Treatment and Therapies for Autism Tips

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What is ABA?

Applied Behavior Analysis

Applied Behavior Analysis (ABA) is perhaps the most popular approach in the treatment of autism and other pervasive developmental disorders. This teaching strategy has roots deep in the Behaviorist approach to psychology. It also serves to break complex tasks down into their most fundamental elements. The child is introduced to a task on its most fundamental level. Once the child masters the first step he is introduced to the next. The process is called chaining . One skill is linked to the next until the child has mastered the task. For example, if a therapist is using ABA to teach the student to color, he would begin with picking up the crayon. If the student follows through correctly, he is immediately rewarded. Once he demonstrates that he consistently follows through the next step would be introduced. Applied Behavior Analysis relies heavily on rewarding desired behavior and redirecting negative behavior. Negative behavior is typically ignored unless it is a non-negotiable like hitting. This approach is the foundation for drills and activities used in the treatment for autism such as discrete trial.

What are the benefits of using technology in the treament of autism?

Benefits of Technology in Autism

Technological devices have proved to be very motivating for individuals who have autism and related pervasive developmental disorders. Many autistic children like to interact with computers and electronic games and these instruments can help them stay on task for longer periods of time. The motivated individual is commonly more receptive to learning. Using pictures, gestures and other technology is useful in encouraging the autistic child to enjoy his learning environment. Most technological interventions, whether low, mid or high-tech are visual in nature. Many autistic children think in pictures rather than in words so using images is a great way to facilitate communication. Technology can be used to teach cause and effect. For example, the child turns the crank on a jack-in-the-box and the toy jumps out at a certain point in the action. The child hands a picture of an apple to his mother and she gives him an apple in return. Individuals who have autism also benefit from using the fine motor skills necessary to manipulate the devices. Fine motor coordination is a major stumbling block for some cases of autism. Technological devices can be used to help an autistic individual type rather than write the words he wants to use.

How can negative behavior be addressed?

The ABC Chart

The ABC chart is a data collection sheet used to determine possible causes for a particular negative behavior. ABC stands for antecedent, behavior and consequence. The information collected can help to address certain repetitive negative behavior. The antecedent to the behavior is what occurs right before the negative behavior. This is not necessarily the specific trigger for the incident but it can be an indicator of what is going on. The behavior itself is recorded then the consequence for the behavior is written on the chart as well. While this seems quite straight forward it does require keen observation as well as some thought. The events that are recorded on the ABC chart are always objective and measurable. The individual collecting data should not interpret the events or add emotionally-charged language in the chart. For example an incorrect entry would look like: Antecedent= child didn't want to sit Behavior= child got mad about being told to sit Consequence= child had a tantrum but had to sit anyway These statements are emotionally charged and they think for the child. The ABC chart is not a summary of the observer's conclusions. It is a collection of observable behavior. The correct approach would be: Antecedent= Child was directed to "come sit" Behavior = Child threw himself on the floor, kicking and screaming. Consequence= Child was physically prompted to take his seat. The second example presents the events in an objective, observable manner. If the behavior is repeated and the information is recorded accurately, the team can determine the cause of the negative behavior. This is not always as simple as it seems. The child may engage in a behavior at a certain time of the day, no matter what activity he is completing. There might be a fragrance or a sound that others might not notice that is aggravating the situation as well. The child may also engage in the behavior for the consequence. For example, the child may like the sensory feedback of the therapist saying, "nope" each time he acts out. He may feel the need to repeat the ritual of running to the corner and whining before each drill. There are many reasons that a child will engage in a certain negative behavior. Finding the source of the problem usually takes some time.

What is safety awareness?

Safety Awareness

One of the most important factors to consider in the community setting is safety. Many children with autism are not fully aware of their surroundings. They also have difficulty with body awareness (the relation of their self to their environment). Cars and steep hills do not feel threatening to many children with autism and they often do not understand the rules when it comes to crossing the street or entering and exiting buildings. Many individuals with autism also like the sensory feedback they receive from running, especially with the added sensation of being outdoors. Drilling the individual with autism on issues about safety awareness is crucial when embarking on community outings. The drills typically involve a lot of physical and verbal prompting to help the child understand what is expected. Rewards and positive reinforcement are important when engaging in safety awareness drills. It is a good idea to save very special treats for the safety awareness drills. The child does not receive the same treat in other settings. Bringing that specific treat into the community setting will help the individual with autism make a strong connection to the powerful motivator. For example, a therapist or parent may want to focus on the command "stop" and they want to associate that command with chocolate chips. The drill would include an image of a stop sign, the verbal cue "stop" and the sign for stop as well. When the cues and pictures are used in the community setting with the presence of the reward, the individual with autism is more likely to attend and follow through.

What is the floortime treatment approach?


The floortime treatment approach to autism and related pervasive developmental disorders recognizes that all children learn through play. Floortime was developed by Dr. Stanley Greenspan who contends that children can regulate their behavior once they are able to regulate their emotions. Greenspan's floortime is a treatment that does not take a behavioral approach. The play activities are rewarding in nature and the focus is social rather than behavioral. The floortime approach is child-centered and the adult involved with the process follows the child's lead as he plays. Floortime involves observation and gradual interactions that are helpful in shaping the child's behavior. A child may love to line objects in a row and the parent can use this activity as a way to open the doors of interaction. The parent would simply add items to the line of objects at first then gradually begin to alter the activity. He could begin by branching the line in different direction. Later, the parent can make the items walk or dance while encouraging the child to respond or imitate.

Should the same interventions be used in all cases of autism?

Autism and the Individual

Many of the interventions in cases of autism and related pervasive developmental disorders seem to communicate a "cookie cutter" approach to treatment. However, each case is unique and interventions and rewards should be catered to the individual. One important thing to remember is that each individual is unique. Interventions that work for one person within the autism spectrum of disorders might not work for another. Taking the individual's strengths, interests and needs into consideration will increase the probability that interventions will be successful. The individual with autism is not the only person to consider when using interventions and various treatment approaches. The person implementing the interventions should be considered as well. An individual who is analytical in nature might fair better beginning with play therapy while a person who is focused on cause and effect might fair better by using behavioral interventions from the start. The autism spectrum of disorders is vast and there are many different levels of abilities and needs among the autistic population. Interventions that are effective with one child might not be effective for another. What is motivating for one child may not be rewarding for another. For example, many children within the autism spectrum of disorders crave hugs and physical contact. Others may not be able to tolerate hugs and excessive physical contact because it is overwhelming to their sensory systems. Using a big hug as a reinforcing reward would be beneficial for some while it would be distracting and uncomfortable for others. Individuals with autism offer a wide variety of strengths and interests. Taking time to observe and consider these characters specific to the individual is crucial in determining which interventions to use.

How is communication addressed in the home environment?


Much of the stress in the home environment revolves around the child's lack of communication skills. Developing ways to facilitate communication will help ease the stress greatly. Part of the focus when working with autism in the home environment is to find ways to express his wants and needs effectively. Once the child is able to communicate effectively, there is greater chance that negative behavior and tantrums will decrease. Much of the negative behavior that is exhibited in the home environment can be linked to frustration and the inability to communicate. Specific interventions that address communication deficits include sign language, the Picture Exchange Communication System and verbal cues.

  • Verbal cues are direct and succinct, consisting of one or two words that are familiar to the child. Common verbal cues are: stop, wait, no, yes, more and all done.

  • The Picture Exchange Communication System (PECS) has yielded great results in many home environments. Families can use the images to help the child transition and complete daily activities like bathing. The PECS can be used as a way for the child to initiate communication as well. The child simply exchanges a picture for the desired object. The PECS approach works well because it is concrete and visual in nature.

  • Sign language is another visual approach that helps facilitate communication in the home environment. Sign language does require some gross and fine motor skills and will need to be taught systematically so the child makes a connection between the sign and the consequence for using the sign.

In some cases, families choose to use augmentative devices that aid in communication in the home environment as well. These mid technologies can be very useful in facilitation communication.

What is the Son Rise Program?

The Son Rise Program

One program has been developed that focus on self stimulatory behaviors and motivation. The Son Rise Program was developed by parents of an autistic boy. Barry and Samahria Kaufmann developed a home-based, child-centered program that uses the child's interests as a way of connecting with others. Rather than discouraging the child from engaging in self stimulatory behaviors, the Son Rise Program embraces them as the central part of the child's therapy. With this approach, the individual who is working with the child imitates the child's self stimulatory behaviors. If the child shifts his weight from one foot to the other while staring at a line of blocks, the therapist does as well. The theory behind this approach is that the therapist and parents enter the child's world in an effort to pull him out. The goal of the Son Rise Program is to encourage interaction by using the child's interests and likes. The hope of making a significant connection that facilitates communication, awareness and understanding is a big part of the program. Once the connection is made the child will reciprocate and interact better.

What is RDI?

RDI: Relationship Development Intervention

RDI or Relationship Development Intervention is like Greenspan's floortime in that it focuses on emotional development rather than taking a behavioral approach. This approach is unique in that it is an entire program rather than a component to other treatments for autism unless the child is nonverbal. Relationship Development Intervention was developed by Dr. Steven Gutstein. The focus of RDI is to create a systematic approach to social interaction and relationship development. The development of social and emotional attachment is strongly tied to the student's communication and cognitive development as well. The fundamental basis for RDI is Experience Sharing, a model developed by Dr. Steven Gutstein. Dr. Gutstein considers normal emotional development as well as the special circumstances and obstacles individuals within the autism spectrum of disorders face. A parent can engage the child in a game of peek-a-boo. This game is ideal because it encourages the child to reference the adult's face.

What is mid technology?

Voice in the Box

Mid technology in the treatment of autism and related pervasive developmental disorders involves electronic devices used to aid communication. Many individuals who have autistic disorder never develop speech. However, many do have the capacity to receptively understand language. Mid technology provides the means of expressive language that the autistic individual lacks. Common devices used to help an individual express himself include a tape recorder as well as devices created especially for communication. The Voice in the Box is an augmentative communication device that contains recorded messages that correspond to buttons with images on them. The individual uses the icons on the buttons to determine what message he wants to play.

How are visual schedules used in community settings?

Visual Schedules

Taking a visual schedule into the community setting may not seem like the most convenient approach but it can be very helpful. The visual schedule is valuable because it provides concrete images of what to expect and what is expected in the community setting. The schedule can be as detailed or as brief as necessary. These familiar items are used in the home and school settings and they are helpful in building expectations and providing instruction. Transitions are always difficult but if a visual schedule is designed that outlines the events that are about to occur the individual with autism will make smoother transitions. A simple schedule would include the following: Car Walk Shopping Cart Wait Cashier Walk Car Home All Done The focus of this visual schedule is the transitional moments. As each event is accomplished, the child can remove the picture from the visual schedule.

What is fluency?


One of the biggest obstacles that the treatment of autism and related developmental disorders faces is the loss of previously mastered skills. Fluency is designed to maintain and strengthen skills that the child has learned in the past. Fluency poses new challenges for the student in that the child may be asked to demonstrate skills while distractions are present. The treatment for autism also requires the student to generalize the skills in a number of different settings. Speed and accuracy are also factored into the fluency treatment for autism as well. Time limits are introduced into tasks. For example, a child may be prompted to identify as many numbers as he can within a 30 second time frame. Fluency is a great approach to generalizing mastered skills. It can also be used to help the child understand that "cat" refers to more than just one specific animal. The child may be encouraged to identify various images of cats, three dimensional cats, cartoon cats and live pets during the process.

How is technology used in the treatment of autism?

Implementing Technology

As a general rule, technology in the treatment of autism should always begin with the simplest approach. Low technology is the best starting point because it is the least intrusive and most connected to real-life experience. Technology in its most fundamental forms includes verbal, visual and physical prompts that serve as a type of behavioral guide for the subject. Any time a teacher or parent asks a child to sit while gesturing toward a chair he is using low technology. Physical prompts like leading the child to his seat by hand is low technology as well. The introduction of simple electronic devices can be used in some cases to facilitate communication and motivated the child in mid technology and more complex devices can be introduced in high technology. The approaches used to introduce these instruments in the treatment of autism are systematic and deliberate in nature. It is important that the child is developmentally ready for the process when using the mid and high technological devices. Otherwise, the child may use the device as a source of empty entertainment rather than as a learning tool.

Are there drawbacks to using technology in the treatment of autism?

Drawbacks to Technology

There are some significant drawbacks to using technology in the treatment of autism in some cases. Those who use mid technology and high technology for individuals who are not developmentally prepared may find that the child uses the devices for stimulation rather than communication or cognitive development. These augmentative technological devices offer sensory feedback that many autistic children will enjoy strictly for their presentational value. They may not use the device as a means of expressive communication but as a means of entertainment. Video games are of particular concern because the serve as a type of escape for the player. The goal for the treatment of autism is to integrate the individual into his surroundings. Activities like video games and computer games isolate the individual and may be a source of an obsession rather than as a means of social and cognitive development.

How can choices help to increase compliant behavior?

Choices and Compliant Behavior

It is never a good idea to cave in when faced with a full-blown tantrum. However, parents and therapists can use choices as a kind of compromise when the child is trying to communicate that he does not want to engage in a task through more appropriate ways. Providing simple choices while encouraging the individual to complete the task is a great approach to gaining complaint behavior. For example, a child may have an aversion to brushing her teeth. She has sensory issues that make the whole ordeal uncomfortable. However, this is a task that needs to be addressed. Starting with simple choices like a selection of toothpastes and toothbrushes is a start. Also, breaking down the task into very small steps and ending the session is another way to encourage compliant behavior as well. The parent or therapist could model brushing teeth and prompt the child to choose a toothbrush. Once the child makes the choice, she is rewarded and the process is ended. At a later time, the toothbrush activity is introduced again and the initial step of choosing a toothbrush is followed by choosing a toothpaste. One step is added to the next progressively, all the while the child is given choices to make in order to encourage compliance.

What is the focus of treatments for autism?

Focus of Treatment for Autism

Currently, there is no cure for pervasive developmental disorders. However, a number of treatment approaches have been developed over the years that have yielded great results. The focus on treatment for autism lies in communication, behavior, social interaction and self care. Each individual is different and the treatment that an autistic child receives should be tailored to his specific needs. The approaches should also embrace his strengths to maximize his potential. A treatment plan is typically developed in a collaborative effort. The child's caretakers, caseworkers and doctor build the treatment plan by recognizing the child's needs and strengths and developing goals. The goals are outlined in the individual's treatment plan. The focus of treatment for autism will rest on those goals and the treatment plan outlines specific interventions and strategies that will help the child attain them. When a treatment plan is developed the parents outline specific areas of concern. For example, the child may not use words to access wants and needs. The goal for the child would be: "Child will use words, sign language or gestures to access wants and needs with 80 percent accuracy." The parents are encouraged to prompt the child to use some form of functional communication to access wants and needs. The therapists on staff will engage the child in drills specific to this goal. A common drill that would be used is to prompt the child to sign or say, "want" in the presence of a desired object or activity. When the child follows through, he is immediately given the reward. Typically, the doctor will evaluate the child's progress and determine if the treatment plan needs to be reworked. Meetings are commonly held to evaluate the treatment plan on a quarterly basis. The physician may also prescribe medication in the treatment of autism in some cases.

Why are self help skills a challenge in the home environment

Self Help Skills

The goal of most interventions in the treatment of autism and related pervasive developmental disorders is to help the individual gain independence. Self care can be challenging for some people with autism for a number of reasons. Many individuals with autism need help with activities that require fine motor skills. Fine motor skills are necessary to complete everyday activities like buttoning a shirt or closing a zipper. These tasks require hand-eye coordination, attention and some patience. Many individuals who have autism attend occupational therapy sessions that are designed to develop fine motor skills and gross motor skills. However, families can encourage fine motor activities throughout the day. There are plenty of options that promote these skills. Play Doh(R) is a wonderful tool for developing fine motor skills. The activity is often rewarding in itself and it can also be used as a tool for interaction as well as communication. Other fine motor activities include drawing, typing, lacing string and anything that requires some dexterity. Self help skills also face another great obstacle that many individuals with autism have. Sensory issues can be detrimental to the efforts of completing self care activities. For example, a child may not tolerate the feeling of a brush or comb in his hair. The intolerance is not due to non-compliance. It is often due to sensory issues.

What is negative reinforcement?

Negative Reinforcement

Negative reinforcement is not exactly the opposite of positive reinforcement as one would expect. This strategy in the treatment of autism and related pervasive developmental disorders uses undesired objects or activities as a shaping tool for behavior. Basically, the objectionable object is removed or the child no longer has to engage in the undesirable activity. For example, a therapist is working with an autistic child with the specific goal of teaching him to sign “all done.” This student hates coloring. The approach of using negative reinforcement would use coloring as a tool for learning. The child is introduced to the task that he dislikes and the therapist prompts him to sign “all done” and once the child does the task is quickly taken away. In this example the target is not the activity of coloring. The target is the communication sign “all done.” The task of coloring is used as negative reinforcement in order to motivate the child to indicate that he no longer wants to participate in the activity.

What is positive reinforcement?

Positive Reinforcement

Since communication is such a significant problem in the treatment of autism and related pervasive developmental disorders, therapists use positive reinforcement to help their students understand which behaviors to exhibit. Positive reinforcement is simply rewards. There are a few key components to successfully use rewards as motivators in the treatment of autistic disorder. The positive reinforcement needs to be meaningful to the student. The therapist may love chocolate but if the student is indifferent to the treat it does little or no good. The child has to be motivated enough to want to complete a task in order to get his reward. Using powerful motivators in the treatment of autism helps to keep the child focused on the task and it helps to shape desired behavior. The student needs to make a concrete connection between his actions and the positive reinforcement so it is crucial that the reward is given immediately following the desired behavior. The child needs to make a connection between his behavior and the consequence. During the initial stages of ABA and discrete trial positive reinforcement needs to be used consistently and frequently. The reward should be concrete as well so many therapists use treats. The child’s favorite candy is commonly used because it can be delivered immediately and it is tangible.

What is the difference between a behavioral and analytical approach?

Behavioral and Analytical Approaches

Basically, we can look at an individual who works in the field of autism as behavioral or analytical. The behavioral approach is suitable for a therapist who prefers to jump right into discrete trials and Applied Behavior Analysis. The behavioral approach is useful in setting a tone and laying down the rules. The child grasps the concrete, concise prompts and visual nature of the program. Play activities are used as rewards for desired behavior. Starting with a behavioral approach is a common practice for many interventions. However, those who are more analytical in nature may want to use another approach. Many therapists like to observe the child and gradually work their way into his environment. RDI and Greenspan's floortime are great approaches for the therapist who wants to make a personal connection and build trust before introducing behavior-based therapies. The approach you choose will depend on your personality and the way that you interact with children.

How do families prepare for outings in the community setting.

Preparing for Community Settings

Some preventative measures can be taken to help the individual with autism thrive in the community setting without incident. Some steps can be taken to insure that the likeliness of a tantrum will be lessened and some interventions can be used when a tantrum is forming while in the community setting:

  • Planning ahead for the outing involves preparing the individual for the activities and experiences. Social stories are used as preventative measures through building expectations and rehearsing responses.

  • Safety awareness drills can be completed in a safe environment and practiced until the outing takes place in the community setting. The familiar verbal cues and visual aids along with motivating rewards help the individual follow safety instructions in the community setting.

  • Organizing a visual schedule as well as valuable PECS is a big part of planning for a community setting and choosing the most opportune time of the day is important as well.

  • Considering the individual with autism's prime time of day may take a little time and a lot of observation. Avoid taking the child on a trip when he is typically tired or hungry

  • Preparing some sensory integration activities like a quick stop at a park can serve as a release as well as an reward. Community settings can offer great opportunities for an individual with autism to learn and play.


Using Social Stories to Treat Autism

Social stories can be used to treat autism. This autism treatment method was designed by Carol Gray. The social stories method is intended to teach autistic children social skills that they may be lacking. The stories used in this method are written in the first person and the present tense, contain descriptive sentences, perspective sentences and directive sentences, can incorporate pictures or music and are written to address a child's specific fear. The descriptive sentences describe the situation, the perspective sentences offer insight into the feelings of those in the story and the directive sentences are aimed at eliciting a response from the patient.


Using Floor Time to Treat Autism

Floor time is an autism treatment method that was designed by child psychologist Stanley Greenspan. This is an educational treatment method that is often used during a child's play time and in conjunction with other treatment methods such as applied behavioral analysis. According to Greenspan's theory there are six stages of development that are necessary for more advanced learning. This treatment involves systematically increases interaction between the child and an adult. This method is aimed at helping the patient to meet their developmental milestones by helping them to overcome problems such as over or under reacting to senses, difficulty processing information and difficulty coordinating their body's movements. Another aspect of this treatment method is encouraging interaction between child and adult. The parents or educators attempt to engage the child in interaction by following the child's lead and helping them to build upon their actions.

How can sign language help in the community setting?

Sign Language

Sign language is a valuable tool in the community setting. This form of communication is visual in nature and the child can attend to the signs easier than most spoken words. Facilitating communication through sign language can help to ease stress and frustration in these unfamiliar surroundings. The individual with autism benefits from seeing familiar signs that help him navigate through stressful situations. The ability to make a connection with all of the distractions present in the community setting is very valuable. A parent or therapist does not have to be fluent in sign language to effectively communicate using this system. The individual with autism is usually taught a lot of useful signs that are helpful and knowing these key signs will help facilitate communication. Sign language is also unobtrusive. It requires no pictures so there is no fumbling around for icons. If the individual with autism is familiar enough with the sign language he will attend to them. Common signs that are used in the community include: Stop Wait Help All Done More Potty Eat Many of these signs are commonly used in the home, school and therapy settings. Integrating them into the community setting will provide a great means of communication and it will help make the surroundings less intimidating by introducing familiar elements.


Using Sensory Integration to Treat Autism

Another treatment method for autism includes sensory integration (SI). This method assists children who have difficulty with sensory integration are likely to either over or under react to stimuli that affects the senses such as sounds, sights, smells, tastes or feeling. SI methods work to desensitize the child to the stimuli that they have difficulty processing. For example children who have difficulty with touch may be treated by exposure to objects of a variety of textures so they will be less reactive to objects that have these textures. Exposing the patient to a variety of sounds and decibel levels can be beneficial for a child who has difficulty processing sounds. These types of treatments should take place under the supervision of a specialist who has carefully evaluated the patient prior to beginning treatment.


Using Applied Behavioral Analysis to Treat Autism

One method of treating autism is the applied behavioral analysis (ABA) method. This method uses positive reinforcement, repetition and prompting to teach language, play and social skills. Discrete trial teaching (DTT) is the most common teaching style incorporated into the ABA method. This teaching style involves breaking behaviors down into subcategories and teaching each subcategory through repetition, positive reinforcement and prompts that are gradually removed from the program as the child progresses. During this teaching, each subcategory is taught intensely and exclusively until the behavior is learned to help to ensure success for the child.

What is discrete trial?

Discrete Trial

One of the most popular components in applied behavioral analysis is discrete trial. This treatment for autism uses cause-and-effect learning as well as scaffolding. Tasks are broken down into their most fundamental elements. The child is introduced to each element from easiest to complex throughout a progression of drills. The program uses a lot of repetition. The student has two independent chances to make a correct response. If he is unable to give the desired response, the therapist prompts him and repeats the command. The student learns that there is a definite routine that has an identifiable beginning, middle and end through the discrete trial drills. Discrete trial also uses consistent rewards for each and every desired response that the autistic individual provides. Positive reinforcement is very important in the process. It helps the student understand when he has given a correct response. This treatment for autism focuses on the positive and negates undesired behavior. Since discrete trial keeps the child focused on a small amount of information during each drill, it is ideal for autism therapy. The student can pay attention to the specific command. He develops an understanding that he is supposed to give a response and he learns that there are consequences for that response.

What is picture exchange communication system?


Individuals who have a diagnosis within the autism spectrum of disorders typically have great difficulty with communication. They have trouble processing language and they have trouble using language to express wants and needs. On the other hand, autistic individuals are very visual. The Picture Exchange Communication System (PECS) is an intricate teaching tool that uses pictures to help individual with autism or other communicative disorders communicate. The pictures used in PECS are commonly printed and laminated on two-inch by two-inch cards. This teaching tool is very helpful as a means of communication. The process of using PECS is a little complex. There are six deliberate steps that this treatment for autism uses in order to help the child understand the concept behind the pictures. The six phases of PECS are systematic. As with many of the treatments for autism, this approach uses small steps to reach a specific goal and each phase must be presented in order to maximize the benefits of the program. As the child masters one phase he is introduced to the next successive step. Using pictures to facilitate communication has yielded great success in the treatment for autism and related pervasive developmental disorders. The ability to communicate effectively is one of the major obstacles that individuals with autism face.

Can PECS be used effectively in the community setting?

PECS: Picture Exchange Communication System

The Picture Exchange Communication System is the core of most visual schedules. The images are printed on laminated cards that are 2" by 2" or 1" by 1" and are attached to the schedule with Velcro. This makes placing and removing the images quick and easy. Once a task is completed the PEC is put into a "done" envelop in most cases. While the PECS approach is used to help make smooth transitions, facilitate communication and build expectations, it can also be helpful in calming and organizing behavior as well. When the child with autism knows what to expect and he is able to communicate a little better he feels less stress and frustration. However, the unexpected often occurs that can really through things off. Using certain PECS can help the individual with autism calm and organize his behavior in the community setting. PECS that can be used include: Quiet Quiet hands Okay Good Job Wait These images are used in the home, school and therapy settings and they are strongly tied to dealing with anxious moments and unexpected events. One of the most effective is the "Okay" PEC that lets the child know that everything is fine.

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