A PECS user is transitioning to speech. What is the MOST appropriate approach to integrate PECS with a Voice Output Communication Aid (VOCA)?

The most appropriate approach to integrate Picture Exchange Communication System (PECS) with a Voice Output Communication Aid (VOCA) for a transitioning PECS user involves a gradual, layered fading strategy, prioritizing communicative functions and maintaining the user's comfort and success. PECS is a visual communication system where individuals use pictures to request items, activities, or express feelings. A VOCA, also known as an augmentative and alternative communication (AAC) device, is an electronic device that produces synthesized speech. The goal of integration is to shift reliance from PECS to the VOCA while ensuring the user continues to communicate effectively and doesn't experience communication breakdowns.

The initial phase focuses on parallel use. Both PECS and the VOCA are available and used simultaneously. The user continues to request using PECS, but now also learns to select the same request on the VOCA. This allows the user to become familiar with the VOCA’s interface and vocabulary without abandoning their established communication method. For example, if a user typically uses a picture of an apple to request an apple, they now also learn to press the button on the VOCA that says “I want an apple.” The therapist or communication partner models the VOCA use, demonstrating how to select the message and listen to it.

Next, a layered fading approach is implemented. This means gradually reducing the reliance on PECS while increasing the use of the VOCA. This fading is not abrupt; it’s carefully managed based on the user’s progress and comfort. One common strategy is to introduce 'core vocabulary' on the VOCA first. Core vocabulary refers to a small set of words (e.g., 'want,' 'more,' 'go,' 'help') that are used frequently across various communication contexts. Teaching these words on the VOCA allows the user to express a wider range of needs and ideas than just requesting specific items. The PECS pictures for core words are then gradually faded or removed from the user’s communication book. For instance, the picture for 'want' might be removed, encouraging the user to use the 'want' button on the VOCA.

Another fading technique involves introducing 'novel' requests on the VOCA before fading PECS requests. Novel requests are those that the user hasn't previously communicated using PECS. This encourages exploration of the VOCA’s capabilities and expands the user’s expressive language. Once the user consistently uses the VOCA for novel requests, PECS pictures for similar requests can be faded.

Throughout the integration process, it’s crucial to maintain the communicative function of PECS. This means ensuring the user can still communicate their needs even if they are struggling with the VOCA. PECS should remain available as a backup system, especially during periods of transition or when the VOCA is unavailable. The communication partner should consistently model the use of the VOCA and provide positive reinforcement for successful attempts. Data collection is essential to monitor progress and adjust the fading strategy as needed. The rate of fading should be individualized and driven by the user’s performance and comfort level, not by a predetermined timeline. Finally, the VOCA should be programmed with the user’s frequently used PECS pictures initially, allowing for a smoother transition and familiar vocabulary.