I have been having a lot of thought lately (& discussions) about getting kids past that hurdle of understanding. Reading my blog might give others the impression it was easy for us, and somewhat miraculous and years down the track it almost seems even to us that it is!
It helps to have a motivated child who is keen on learning and receptive to what they are being given and shown. Perhaps now at almost 8 years old our son seems to be that way. However, that wasn't always the case.
He complained, he refused to look, he wouldn't let you redirect his hands, he wouldn't even engage with the iPad originally and certainly didn't have the fine motor skills to manage it. He has astigmatism and won't use his glasses so his eyesight isn't the best either. These are all factors that go against his being successful with ANY form of communication. For years we just got grumps and passive acceptance of whatever he was given, he just learnt to be Ok with whatever was going on and we had a lot of bad behaviour formed out of frustration. We always gave him Marmite on toast but when he learnt to communicate we learned he actually loved Honey which was why he tended to throw away his toast and not eat it!
At the beginning I totally expected my son to 'see' and understand the pictures he was given, to associate that a picture of cheese was actually cheese. But somehow he didn't get it, I could tell him that the photo I was showing him was cheese and he would be happy with that, he would accept that it was cheese even though he knew it wasn't edible and totally wasn't cheese, it was just a PHOTO of cheese. Herein lies the problem, we as parents and adults know that a photo of cheese, is just a photo of cheese, we know that we can go into the fridge and get some cheese and cut a piece (or unwrap a piece) of said cheese. Your child knows you have cheese somewhere, probably in the fridge and they know a bit of complaining and maybe even fussing at the fridge will make you guess they need or want some cheese. Maybe every morning tea they get cheese and they look forward to that special time the cheese miraculously arrives in front of them. However one morning you don't give them cheese you decide on a piece of apple instead. But they wanted cheese! Ensuing complaining and behaviours start. We don't get it, they love apple, but suddenly they are upset! If ONLY they could tell us what the problem was, maybe they're sick? tired? Did we say something wrong? Who knows?
We might try signing, trying to ask lots of questions and add to the kids confusion.
This is the scenario we are faced with, so we maybe with the help of an SLT create a bunch of PCCs (Picture Communication Cards) or PCS. Usually they are large photos of desirable items, like cheese. We encourage our kids to look at these photos, we explain they are cheese, we expect them to get it, and we feel defeated after weeks of showing them the photo of cheese, telling them its cheese and they refuse to touch it appropriately in order to get cheese. When we test them by showing them a picture of socks and a picture of cheese they happily touch the socks photo and expect to get cheese. We suddenly realise our kids didn't really understand the photos and we wonder if they are as smart as we think they are if they continually choose socks instead of the cheese photo.
Well I am about to shock you...STOP RIGHT THERE!!
I've been there too, its disheartening, its confusing, bewildering and causes you to re-evaluate everything you think, do and expect. You can completely give up and think your child will never get it. THEY WILL AND THEY DID....
Something I found was that the SLT's never mentioned the obvious. Your child DID get what you were trying to get them to do, they DID communicate. They may not have chosen the right card but they DID CHOOSE. What you did was Step one in a long process, you got them to understand what was expected in this communication journey. They learnt that in order to get what they wanted (whatever it was) they had to touch a CARD to get it. That is enormous! That is communication! That is progress. So DON'T feel defeated, don't think your kid is stupid, because they are not. They got what you were trying to show them. If they do something like touch a card (or an ipad button) they get something they want. You have just shaped a behaviour. It doesn't matter what is on the card, or the button, right now they don't really understand whats on that card or button. They understand the concept of doing something to get something else, and thats what we want.
Phase 1 of PECs training is all about shaping behaviour to get a desired result, all that phase is after is getting the child to hand over a card in order to get something. It really doesn't matter WHAT is on that card, it could be anything from a word, to a picture to a colour to anything you feel like. You are teaching them a process first, picture recognition comes later.
We have had to reset before and go backwards and not use cards too, and we still do to some degree use physical objects for choice making. We will often show a banana and a yoghurt say and get him to choose between them by handing us the one he wants. Thats still a useful communication tool. Thats still a choice. In the early days we often at breakfast had two cards in front of him (FOOD and DRINK) and just out of his reach was his weetbix bowl and a drink of milk. Both cards sat in front of those items and we would point at the cards and then at the physical options and say slowly and calmly what each item was. He would reach for the weetbix and we would gently push his hand down to the FOOD card and say 'FOOD'. He often wouldn't look and would again reach for the bowl and maybe start to vocalise angrily. We would then hold the card up and say 'FOOD' again and then hold the bowl up and again say 'FOOD'. He would just continually reach for his bowl and complain getting quite teary. It took a LONG time to shape behaviour into touching a card and get past the tears and frustration. Many times we wanted to give up and didn't think he would ever get it. We have discovered with many things with our son that everything TAKES TIME. I really wish there was an express train to training but there isn't. At the beginning don't expect your child to understand the symbols, photos or whatever you are using. Get them instead to step one, understanding if they want something they need to first do something for you. Shape that behaviour and you have success. Eventually you can teach them the point of each card. You need to first motivate them to communicate and to want to do something for you so you can do something for them. Find what their motivation is, a favourite toy, a DVD they love, some food or drink they MUST have, a trip to the park. Whatever it is, you need to say to them 'Well if you want this then you need to do this for me first'. They will get it quickly, trust me. But whatever you do it must be a positive and successful experience, don't set yourself and them to fail. If you are offering them cheese then have it ready to give straight away, no fussing, no going to the fridge, no going to cut it or otherwise. If you're setting up the environment for success have the object nearby to associate with. In the case of the park you might drive there in the car and then point at it and a picture in your hand and ask them to touch the card before then getting out of the car and going to the park. If they don't touch the card you might instead drive off up the road and try again. Focus on the learning on days your doing that, don't be distracted by other things or the child will learn that the phone ringing or a sibling being involved is all part of the process and will expect the phone to ring before they touch a card and get what they want. Kids are literal. They learn process. If one time they were successful in getting what they wanted but the phone rang in the middle of it or you spoke to their sibling to get the item, you may find they refuse to do the same thing a different day and wait passively or don't engage because they are waiting for the phone to ring or the sibling to arrive to start the whole process. Try and make it a quiet time with little distraction, I know how easy that sounds when I only have one child, but for the beginning process its what you have to do. ANY distraction will ruin yours and their success.
Take heart, it does seem a tough road but once you break through you can quickly leave that behind.
PS> heres a great link discussing Teaching using repetition: http://www.autismmind.com/Teaching_Strategies_srk/Repetition_cnk/