The Picture Exchange Communication System (PECS)

The Picture Exchange Communication System (PECS) is an augmentative communication system developed to help individuals quickly acquire a functional means of communication (Bondy and Frost, 1994). PECS is appropriate for individuals who do not use speech or who may speak with limited effectiveness: those who have articulation or motor planning difficulties, limited communicative partners, lack of initiative in communication, etc.

In my experience, PECS has a number of advantages over other methods of addressing communication:

Each exchange is clearly intentional and readily understood. When a child hands you a picture or sentence strip, the request or comment is quickly determined. The child is given an effective avenue for swiftly and easily meeting his needs.

From the start, communication is initiated by the child. Children are not drilled in rote responses to specific phrases or instructions, rather they are encouraged to independently seek out communication partners in naturally occurring settings.

Communication is meaningful and highly motivating. Reinforcement for communication is natural and strongly rewarding.

Materials are cheap, easy to prepare, and portable. A PECS symbol can be as simple as a hand-drawn picture, or a snapshot.

With PECS, the child has an essentially unlimited pool of potential communicative partners. Anyone willing to accept a picture is available, not just those who understand sign language or who are familiar enough with the child to understand him despite his articulation or motor planning difficulties. Children are able to generalize communication to a wide circle of people very quickly.

I know that the decision between PECS and sign language as an augmentative means of communication is often a source of concern for people dealing with non-verbal individuals or those with very limited verbal ability. Personally, I love the concrete and consistent visual nature of PECS and the fact that it doesn't require the more difficult motor planning that many signs do. I like, too, that PECS symbols are often very quickly acquired, and that they can be rapidly generalized across many aspects of the child's life, without having to teach staff, family, and peers a number of signs along with the child. However, while there is little to support the idea that PECS (when done correctly) will impede development of speech, and in fact there is some evidence that the use of such systems enhances the development of speech (Silverman, 1996), the theory among some is that sign may be more effective in developing speech. The thought is that sign, like speech, is a topographic form of communication (a form wherein each word requires a different behavior, specifically a difference in muscle use, be it the muscles of the hands and arms, or of the lips, mouth, and tongue), whereas picture exchange is a selection-based communication system (where a single set of behaviors, selecting and exchanging, is necessary). The more complex, topographical nature of sign may lead more naturally to speech than the use of PECS. I haven't the background to speak on this point much further, however.
When the team that works with a child has decided that a picture exchange system would be an appropriate means of augmentative communication, it is important that the child have access to and be successful with that means of communication throughout his day. The child should have his pictures available to him at home, on the bus, at school, at friends' houses, out in the community, everywhere he might be. Of course, you may use a smaller, more limited picture book at grandma and grandpa's house than at school, but the child should still have access to those pictures which are applicable to each situation, so communication is not just an "at home" or "at school" thing.

The Phases of Picture Exchange
There are typically six phases through which one moves when teaching a child to use a picture exchange system. While these phases should be approached and taught sequentially, there may be times when a student is working on two or more phases simultaneously. For example, if the child is discriminating between a fairly large number of pictures pretty well (Phase III), you may well want begin work on Phase IV and begin teaching sentence structure with the symbols. You can do this while still working on Phase III, trying to increase the child's discrimination skill.

• Phase I
  

The first lesson we want to teach in the PECS program is to spontaneously request items or activities. To do this we first need to identify what exactly the individual wants, those things for which he would be willing to make a request. As soon as I can get it converted into a PDF file, I will include here a vocabulary selection worksheet to help guide a team through this initial stage of a PECS program.

This first phase usually requires two teachers or family members to work with the child. The first adult (the person with whom we want the child to address most of her first requests) entices the child with an object that she really likes. The role of the second adult is to stay behind the student and wait for her to reach for the item, and then to physically assist the child to pick up the picture of that item and hand it to the first adult. When the first adult receives the picture, he immediately gives the child the reward, along with an appropriate comment (e.g. "Oh, you want a raisin!"). As soon as possible, the physical assistance from the second adult should be faded out until the child is exchanging a picture for the item independently with the first adult.

Because the goal is for the child to initiate communication, for him to ask spontaneously and not simply respond to our requests, we as teachers and parents need to resist the urge to ask, "What do you want?" or to use other verbal prompts. We want the child, from the start, to seek us out.

• Phase II

Once the child can reliably exchange a single picture, independently making a request of a single adult for a very rewarding object, the move is made into the second phase of the process. The child now is encouraged to use greater spontaneity and persistence, and to generalize the skill he has acquired. The child continues to request very motivating items or activities, only now he is required to move a longer distance to get to a communication partner or to get to the picture. He also begins to make requests in settings different from that in which he was taught the initial phase (different rooms, at the park, at the store, etc.), and with a variety of different people (parents, grandparents, teachers, siblings, schoolmates).

The child also begins expanding his vocabulary of symbols, requesting different reinforcing objects or activities. He is still encountering only one symbol on a board at any one time, however.

• 
  Phase III

In the third phase of the PECS system, we begin to ask the child to discriminate between a number of items on a board, making choices as to what items she may want, or activities she may want to try. The child begins by answering forms of the question, "What do you want?" but these are faded quickly so the child will make choices spontaneously as well as in response to a question. If discrimination is a new skill for the child, one should begin with a very small array, usually just two items. As the child becomes more comfortable with discriminations, a third item can be added, and so on, until the child is quickly and comfortably finding objects from a large array of pictures (maybe several pages with a dozen pictures on each page).

• 
  Phase IV
  

Once the child is easily discriminating between and making requests for a variety of items, to a variety of people, and in a variety of environments, the program begins to focus on sentence structure. The child is taught to use sentence strips to make longer requests. The child will start combining a picture for "I want" with a picture of the requested item or activity. The two pictures will be attached to a sentence strip and the entire strip would be exchanged with the communicative partner for the pictured item or activity.

• 
  Phase V

The fifth and sixth phases occur at the same time, focusing on different extensions of the child's skill with picture exchange. The fifth phase extends the sentence structure begun in Phase IV. Adjectives and other words can be added to the child's repertoire to help her further refine her requests. For example, she could move from " I want candy," to "I want three green candies."

• 
  Phase VI

The sixth phase of a PECS system is a fundamental shift in the child's communication and the expected outcome from the teachers or peers. Through the use of pictures for "I see," "I hear," "I feel," "I smell," etc. the child will be taught to comment on elements of his environment.

Jason M. Wallin, Oak Harbor, Washington, USA