miss Lisa selected images of things that Nate likes best: bubbles, raisins, and, of course, Curious George. She also included pictures of activities we do in therapy such as shape sorter, Mr. Potato Head, puzzles, and stacking blocks.
At the start of each therapy session, his therapists now create a “picture schedule” for Nate. It’s a small, laminated paper, folded so that it has a pocket. On the front is a strip of Velcro. His teachers attach four or five activities, in the order that they will be done, to the front of the schedule. We start out the day by showing Nate the activities he will do and he has to point to each one. Then we go back to the card for the first activity so he knows what we’re about to do.
Let’s say the first activity is the ring stacker. Nate’s therapist takes all of the rings and puts Nate’s ring stacker PECS card near him. Nate needs to pick up the card, reach toward his therapist, and release the card in his therapist’s hand in order to get a ring. He needs to put the ring on the stacker and we start all over again with the picture card request. It’s teaching Nate that when he requests something using this system, he gets it. When he’s requested all of the rings for the stacker and put them on properly, he needs to clean up his activity. Then, to demonstrate that we’re finished, Nate needs to sign “all done,” take the ring stacker picture off of the picture schedule, and pop it in the envelope pouch. Then we show him the next activity on the schedule and move on.
Nate’s favorite part is putting away the activity card. Sometimes, when he really doesn’t like an activity, he tries to find the picture schedule and starts tugging at the card in an effort to put it in the envelope. (That doesn’t work….refer back to our “I Hope You Like The Toy You Picked” entry. You have to finish what you started, buddy!) However, it is showing that he’s starting to understand the system. And that warms our heart.
At this point in the game, we’re just using one picture appropriate to the activity Nate’s doing. We’ve done a few random tests with his therapists to see if he can differentiate the pictures (i.e. give him the picture of the cup and crackers and ask which one he wants) and we think he can. But having a book of fifty pictures can be quite overwhelming, and he’s we don’t think he can flip through the book, find what he wants, and bring the picture to an adult. Until yesterday.
I have a spectacular mother’s helper, Olivia. She’s eleven and has her babysitter’s license: she’s trained in changing diapers, feeding jar food, and even has her CPR certification. (To be honest, she’s more certified that I was when I gave birth to Nate.) She recognizes that Nate’s a bit of a handful for her so she comes over one day a week to help me out and gain experience in caring for an unpredictable toddler.
For Valentine’s Day, Chad and I bought Nate a ton of bubble soap and bubble paraphernalia. Thirty bubble wands, to be exact. The wands have disappeared all throughout the house: under the couch, in the bathroom, under Nate’s crib. You never know when one will show up. When we got home from grocery shopping, Olivia and I brought Nate inside, took off his coat and shoes, and set him loose. He ran about for a few minutes and found his super long, bright red bubble wand. He picked it up, waved it around like Harry Potter, and made some sounds. And then, something clicked. (Seriously. It was so loud in his wee mind that I think we heard it.) Nate’s little feet ran as fast as they could to his PECS binder, which happened to be on his playmat. (It’s usually on the bookcase, as it’s only being used during therapy at the moment.) He opened the cover, flipped through the pages, found the bubbles picture, ripped it out, and handed it to Olivia. I breathlessly said, “Oliviagogetthebubbles—quick!” Needless to say, Nate danced in bubbles for the next half hour.
We had Nate “request” bubbles from Olivia using his PECS card. I started hiding the card, putting it on top of a bowl or out of his immediate reach. Instead than getting frustrated, hitting his head or trying to take the bubble wand from Olivia when the bubbles stopped, he went on an all-out search for his card. If Nate owned a bloodhound, the pup would have been employed. Every time, my boy found the dang card. He picked it up, reached, and released it into her hand. Then he patiently sat in my lap and waited for the bubbles to ensue.
There are stages and phases to this PECS thing and I know we’re in the wee beginnings of it. I’ve been told by his therapists that, in order to move on to the next phase (which one therapist accidentally told me what it was—travelling across a room to make a request with a PECS card), Nate needs to do the following things. First, when he picks up a card, he has to give it to whomever he’s making the request of. He can’t fiddle with the Velcro on the back or make the card do a little dance (like he did in therapy this morning). Nate has to pick up the card, reach to give it to a person, and release the card in the person’s hand. He needs to do this pick-up-reach-release 100% of the time over three activities with three therapists in three different environments (i.e. the living room, dining room, and bathroom). That’s a lot of consistency for an adult, let alone a twenty-month-old toddler.
And why the different environments? Well, Nate’s not translating learned skills to other activities. For example, he knows the sign “more” and uses it in his high chair to get more grapes or more toast or more cookies. However, he can’t associate the sign when we’re playing trucks and we stop doing the activity. If he wants “more trucks,” he gets frustrated and bonks his head instead of signing “more.” (I must note that we’ve been asked to stop using the sign “more,” since it’s so non-descript. If he signs “more,” I might not have a clue as to what he wants more of. But if he makes activity specific signs, like “eat,” I can help him. But still….it’s the only clear example I have of stuff not translating from activity to activity.)
We are so excited to have a way to help Nate “talk” and grateful that, so far, the PECS cards have all remained in the binder. I do suspect that some will get lost, mangled, or accidentally wind up in the garbage can but that’s ok. I’m crafty. I can always make him “more.”