Waiting for that moment when a child says their first word can feel like a lifetime, and for some parents it truly is. With communication being one of the core deficits of autism, approximately 40% of individuals on the autism spectrum do not use spoken words to communicate. These individuals may learn to use alternative forms of communication to get their wants and needs met, prior to, or while their vocal speech emerges.
One of these forms of communication is the Picture Exchange Communication System, or PECS. The primary goal of PECS is to teach an individual how to ask for what they want or need. PECS is frequently and effectively used with children who have few to no spoken words, or when spoken words are difficult to understand. Long-term, some children will continue using PECS, transition to a speech generating device (SGD), develop vocal speech, or use a combination of these forms. The body of research supporting the effectiveness of PECS as an evidence-based practice is substantial and continues to expand.
PECS is a way for children to communicate their wants and needs clearly. Some parents are left guessing what their child is trying to ask for by offering a variety of items until they find the right one. This is where PECS can be helpful. Parents can teach their child to ask for exactly what they want by exchanging a picture of that item.
There are 6 phases of PECS. The first phase simply involves teaching the child to exchange the picture. As the child becomes fluent with making the exchange of various PECS, subsequent phases teach the child to walk a distance to make the exchange, discriminate and make choices amongst a variety of pictures, build sentences, and make comments.
To get PECS started, create a list of items that the child likes most. These can be foods, toys, or activities. Take pictures of these items, print, and cut them out. If you have a laminator on hand, you can use it to increase the durability of the PECS. You can also add Velcro to the back to stick them to a laminated sheet or “PECS book”. If not, simply re-print and cut out the PECS as you need them.
To begin PECS Phase 1, you will ideally have two people present, one who sits behind the child to assist them in picking up the PEC to exchange (the “prompter”), and another to receive the PEC and to give the child the item (the “communicative partner”). Next, select 1-3 items the child really likes and put them within the child’s sight, but out of reach. You may also hold the item(s) up. It will be important that the child does not have open access to these items throughout the day, as it will reduce their motivation to communicate to request them. For instance, if the child loves chips but has a bag of chips that they can graze on throughout the day, there wouldn’t be a need for the child to ask you for them, which reduces the opportunity for the child to practice communication. To begin your first PECS exchange, place a picture of chips directly in front of the child. Hold up a chip so that the child sees it. If the child reaches for the chip to indicate that they want one, the prompter, who is seated directly behind the child, assists the child to pick up the PEC and reach to place it in the hand of the communicative partner (CP). The CP receives the PEC, vocally labels the item (“Chip!”), and immediately hands the chip to the child. This process is then repeated while the child continues to show interest in the items you have.
Keep in mind that this process will only work if the child wants what you have. If they do not, you must find other items/activities that they want to request. As the child continues to practice the exchange, it become easier and easier, and the prompter is no longer needed. Over time, you may also increase the expectation of the child exchanging the PEC while vocalizing the beginning letter sound of the item such as “ch”, then “chi” and eventually to say the word “chip”, depending on the child’s vocal repertoire.
To learn more about how to implement PECS, visit www.pecsusa.com. If you already have an ABA team, reach out to your Board-Certified Behavior Analyst (BCBA), so that they can help with all of the details needed to progress through each phase.
Carrie Snyder M.S., BCBA, COBA