THE PICTURE EXCHANGE COMMUNICATION SYSTEM

The Picture Exchange Communication System (PECS) is an Augmentative and Alternative Communication (AAC) approach used to teach children with autism self-initiated requesting with aided symbols (Beukelman & Mirenda, 1998). PECS was originally developed in 1985 by Frost and Bondy for use with preschool-aged children with autism spectrum disorders (ASD), and other communicative disorders who display no functional or socially acceptable speech (Frost & Bondy, 2002), this system has since become widely used across preschool settings and schools (Wall, 2004).

AUTISM AND PECS

According to Ganz and Simpson (2004), at present aided, picture-based AAC systems, such as PECS, are used more frequently and successfully with individuals with ASD than unaided systems, such as sign language. The authors attribute this to being due to a match between the characteristics of ASD and the ease of use of such systems.

SPEECH AND PECS

As children with autism learn to communicate via the use of picture symbols whilst progressing through the stages of PECS, they are also being exposed to the spoken language of the Speech Pathologist and others. This can also result in an increase in their spoken language. A study by Charlop-Christy, Carpenter, Le, LeBlanc and Kellet (2002), found all three children with autism showed increased spontaneous and imitative speech as a result of PECS training.

EXPRESSIVE LANGUAGE AND PECS

PECS involves the child learning to communicate with the aid of symbols; therefore it may result in an increase in the child’s expressive language skills. In the initial phases the child uses single symbols in their communication exchanges; however, they can progress and learn to build phrases and sentences.

BEHAVIOUR AND SOCIAL SKILLS AND PECS

The use of PECS may help reduce some of the behavioural and social-communicative problems seen in children with autism. Anecdotal reports have indicated positive effects regarding problem behaviours (e.g., tantrums) and social-communicative skills as a result of PECS training with three children with autism between the ages of 3 and 12 years (Charlop-Christy et al., 2002). As PECS involves the child learning to respond to questions and spontaneously request and comment this can lead to improvements in the child’s social communicative skills. PECS involves teaching the child to communicate their message in a more socially appropriate manner by seeking the attention of their communicative partner with their communication board instead of behaving in a disruptive way.

IMPLEMENTATION OF PECS

Access to the PECS training manual is essential for anyone planning to implement PECS as it includes a comprehensive guide for each phase of training. The manual includes instructions for constructing the pictures, discrimination training tips, data sheets, and a PECS parent handout.

Two trainers are required in the initial two phases of PECS, then later the child interacts with only one trainer at a time. Many people, such as family members and staff, should act as trainers in the later stages so that the child has numerous opportunities to interact throughout the day (Frost & Bondy, 2002).

As stated in Frost & Bondy (2002), PECS is based on the principles of Applied Behaviour Analysis (ABA) and it has also been influenced by Skinner’s description of verbal operants . PECS is based on the ‘Pyramid Approach’ to education, created by Dr. Andrew Bondy that establishes effective learning environments for individuals with autism (http://www.pecsaustralia.com/fs_pyramid_approach.htm). The ‘Pyramid Approach’ consists of the following learning elements:

  1. Functional activities and communication

  2. Powerful reinforcers

  3. Behaviour intervention plans

  4. Lesson formats

  5. Prompt strategies

  6. Error correction strategies

  7. Generalisation

These seven learning elements are required to make lessons as effective as possible for the child in various environments (Frost & Bondy, 2002).

PECS consists of six phases (adapted from Frost & Bondy, 2002):

Phase I

In this phase the child is put in situations where they are required to communicate. For example, a child sees a highly desired item and reaches for it. The goal in this phase is for the child to learn to pick up a picture of this item instead and place it into the trainer’s hand. This process is teaching the child about the nature of communication by approaching another person and directing an action to receive a desired outcome.

Phase II

In the second phase the child is taught to be more independent with skills learned in phase I. The child goes to his/her communication board, pulls the picture off, gains the trainer’s attention, and places the picture into the trainer’s hand. In this phase the child is taught to communicate in more realistic situations.

Phase III

In this phase the child learns to discriminate between specific symbols. The child learns to request a desired item by going to their communication book, selecting the appropriate picture from a selection of pictures, and approaching the trainer and giving them the picture. This is done by presenting the child with a choice of two pictures, a highly preferred choice (e.g., chips) and a less preferred choice (e.g., socks). In this way the child learns that there are specific consequences for exchanging one picture instead of another.

Phase IV:

In this phase the child learns to use simple phrases (e.g., “I want”, “I see”) to request for items. The child is taught to go to their book, pick up a picture/symbol of a phrase (e.g. “I want”), put it on a sentence strip, pick out the picture of what they want, put it on the sentence strip, remove the strip from the communicative board, and give the sentence strip to the communicative partner. By the end of this phase the child’s communication board typically has twenty or more pictures and the child is communicating with a variety of partners.

Phase V

In this phase the child learns to respond to the question “What do you want?” as well as learning to request spontaneously for a variety of items.

Phase VI

This final phase involves the child learning to comment when responding to questions as well as spontaneously. The child learns to answer various other questions, such as “What do you see?” and spontaneously make requests and comments.

PROFESSIONAL TRAINING

Before incorporating PECS as a treatment method, a person must participate in PECS training. Two day PECS training workshops have been running in Australia since 1999 and they are held throughout the year in various cities ( Sydney, Adelaide, Brisbane, Melbourne and Perth) (http://www.pecsaustralia.com/fs_two_day_pecs.htm).

These workshops can be very useful for individuals who are working and/or living with individuals with autism.

Further information about PECS workshops can be found on the Pyramid Educational Consultants Australia website: http://www.pecsaustralia.com/fs_home.htm. This website also provides resources and useful information about products such as the PECS training manual.

RESOURCES

The following resources are suggested to implement PECS:

  • PECS training manual

  • PECS symbols

  • PECS folders

  • Computer and printer

ADVANTAGES OF PECS

There are numerous advantages to using PECS, these include:

  • According to Kravits, Kamps, Kemmerer, & Potucek (2002), unlike many other speech treatments, it does not overly rely on the child’s communication partner instructing and prompting the child. Instead PECS teaches the child to initiate communication rather than it being controlled by adult verbal cues.

  • Unlike many traditional speech programs (e.g., speech, sign language), PECS does not require the individual to have prerequisite skills such as eye contact, imitation, facial orientation, or labelling (Beukelman & Mirenda, 1998).

  • It differs from traditional speech training in that it does not begin with teaching the child to respond to verbal prompts (e.g., “Point to the dog”) (Ganz & Simpson, 2004). PECS instead focuses on teaching a social approach to the individual with autism, one of their key deficits being in the area of pragmatics.

DISADVANTAGES OF PECS

Disadvantages of using PECS include:

  • Parents may be resistant to a non-verbal alternative.

  • Access to a computer and a boardmaker program is essential.

  • The program needs to be continually modified to reflect the changing needs of the child.

  • There is a cost associated with treatment materials.

EFFICACY OF PECS

  • According to Ganz and Simpson (2004), despite its wide use in schools, support for PECS is primarily anecdotal in nature, thus having an evidence level of IV (Refer to Evidence Table).

  • As stated in Ganz and Simpson (2004), some recent researchers have reported positive effects regarding the child’s ability to learn to master PECS, a reduction in behavioural problems, and increased social-communicative skills as a result of PECS training with three children with autism aged between 3 and 12 years.

  • Bondy & Frost (cited in Kravits et al., 2002) also noted improved communication for children with autism using the PECS as well as improvements in a child’s spontaneous language acquisition.

  • Several other studies have also provided evidence showing a decrease in maladaptive behaviours following the introduction of PECS, improved social behaviours, and improvements in speech development (Frost & Bondy, 2002).

  • PECS can facilitate the development of spoken language in children with autism. As stated in Charlop-Christy et al., (2002) several reports have suggested that a large number of children with autism who learn PECS also develop spoken language simultaneously.

  • In a case study of three young children with ASD and developmental delays with related characteristics, Ganz & Simpson (2004) found utterances increased in both number of words and complexity of grammar in all three children following the introduction of PECS. This study provided an evidence level of III.2 to support the use of PECS.