How to Initiate Communication Effectively with PECS

Picture Exchange Communication System (PECS)

Picture Exchange Communication System (PECS) is a program that supports functional communication while encouraging expressive and receptive speech & language skills.  Functional communication is demonstrating the ability to make one’s needs known effortlessly, immediately, and efficiently.  This communication begins long before a child says his or her first words.  For some children with autism, speaking is challenging but gesturing may not be, so PECS may be an effective way to introduce the foundation of communication.

PECS Supports Speech-Language Development

PECS is a well-established system that began in 1985 and it is based on B.F. Skinner’s 1957 book, Verbal Behavior.  In Picture Exchange, a child is taught how to initiate communication by handing a picture to an adult.  This process may or may not involve speaking; regardless, Picture Exchange does not ignore speech, rather it promotes both speech and language development.  After the child places a picture in someone else’s hand, the communicative partner models speech & language sentence structure by naturally labeling objects/ actions.  A sample exchange may look like this:

1. Child: Retrieves, then hands a picture to a communication partner.
2. Partner: “Book!  Billy says, I want to read a book.  Let’s read this book.”
3. Child: After hearing the word book may naturally imitate a sound/word/phrase/sentence.

In the above example, the communicative partner uses a natural approach by modeling language that mirrors conversational speech as opposed to telling the child to “say” the word book.  Communication is not about telling each other what words to say next. By handing the picture of a desired object, the child has communicated his wants.  We no longer need to guess and navigate frustrations.  Instead, we have a teachable moment to work on enhancing speech articulation and sentence length.

Another way that PECS supports language development is through teaching clients to differentiate among picture choices.  Being able to distinguish between a number of options demonstrates that the child is using his receptive comprehension skills.  Through PECS training, he has learned to attach meaning to the images and can make selections with ease.

Caregiver Support

PECS is not something that children can learn in school or private practice speech sessions and then generalize.  In fact, the program is ineffective unless practiced in multiple settings with a variety of communication partners using an array of reinforcements.  Here are some specific roles and responsibilities of caregivers with regards to PECS:

• Offering suggestions for tangible motivators that will encourage their child to participate in PECS
• Providing an extra set of hands to prompt the child for specific actions during training (i.e., help pick up the picture, physically guide towards a communication partner)
• Carrying over practice of techniques at home/ grandparents/ extracurricular activities

PECS Phases

Picture Exchange is taught in six phases.  The process begins in the same manner regardless of age; however, older clients may move through training stages faster.  Throughout the training, both communication partners and those physically assisting the child must remain silent.  This sounds simple, but it is much harder than you may think.

PECS is a communication system where the child starts the conversational exchange by performing an action to make his needs known.  When we start asking questions or using verbal directions to instruct the child, then we are no longer working on picture exchange.  So, a communication partner asking, “What do you want?”, has started the exchange, not the child.  If the partner verbally instructs the child to, “Get the picture” or “Bring it to me,” then the child may rely on this cue for future exchanges.

PECS Phase One

The goal for the first phase is to teach the client to initiate or start a communicative exchange by picking up a visual, reaching toward a partner, and releasing that picture into the partner’s hand.  We do this by having the child sit in close proximity to a communication partner while a second adult sits behind the child.  At first, the helper sitting behind the child may need to guide the child’s arm through each step.  PECS uses a “first one’s free” approach by observing the child’s interest in a food or toy within reach.  If the object is of interest, then we start teaching the “nature of communication” through the following sequence:

Pick up picture —> Reach towards communication partner —> Release picture

Once that picture hits the communication partner’s hand, then that reward must happen immediately!  No need to wait until the child says a word or answers a question.  Throughout this phrase, you will want to introduce different communication partners with a variety of identified rewards, fading physical supports as indicated.

PECS Phase Two

In phase two, we teach distance and persistence with the end goal being to have the child gain someone’s attention by bringing a picture or communication book to locate the communication partner in another room.  This phase can take a long time to achieve. Be patient, stay silent, physically assist when needed and your child will progress.  The four training steps in this phase are as follows:

1. Repeat the “first one’s free” approach to assure that it interests him.  If so, then place a picture of that item on the child’s cover of his communication book that houses all of the identified reinforcements.  The physical prompter can assist the child in removing, reaching, and releasing the picture as needed.
2. The communication partner should start slowly moving away from the child and gradually increase this distance by inches, feet, then yards.  The physical prompter may step in if needed.  If the child drops the picture along the way, then the prompter picks it up and brings it to the last successful step the child was able to complete.  In this case, that would be back on the communication book cover.  Again, there is no verbal prompting in this process, just physical guidance.
3. Once the child can reliably and independently travel to a communication partner 5-8 feet away from the child, then increase the distance between the child and his book.  Eventually, you will want to designate a location in the room for the book. Every location should have a spot that is within a child’s reach, but not necessarily right next to him at all times.
4. Assess and eliminate any additional prompts.  Your speech pathologist will guide you for behaviors to monitor like, showing an expectant look on your face as you wait for your child to retrieve a picture.

PECS Phase Three

By phase three, we work on teaching the client to choose a picture amiss all pictures in his communication book.  At this point in the training, we are trying to create many opportunities for spontaneous requesting during daily functional activities.  By this point, the child has learned the “nature of communication” and can independently find his communication book and partner to make requests.  Up until now, we have been placing just one picture on the child’s book cover.  Now, we will start the process of teaching picture discrimination through these steps:

1. Discriminating between a highly preferred and a distracter picture.  For example, you may pair candy (something he really likes) with a spoon (something he would not want over candy.)  During this step, both pictures will be varied along with positioning on the child’s book.
2. Next, you will work on discriminating between two reinforcing pictures and gradually add more than two choices.
3. The final step is for the child to look inside his book for a specific picture.

PECS Phase Four

In phase four, we work at the sentence level by teaching clients to construct and exchange a strip of paper with a sentence on it to make requests.  This sentence strip will adhere to the bottom of the child’s communication book for easy access.  You will begin with simple sentences like one picture that indicates: “I want” and the other representing the child’s reinforcement.  This phase progresses to having a child construct a compound sentence like: “I want” + “object” + “and” + “object”, then sentences with attributes like:

• color: I want red candy.
• size: I want small ball.
• shape: I want round cookie.
• position: I want doll in box.
• body parts: I want Mr Potato Head arm.
• temperature:  I want cold water.
• speed: I want fast dance.
• texture:  I want bumpy chips.
• quantity: I want 6 gummies.

PECS Phase Five

Phase five works on responding to a question while maintaining requesting.  Up until this point in PECS, the communication partner refrains from initiating interactions by sitting quietly.  During phase five, we are continuing to work on encouraging the child to initiate and make requests while occasionally responding to more questions posed by communication partners.  This helps expand communication turns in conversations to make discussions longer.

PECS Phase Six

The final phase six works on helping the child learn to make spontaneous comments about the world around him.  This phrase begins by placing a picture image of “I see” on the cover of the child’s communication book and moving the “I want” image to a storage page inside the book.  Some suggested activities to pair with training commenting include:

• Containing items in a mystery bag and then commenting on one object at a time as it is pulled out of the bag.
• Looking through a photo album from the child’s home.
• Watching a video of a favorite book on You Tube

The entire training period for PECS varies for each individual and is dependent on ability level and amount of practice time in both the clinical and home settings.  Speech pathologists trained in PECS have resources for trouble shooting, so do not hesitate to talk with your child’s therapist if you need help with carryover.

For more detailed information about this program visit http://www.pecsusa.com/